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

What's Happening in Enzymatic Cleaning?

By Kelli M. Donley

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

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

Bass, a successful businessman, became interested in developing high-qualitycleaning products for surgical instruments. As a natural salesman, he talked hisway into hospitals around the country to observe cleaning techniques andoperating room procedures. He realized that standard dishwashing detergents wereinsufficient. He knew that with the right chemistry, he could improve cleansersand change the field.

After being approached by Bass, Esquenet realized that the enzymaticsolutions he had developed to remove barnacles could also clean surgicalinstruments. The enzymes he had once used to eat away at marine organism residuewould soon be eating away at organic contaminants. With Esquenet's chemicalknowledge and Bass's marketing and business acumen, the Ruhof Corporation wasformed.

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

Why are enzymes used to clean surgical equipment? All instruments used insurgery are contaminated with organic matter that common detergents are unableto remove. Furthermore, to sterilize an instrument effectively, specific enzymesare required to digest different components of bio-burden. Inextricablyintermingled, the four components of bio-burden are: blood, fat, carbohydrates,and protein. Just one component left undigested, such as lipids (fat), can actas a blanket, preventing the enzymes from digesting the other components beneathit. Once the surface of the undissovled biomass is broken, contaminants areexposed, creating a significant threat to the patient and the professionalhandling them. To prove that enzymes are needed to dissolve bio-burden, Bassdeveloped the Ruhof Bio-burden Visualization System. This system allows you tosee contaminants left on supposedly clean instruments, exposing a new world ofinvisible 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 solutionsdesigned to completely remove all bio-burden. After developing enzymaticcleansers to work on specific proteins, the chemists at the company realizedthat an enzymatic cleaner must have the right mixture of various enzymes to be atotal cleaner. Esquenet engineered the first multi-tiered enzymatic cleaner withlipase, protease, carbohydrase, amylase, and proprietary enzymes.

Multi-Tierd Endozime AW Plus ensures complete removal of all bio-burden intwo or three minutes with a half ounce per gallon of water dilution (the lowestrecommended for any cleaner presently on the market). After instruments arerinsed with tap, distilled, or sterile water, Premixslip should be applied as alubricant and rust inhibitor for protection. Should any rust accrue, Surgistaincan be used to restore the original finish on stainless steel instruments. Thisthree-step Ruhof system is designed to provide CS departments with everythingneeded for complete cleaning and maintenance of surgical instruments and scopes.It also eliminates the risks of cross contamination while reducing repair andreplacement costs.

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

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

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

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