Infection Control Today - 04/2001: What's Happening in Enzymatic Cleaning?

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What's Happening in Enzymatic Cleaning?

By Kelli M. Donley


Figure 1: Endoscope before and after being cleaned with Olestrazyme.

Frank Bass and Bernard Esquenet never thought barnacles would lay the foundation for their careers. Ironically, it was marine crustaceans that brought these men together to form the first enzymatic cleaning company dedicated to the healthcare market.

Esquenet, a chemist from France, was developing cleaning solutions for the US Navy. He used these solutions to combat the nagging problem of sea parasites on the hulls of Navy ships. His solutions cleaned barnacles and other crustaceous marine residues from submarines and other vessels.

Bass, a successful businessman, became interested in developing high-quality cleaning products for surgical instruments. As a natural salesman, he talked his way into hospitals around the country to observe cleaning techniques and operating room procedures. He realized that standard dishwashing detergents were insufficient. He knew that with the right chemistry, he could improve cleansers and change the field.

After being approached by Bass, Esquenet realized that the enzymatic solutions he had developed to remove barnacles could also clean surgical instruments. The enzymes he had once used to eat away at marine organism residue would soon be eating away at organic contaminants. With Esquenet's chemical knowledge and Bass's marketing and business acumen, the Ruhof Corporation was formed.

Ruhof introduced the first enzymatic cleaner (Protozyme) to the healthcare industry in 1976. Although it represented a cleaning breakthrough, it was met with skepticism. There was little knowledge or protocol on removing bio-burden from instruments at the time. Also, Protozyme was more expensive than the green soap detergents used in hospital CS departments. Bass convinced hospitals of the necessity to reprocess surgical instruments and scopes with enzymatic cleaners. His business motto is that the best products are not always the cheapest and that hospitals would save money in the long run by using enzymatic cleansers to increase the longevity of their instruments. This ideology proved successful. Bass began a grassroots campaign, educating healthcare professionals nationwide of this safer, more effective option for cleaner surgical equipment.

Why are enzymes used to clean surgical equipment? All instruments used in surgery are contaminated with organic matter that common detergents are unable to remove. Furthermore, to sterilize an instrument effectively, specific enzymes are required to digest different components of bio-burden. Inextricably intermingled, the four components of bio-burden are: blood, fat, carbohydrates, and protein. Just one component left undigested, such as lipids (fat), can act as a blanket, preventing the enzymes from digesting the other components beneath it. Once the surface of the undissovled biomass is broken, contaminants are exposed, creating a significant threat to the patient and the professional handling them. To prove that enzymes are needed to dissolve bio-burden, Bass developed the Ruhof Bio-burden Visualization System. This system allows you to see contaminants left on supposedly clean instruments, exposing a new world of invisible bio-burden that inferior cleaning products fail to remove.

Addressing the ever-increasing concern of cross contamination in hospitals, Esquenet and his R&D department began formulating new enzymatic solutions designed to completely remove all bio-burden. After developing enzymatic cleansers to work on specific proteins, the chemists at the company realized that an enzymatic cleaner must have the right mixture of various enzymes to be a total cleaner. Esquenet engineered the first multi-tiered enzymatic cleaner with lipase, protease, carbohydrase, amylase, and proprietary enzymes.

Multi-Tierd Endozime AW Plus ensures complete removal of all bio-burden in two or three minutes with a half ounce per gallon of water dilution (the lowest recommended for any cleaner presently on the market). After instruments are rinsed with tap, distilled, or sterile water, Premixslip should be applied as a lubricant and rust inhibitor for protection. Should any rust accrue, Surgistain can be used to restore the original finish on stainless steel instruments. This three-step Ruhof system is designed to provide CS departments with everything needed for complete cleaning and maintenance of surgical instruments and scopes. It also eliminates the risks of cross contamination while reducing repair and replacement costs.

Staying on top of the enzymatic cleaner market is crucial.

Staying on top of the enzymatic cleaner market is crucial. With new challenges arising daily the company chemists create innovative cleansers to deal with problems facing today's CS and GI departments. For example, Olean (also known as Olestra), marketed and created by Proctor and Gamble, was introduced in 1998 as a substitute in fat-free snack foods. Olean, P&G's name for sucrose polyester (synthetic lipids), keeps the physical property of natural fat, but is not digested or absorbed by the human body. "Wow,"-type potato/tortilla chips and certain brand name products can be identified as those cooked using Olestra in place of animal or plant-based fat. When ingested by a patient prior to an endoscopic procedure, the chemical leaves an orange/pink oily substance that coats the insertion tubes and internal channels of a scope. (Figure 1).

"The scope gets jammed up by Olestra. This oil does not break down during cleaning, but redeposits itself in different areas-becoming difficult to remove," Bass says. Taking this latest problem into consideration, Esquenet came up with a solution, creating the company's latest cleaner, Olestrazime.

"Olestrazime, used as a preventive maintenance, stops synthetic lipid residues from accumulating on biopsy forceps as well as on the outer sheath and internal channels of a scope. This is the only product that does that. It is designed to molecularly displace synthetic lipids, allowing them to be rinsed off, while dissolving the fat, blood, protein, and carbohydrates," he says. The company worked on this project for more than two years before developing Olestrazime. "It is a specific product for a specific problem," Bass says.

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