CROSS REFERENCE TO RELATED APPLICATIONS

[001] This application claims priority and benefit of U.S. Provisional application with serial number 62/835,640, filed April 18, 2019, entitled IMPROVED ENDOSCOPE FLUSHING AID, which is herein incorporated by reference in its entirety.

FIELD OF THE INVENTION

[002] The invention relates generally to processes to clean medical devices, such as endoscopes, with a turbulent cleaning solution provided by inclusion of a peristaltic pump(s).

BACKGROUND OF THE INVENTION

[003] Medical devices designed to come into contact with the body of a patient during treatment and or diagnosis require, before being re-used on a new patient, to be "reprocessed", so that the device can be used without concern for patient safety, infection and death resulting from remaining body fluid(s), body waste(s), virus(es) and or bacteria.

[004] Such a sanitation treatment can be a simple disinfection or a sterilization process, performed at either hot or cold temperatures depending on the construction materials of the device.

[005] One approach to clean medical devices which are sensitive to the relatively high temperatures of disinfection autoclaves is by treatment with an aqueous cleaning solution that includes one or more chemical agents having decontaminating/sterilant properties. However, such approaches do not ensure that all body fluids and waste have been removed from the surfaces of the medical device. Therefore, cleaning of the medical device often includes a physical cleaning aspect, such as brushing with an instrument, that helps to remove the body fluid(s) and waste(s).

[006] Brushing, rubbing, scraping, scratching, abrading, etc. of the medical device surface, both internal, such as lumens, and external can compromise the surface of the device with scratches or abrasions. Such surface imperfections can be breeding grounds for unwanted and unremoved, debris, body waste, bacteria or vims(es) from the surface of the medical device. Such contamination can serve as a source that can compromise a patient’s health and safety. Therefore, it is advantageous to avoid removal of body fluid(s), body waste(s), virus(es) and/or bacteria from medical device surfaces without the use of cleaning materials that have an abrasive aspect to the cleaning.

[007] Therefore, a need exists for disinfection and or sterilization approaches that overcomes one or more of the current disadvantages noted above.

BRIEF SUMMARY OF THE INVENTION

[008] The present embodiments surprisingly provide a simple and efficient process to clean an interior portion of a medical device, such as a lumen. The process includes providing a cleaning solution in a first delivery system and providing a gas in a second delivery system, wherein the first and second delivery system are connected to a third delivery system that allows the cleaning solution and gas to combine to provide a turbulent cleaning solution that can be passed through a lumen of a medical device.

[009] In one embodiment the process is generally accomplished by use of a peristaltic pump with two heads; one head for each of the delivery system. The resultant turbulent cleaning solution provides enough force to dislodge most body fluids, debris, bacteria and/or virus(es) from the surface of the medical device without the requirement for physical scrubbing or brushing of the surface.

[010] While multiple embodiments are disclosed, still other embodiments of the present invention will become apparent to those skilled in the art from the following detailed description. As will be apparent, the invention is capable of modifications in various obvious aspects, all without departing from the spirit and scope of the present invention. Accordingly, the detailed descriptions are to be regarded as illustrative in nature and not restrictive.

DETAILED DESCRIPTION

[011] In the specification and in the claims, the terms "including" and "comprising" are open-ended terms and should be interpreted to mean "including, but not limited to. . . . " These terms encompass the more restrictive terms“consisting essentially of’ and“consisting of.”

[012] It must be noted that as used herein and in the appended claims, the singular forms "a", "an", and "the" include plural reference unless the context clearly dictates otherwise. As well, the terms "a" (or "an"), "one or more" and "at least one" can be used interchangeably herein. It is also to be noted that the terms "comprising", "including",“characterized by” and "having" can be used interchangeably.

[013] Values expressed in a range format should be interpreted in a flexible manner to include not only the numerical values explicitly recited as the limits of the range, but also to include all the individual numerical values or sub-ranges encompassed within that range as if each numerical value and sub-range is explicitly recited. For example, a range of "about 0.1% to about 5%" should be interpreted to include not only the explicitly recited amount of about 0.1 wt. % to about 5 wt. %, but also the individual concentrations (e.g., 1%, 2%, 3%, and 4%) and the sub-ranges (e.g., 0.5%, 1.1%, 2.2%, 3.3%, and 4.4%) within the indicated range.

[014] When describing the present invention, the following terms have the following meanings, unless otherwise indicated.

[015] The term "about" can allow for a degree of variability in a value or range, for example, within 10%, within 5%, or within 1% of a stated value or of a stated limit of a range.

[016] As used herein, "cleaner" refers to a substance capable of effectively cleaning a substrate (e.g., medical device). The substance can effectively remove foreign or extraneous matter from the substrate.

[017] As used herein, "solubilizer" refers to a substance that makes soluble, aids in the solubility, or otherwise increases the solubility, of a substance in a liquid diluent or carrier. In specific embodiments of the invention, the solubilizer can include propylene glycol.

[018] As used herein, "diluent" or "carrier" refers to a liquid medium in which substances are suspended, completely dissolved, or partially dissolved in. In specific embodiments of the invention, the diluent can include water (e.g., DI water).

[019] As used herein, "pH" refers to the measure of the acidity or basicity of an aqueous solution. Solutions with a pH less than 7 are said to be acidic and solutions with a pH greater than 7 are basic or alkaline. Pure water has a pH very close to 7. The pH scale is traceable to a set of standard solutions whose pH is established by international agreement. Primary pH standard values are determined using a concentration cell with transference, by measuring the potential difference between a hydrogen electrode and a standard electrode such as the silver chloride electrode. Measurement of pH for aqueous solutions can be done, e.g., with a glass electrode and a pH meter, or using indicators. Mathematically, pH is the negative logarithm of the activity of the (solvated) hydronium ion, more often expressed as the measure of the hydronium ion concentration

[020] As used herein, "purified water" refers to water that is mechanically filtered or processed to be cleaned for consumption. Distilled water and deionized (DI) water have been the most common forms of purified water, but water can also be purified by other processes including reverse osmosis, carbon filtration, microfiltration, ultrafiltration, ultraviolet oxidation, or electrodialysis

[021] As used herein, "deionized water" or "DI water" refers to demineralized water/DM water (DI water, DIW or de-ionized water), which is water that has had almost all of its mineral ions removed, such as cations like sodium, calcium, iron, and copper, and anions such as chloride and sulfate. Deionization is a chemical process that uses specially manufactured ion- exchange resins which exchange hydrogen ion and hydroxide ion for dissolved minerals, which then recombine to form water. Because most non-particulate water impurities are dissolved salts, deionization produces a high purity water that is generally similar to distilled water, and this process is quick and without scale buildup. However, deionization does not significantly remove uncharged organic molecules, viruses or bacteria, except by incidental trapping in the resin. Specially made strong base anion resins can remove Gram-negative bacteria. Deionization can be done continuously and inexpensively using electrodeionization

[022] As used herein, "reversed osmosis water" refers to purified water obtained using a semipermeable membrane. This membrane technology is not properly a filtration method. In reverse osmosis, an applied pressure is used to overcome osmotic pressure, a colligative property, that is driven by chemical potential, a thermodynamic parameter. Reverse osmosis can remove many types of molecules and ions from solutions, and is used in both industrial processes and the production of potable water. The result is that the solute is retained on the pressurized side of the membrane and the pure solvent is allowed to pass to the other side. To be "selective," this membrane should not allow large molecules or ions through the pores (holes), but should allow smaller components of the solution (such as the solvent) to pass freely.

[023] As used herein, "tap water" or "running water," "city water," or "municipal water" refers to water supplied to a tap (valve). Its uses include drinking, washing, cooking, and the flushing of toilets. Indoor tap water is distributed through "indoor plumbing", which has existed since antiquity but was available to very few people until the second half of the 19th century, when it began to propagate in what are now the developed countries. It became common in many regions during the 20th century, and is now lacking only among the poor, especially in developing countries. Calling a water supply "tap water" distinguishes it from the other main types of fresh water which may be available; these include water from rainwater-collecting cisterns, water from village pumps or town pumps, or water carried from streams, rivers, or lakes (whose potability may vary).

[024] As used herein, "medical device" refers to an instrument, apparatus, implant, in vitro reagent, or similar or related article that is used to diagnose, prevent, or treat disease or other conditions, and does not achieve its purposes through chemical action within or on the body (which would make it a drug). Whereas medicinal products (also called pharmaceuticals) achieve their principal action by pharmacological, metabolic or immunological means, medical devices act by other means like physical, mechanical, or thermal means. Medical devices vary greatly in complexity and application. Examples range from simple devices such as tongue depressors, medical thermometers, and disposable gloves to advanced devices such as computers which assist in the conduct of medical testing, implants, and prostheses. The design of medical devices constitutes a major segment of the field of biomedical engineering. In specific embodiments, the medical device can include an endoscope (e.g., flexible endoscope).

[025] As used herein, "endoscope" refers to an instrument used to examine the interior of a hollow organ or cavity of the body. Unlike most other medical imaging devices, endoscopes are inserted directly into the organ. Endoscope can also refer to using a borescope in technical situations where direct line of-sight observation is not feasible.

[026] An endoscope can consist of: (a) a rigid or flexible tube; (b) a light delivery system to illuminate the organ or object under inspection. The light source is normally outside the body and the light is typically directed via an optical fiber system; (c) a lens system transmitting the image from the objective lens to the viewer, typically a relay lens system in the case of rigid endoscopes or a bundle of fiberoptics in the case of a fiberscope; (d) an eyepiece. Modern instruments may be videoscopes, with no eyepiece, a camera transmits image to a screen for image capture; and (e) an additional channel to allow entry of medical instruments or manipulators.

[027] As used herein, "flexible endoscope" refers to an endoscope that includes a flexible tube. [028] As used herein, "flexible endoscope washer disinfector device" or "washer disinfector device" refers to an apparatus or machine employed to wash a medical device, such as a flexible endoscope or colonoscope. Such an apparatus or machine can also disinfect the medical device, as well as optionally dry and optionally store the medical device. Suitable apparatus or machines that can wash and disinfect the medical device include, e.g., Medivators Advantage Plus™ Automated Endoscope Reprocessor (AER), Medivators Advantage Plus™ Pass-Thru AER, Medivators Scope Buddy™ Endoscope Flushing Aid, Medivators Scope Buddy™ Plus Endoscope Flushing Aid, Olympus OER-PRO ^® AER, Getinge ED-Flow AER, Getinge ED900 AER, Steris SYSTEM 1 ^® and SYSTEM IE ^® Endo Liquid Chemical Sterilant Processing System.

[029] As used herein, "clean," "cleaning," "wash," or "washing" refers to the process of freeing a substrate from foreign or extraneous matter; the process of removing foreign or extraneous matter from a substrate (e.g., medical device).

[030] As used herein, "disinfect" or "disinfecting" refers to the process of destroying, removing, killing and/or inhibiting the action of microorganisms located on a substrate (e.g., medical device).

[031] As used herein, "dry" or "drying" refers to the process of removing moisture from a substrate (e.g., medical device). The process can be carried out, e.g., employing heat (elevated temperature).

[032] As used herein, "store" or "storing" refers to the process of housing a substrate

(e.g., medical device) for future use.

[033] The embodiments described herein relate to methods for conditioning medical equipment following processing (cleaning and disinfection) of said equipment, and to apparatus’ for use in such methods. In particular, embodiments relate to methods and apparatus’ for conditioning flexible medical endoscopes, following processing of said endoscope to a state of high level disinfection.

[034] The term "disinfection" is used herein in preference to the term "sterility" since the latter implies the complete absence of pathogenic organisms, which in practice is rarely, if ever, achievable. It is to be appreciated however that the ultimate aim of disinfecting medical equipment is indeed to get as close to absolute sterility as is practicable. The term "conditioning" is used herein to refer to a method of maintaining the disinfection of medical equipment following processing thereof to a state of high level disinfection.

[035] The present embodiments have been developed in connection with the processing and storage of flexible medical endoscopes, and therefore will be described herein with particular emphasis on this application. It is envisaged however, that the methods described herein may be applied to the processing and storage of substantially all types of medical, surgical, dental and veterinary equipment, apparatus, and instruments, especially those with lumens.

[036] After use in an endoscopic procedure, flexible medical endoscopes are usually subjected to "processing", consisting of rigorous manual cleaning followed by placing the endoscope in an Automated Endoscope Re-processor (AER) which effects a further cleaning and disinfecting procedure to bring the endoscope to a High Level Disinfection Status (HLDS). The endoscope is then stored in a clean environment. Under normal storage conditions, the degree of disinfection of the endoscope can only be maintained at an acceptable level for a relatively short period, usually about 3 hours. This is due to the multiplication of residual pathogens which may remain on the endoscope after disinfection, or which may be present in the atmosphere. If the endoscope is not used in a further endoscopic procedure within this time, then further processing will be necessary prior to its next use. Frequent and repeated processing is undesirable, since it reduces the availability of the endoscope for endoscopic procedures, while increasing the operating costs, due to the need for cleaning and disinfectant materials and the operation of cleaning equipment. Furthermore, repeated processing reduces the lifetime of the endoscope due to wear and tear.

[037] The loss of HLDS over the 3 hour storage period is due to the inability of the

AER completely to dry the internal channels of the endoscope, due to the small internal diameter of these channels. The residual moisture within the channels provides an environment in which micro-organisms can quickly multiply.

[038] The term "cleaning composition" refers to a substance that when applied to non living objects, effectively removes foreign matter located on the objects. For example, when used to clean medical devices, such as flexible endoscopes, the cleaning solution(s) described herein can effectively remove from the medical device at least one of soil, blood, protein, carbohydrate, bodily fluid, and fecal matter. [039] The term "room temperature" as used herein refers to a temperature of about 15°C to 28°C.

[040] The term "hydrogen peroxide" or "H2O2" refers to the compound chemically designated as dihydrogen dioxide, having the CAS Reg. No. 7722-84-1. In specific embodiments, the hydrogen peroxide includes water. In further specific embodiments, the hydrogen peroxide is 50% wt. % hydrogen peroxide in water. The hydrogen peroxide can be present in the composition, in any suitable and effective amount.

[041] The term "organic acid" refers to an organic compound with acidic properties.

The most common organic acids are the carboxylic acids, whose acidity is associated with their carboxyl group— COOH. Sulfonic acids, containing the group— SO2OH, are relatively stronger acids. The relative stability of the conjugate base of the acid determines its acidity. Other groups can also confer acidity, usually weakly:—OH,— SH, the enol group, and the phenol group. Organic compounds containing these groups are generally referred to as organic acids. An example of an organic acid is acetic acid.

[042] The term "acetic acid" or "ethanoic acid" refers to an organic compound with the chemical formula CH ₃ CO ₂ H (also written as CH ₃ COOH), having the CAS Reg. No. 64-19-7.

[043] The term "glacial acetic acid" refers to undiluted and relatively concentrated, water-free (anhydrous) acetic acid.

[044] The term "peracetic acid," "peroxyacetic acid," or "PAA" refers to an organic compound with the chemical formula CH ₃ CO ₃ H.

[045] The term "chelator," "chelant" or "chelating agent" refers to a compound that forms soluble, complex molecules with certain metal ions, inactivating the metal ions (or to some extent, countering the effects of the metal ions), so that they cannot normally react with other compounds, elements or ions. In specific embodiments, the chelator effectively chelates transition metals. One suitable type of chelator is/are sulfonic acids, more particularly, polymers or solid supports which contain sulfonic acid functionality. In specific embodiments, the chelator will effectively chelate any transition metals and/or alkaline earth metals present in any of the components of the composition.

[046] In particular, the chelator can be a sulfonic acid group that is incorporated into a polymer. For example, the polymer can be styrene based that is functionalized with sulfonic acid groups. The styrenic polymer can be a copolymer, such as styrene/divinylbenzene. The polymer may further be crosslinked. Examples of commercially available sulfonic acid functionalized polymers include those such as Dowex® 50WX4-200, Dowex® DR2030, Amberlite IR120 Na, Amberlite IRN99, Amberlyst 15 hydrogen (CAS Number 39389-20-3) and Amberlite strong acidic cation exchange sodium form available from Dow Chemical Company, which are styrene- divinylbenzene copolymers.

[047] Alternatively, a copolymer of tetrafluoroethylene (TFE) and Sulfonyl Fluoride

Vinyl Ether (SFVE) F ₂ C=CF-0-CF ₂ CF ₂ -S0 ₂ F is a useful material. Aquivion® PFSA (perfluoro sulfonic acid) ionomers, available from Solvay, are based on this copolymer and are available in a membrane, as a powder, in a dispersion or as pellets.

[048] In one aspect, the perfluorosulfonic acid pellets can be extruded/coextruded with other polymers to form films or shaped into a container to hold the remaining components of the embodiments. Suitable extrusion polymers include, for example, polyethylenes and polypropylenes.

[049] In another embodiment, the polymer can be derived from 2-acrylamido-2- methylpropane sulfonic acid (AMPS). Additionally, AMPS can be used to coat the lining of a container and then be polymerized to the surface of the container as a protective/chelating coating.

[050] It should be understood that the requisite sulfonic acid group may need to be first treated with an acidic solution to provide the free acid as necessary.

[051 ] The polymeric resin chelator can be added to the compositions described herein.

Alternatively, the compositions can be passed through the polymeric resin chelator. In another embodiment, the polymeric resin chelator can be in the form of a membrane and the membrane is in contact and remains in contact with the composition. In still another embodiment, the polymeric resin chelator is incorporated into a container which hold the compositions described herein. In certain embodiments, the polymer resin chelator is coated onto the interior of a container that is used to store the compositions described herein. In still another embodiment, the polymeric chelator can be placed within a“mesh pouch” or other containment system that can be placed into a container with the compositions described herein.

[052] One advantage of utilizing the polymeric resin chelator is that users of the compositions often contaminate the composition in between uses. That is, an individual may place a used wipe, sponge, or rag, medical device, instrument, etc. against or within the container that houses the composition, thus transferring contaminants to the container. The polymeric resin chelators described herein help to stabilize the peracetic acid/hydrogen peroxide compositions by complexing with/removing the undesired contaminants, such as metal ions.

[053] It should be understood that one advantage of the polymeric resin chelator is that it does not dissolve in the embodiments described herein. That is, the polymer resin remains in the solution but does not become homogeneous with the remaining components. Not to be limited by theory, it is believed that the polymeric resin chelator provides surface contact with the components of the composition and removes metallic contaminants from the solution to stabilize the composition. As a result, the components of the composition, e.g., the hydrogen peroxide and/or the peracetic acid, do not degrade over time due to metallic components. Additionally, the polymeric resin chelator does not cause a residue to remain on a treated surface after the surface has been treated with the compositions described herein.

[054] The term "anticorrosive agent" or "corrosion inhibitor" refers to a compound that, when added to a liquid or gas, decreases the corrosion rate of a material, typically a metal or an alloy. Suitable anticorrosive agents include, e.g., benzotriazole and sodium dodecyl sulfate (SDS).

[055] The term "benzotriazole" or "BTA" refers to the compound lH-benzotriazole or

1,2,3-benzotriazole, having the CAS Reg. No. 95-14-7.

[056] The term "surfactant" refers to a compound capable of lowering the surface tension of a liquid, the interfacial tension between two liquids, or that between a liquid and a solid. Surfactants may act as detergents, wetting agents, emulsifiers, foaming agents, and/or dispersants. The surfactant can be non-ionic, anionic or cationic. Additionally, the surfactant can include one or more non-ionic surfactants, one or more anionic surfactants, and/or one or more cationic surfactants.

[057] The term "non-ionic surfactant" or "nonionic surfactant" refers to a surfactant, in which the total number of electrons is equal to the total number of protons, giving it a net neutral or zero electrical charge. One suitable class of non-ionic surfactants includes the Pluronic® poloxamers.

[058] Poloxamers are nonionic triblock copolymers composed of a central hydrophobic chain of polyoxypropylene (poly(propylene oxide)) flanked by two hydrophilic chains of polyoxyethylene (poly(ethylene oxide)). Poloxamers are also known by the trade name Pluronics®.

[059] Because the lengths of the polymer blocks can be customized, many different poloxamers exist, that have slightly different properties. For the generic term "poloxamer," these copolymers are commonly named with the letter "P" (for poloxamer) followed by three digits, the first two digits “x” (times) 100 give the approximate molecular mass of the polyoxypropylene core, and the last digit x 10 gives the percentage polyoxyethylene content (e.g., P407=Poloxamer with a polyoxypropylene molecular mass of 4,000 g/mol and a 70% polyoxyethylene content). For the Pluronic® tradename, coding of these copolymers starts with a letter to define its physical form at room temperature (L=liquid, P=paste, F=flake (solid)) followed by two or three digits. The first digit (two digits in a three-digit number) in the numerical designation, multiplied by 300, indicates the approximate molecular weight of the hydrophobe; and the last digit x 10 gives the percentage polyoxyethylene content (e.g., L61=Pluronic with a polyoxypropylene molecular mass of 1,800 g/mol and a 10% polyoxyethylene content). In the example given, poloxamer 181 (P181)=Pluronic L61.

[060] The term "Pluronic® 10R5 surfactant block copolymer" refers to polyoxypropylene-polyoxyethylene block copolymer, having the CAS Reg. No. 9003-11-6.

[061] Other nonionic surfactants include, but are not limited to, fatty alcohols, polyoxyethylene glycol alkyl ethers (Brij), polyoxypropylene glycol alkyl ethers, glucoside alkyl ethers, polyoxyethylene glycol octylphenol ethers, polyoxyethylene glycol alkylphenol ethers, glycerol alkyl esters, polyoxyethylene glycol sorbitan alkyl esters, sorbitan alkyl esters, cocamide MEAs, cocamide DEAs, dodecyl dimethylamine oxides, block copolymers of polyethylene glycol and polypropylene glycols.

[062] Suitable fatty alcohols include, but are not limited to, cetyl alcohol, stearyl alcohol, cetostearyl alcohol (consisting predominantly of cetyl and stearyl alcohols) and oleyl alcohol.

[063] Suitable polyoxyethylene glycol alkyl ethers, include but are not limited to (Brij), for example CH3-(CH2)io-i6-(0-C2H4)i-25-OH, or octaethylene glycol monododecyl ether or pentaethylene glycol monododecyl ether.

[064] Suitable polyoxypropylene glycol alkyl ethers include CH ₃ -(CH ₂ )io-i ₆ -(0-C ₃ H ₆ )i-

25-OH. [065] Suitable glucoside alkyl ethers include CH ₃ -(CH ₂ )io-i ₆ -(0-Glucoside)i- ₃ -OH, and, for example, include decyl glucoside, lauryl glucoside, and octyl glucoside.

[066] Suitable polyoxyethylene glycol octylphenol ethers include CsHi ₇ -(C ₆ H ₄ )-(0-

C2H4) _I -25-OH. One exemplary material is TRITON X-100.

[067] Suitable polyoxyethylene glycol alkylphenol ethers include CgHig-iCrTUMO-

C2H4) _I -25-OH. One example is Nonoxynol-9.

[068] In one aspect, a suitable glycerol alkyl ester is glyceryl laurate.

[069] In another aspect, a suitable polyoxyethylene glycol sorbitan alkyl ester is polysorbate.

[070] In still another aspect, suitable sorbitan alkyl esters are referred to as SPAN, e.g.,

SPAN-20, sorbitan monolaurate.

[071 ] The term "cationic surfactant" refers to a surfactant, in which the total number of electrons is less than the total number of protons, giving it a net positive electrical charge.

[072] One kind of cationic surfactant is typically based on pH-dependent primary, secondary or tertiary amines. The primary amines become positively charged at a pH < 10, and the secondary amines become charged at a pH < 4. One example is octenidine dihydrochloride.

[073] Another type of cationic surfactant is based on permanently charged quaternary ammonium cations, such as alkyltrimethylammonium salts. These include but are not limited to cetyl trimethylammonium bromide (CTAB), hexadecyl trimethyl ammonium bromide, cetyl trimethylammonium chloride (CTAC), cetylpyridinium chloride (CPC), polyethoxylated tallow amine (POEA), benzalkonium chloride (BAC), benzethonium chloride (BZT), 5-Bromo-5-nitro- 1,3-dioxane, dimethyldioctadecylammonium chloride and dioctadecyldimethylammonium bromide (DODAB).

[074] The term "anionic surfactant" refers to a surfactant in which the total number of electrons is greater than the total number of protons, giving it a net negative electrical charge. One suitable anionic surfactant is sodium lauryl sulfate.

[075] Anionic surfactants have a permanent anion, such as a sulfate, sulfonate or phosphate anion associated with the surfactant or has a pH-dependent anion, for example, a carboxylate.

[076] Sulfates can be alkyl sulfate or alkyl ether sulfates. [077] Suitable alkyl sulfates include, but are not limited to, ammonium lauryl sulfate or sodium lauryl sulfate (SDS). Suitable alkyl ether sulfates include, but are not limited to, sodium laureth sulfate, also known as sodium lauryl ether sulfate (SLES) or sodium myreth sulfate.

[078] Suitable sulfonates include, but are not limited to, docusate (dioctyl sodium sulfosuccinate), fluorosurfactants that are sulfonated and alkyl benzene sulfonates.

[079] Typical sulfonated fluorosurfactants include, but are not limited to, perfluorooctanesulfonate (PFOS) or perfluorobutanesulfonate.

[080] Phosphates are typically alkyl aryl ether phosphates or alkyl ether phosphates.

[081] Carboxylates are typically alkyl carboxylates, such as fatty acid salts (soaps), such as for example, sodium stearate. Alternatively, the carboxylate can be, but is not limited to, sodium lauryl sarcosinate. In another alternative aspect, the carboxylate includes but is not limited to a carboxylated fluorosurfactant, such as perfluorononanoate, or perfluorooctanoate (PFOA or PFO).

[082] When a single surfactant molecule exhibits both anionic and cationic dissociations it is called amphoteric or zwitterionic. Zwitterionic (amphoteric) surfactant is based on primary, secondary or tertiary amines or quaternary ammonium cation also having a sulfonate, carboxylate or a phosphate.

[083] Suitable zwitterionic surfactants include, but are not limited to, CHAPS (3-[(3-

Cholamidopropyl)dimethylammonio]-l-propanesulfonate) or a sultaine. The sultaine is typically cocamidopropyl hydroxy sultaine.

[084] In one aspect, the carboxylate cation is an amino acid, imino acid or betaine. In one aspect, the betaine is typically cocamidopropyl betaine.

[085] When the zwitterionic surfactant includes a phosphate, lecithin is often chosen as the counterion.

[086] The term "sodium dodecyl sulfate," "SDS," "NaDS," "sodium lauryl sulfate," or

"SFS" refers to an organic compound with the formula CH ₃ (CH ₂ )n0S0 ₃ Na), having the CAS Reg. No. 151-21-3.

[087] The term "disinfectant" refers to a substance that when applied to non-living objects, destroys microorganisms that are living on the objects. The term "disinfect" refers to the process of destruction or prevention of biological contaminants. Disinfection does not necessarily kill all microorganisms, especially nonresistant bacterial spores; it is less effective than sterilization, which is an extreme physical and/or chemical process that kills all types of life.

[088] Disinfectants are different from other antimicrobial agents such as antibiotics, which destroy microorganisms within the body, and antiseptics, which destroy microorganisms on living tissue. Disinfectants are also different from biocides. The latter are intended to destroy all forms of life, not just microorganisms. Sanitizers are substances that simultaneously clean and disinfect.

[089] The term "CFU" refers colony forming units and is a measure of viable cells in which a colony represents an aggregate of cells derived from a single progenitor cell.

[090] In various embodiments, the cleaning composition includes: (a) hydrogen peroxide; (b) an organic acid; (c) a chelator that is not Dequest® 2010 (1-hydroxyethylidene- 1,1,-diphosphonic acid), in particular a sulfonic acid containing polymer, copolymer or a support functionalized with sulfonic acid groups ; and (d) surfactant.

[091 ] It should be understood that certain embodiments disclosed herein do not include l-hydroxyethylidene-l,l,-diphosphonic acid. In embodiments disclosed herein, the compositions and methods do not leave a residue on a treated surface after use of the composition to treat the surface.

[092] In another aspect, (l-hydroxyethylidene-l,l,-diphosphonic acid) can be included in the cleaning composition.

[093] It is appreciated that those of ordinary skill in the art fully understand and appreciate that when a composition includes more than one component, the composition may also include additional components formed as a product of the reaction between the components in the composition. For example, those of skill in the art fully understand and appreciate that a composition including hydrogen peroxide (H ₂ O ₂ ) and acetic acid (CH ₃ CO ₂ H) also includes the oxidized product of acetic acid, peracetic acid (CH ₃ CO ₃ H). As such, reference to the composition including hydrogen peroxide (H ₂ O ₂ ) and acetic acid (CH ₃ CO ₂ H) is proper, as well as reference to the composition being formed from hydrogen peroxide (H ₂ O ₂ ) and acetic acid (CH ₃ CO ₂ H). To that end, a composition of acetic acid and hydrogen peroxide will include significant and appreciable amounts of peracetic acid formed from the reaction of acetic acid with hydrogen peroxide. Further, it is appreciated that those of ordinary skill in the art fully understand and appreciate that an equilibrium exists between hydrogen peroxide and acetic acid, and peracetic acid.

[094] In various embodiments, peracetic acid is present in about 1 wt. % to about 15 wt.

% of the composition. In some embodiments, peracetic acid is present in about 2-14 wt. %, 3-12 wt. %, 4-11 wt. %, 5-9 wt. %, about 6-8 wt. %, or about 1 wt. %, 2 wt. %, 3 wt. %, 4 wt. %, 5 wt. %, 6 wt. %, 7 wt. %, 8 wt. %, 9 wt. %, 10 wt. %, 11 wt. %, 12 wt. %, 13 wt. %, 14 wt. %, or about 15 wt. % or more of the composition. In some embodiments, peracetic acid is present in about 5 wt. % to about 7.5 wt. % of the composition.

[095] In various embodiments, hydrogen peroxide is present in about 10 wt. % to about

50 wt. % of the composition. In some embodiments (e.g., before equilibration and formation of PAA), the hydrogen peroxide is present in about 15-45 wt. %, 20-35 wt. %, or about 25-30 wt. % of the composition. In some embodiments (e.g., after equilibration and formation of PAA), the hydrogen peroxide is present in about 10-40 wt. %, 15-35 wt. %, 18-30 wt. % or about 20-26 wt. % of the composition. In some embodiments, the hydrogen peroxide is present in about 16 wt. %, 18 wt. %, 20 wt. %, 21 wt. %, 22 wt. %, 23 wt. %, 24 wt. %, 25 wt. %, 26 wt. %, 27 wt. %, 28 wt. %, 29 wt. %, 30 wt. %, 31 wt. %, 32 wt. %, 34 wt. %, or about 36 wt. %. In some embodiments, the hydrogen peroxide is about 35 wt. % in water, present in about 18 wt. % to about 32 wt. % of the composition. In some embodiments, hydrogen peroxide is about 35 wt. % in water, present in about 28 wt. % of the composition. In some embodiments, hydrogen peroxide is about 35 wt. % in water, present in about 20 wt. % to about 26 wt. % of the composition.

[096] In various embodiments, the organic acid includes acetic acid. In some embodiments, the organic acid comprises glacial acetic acid. In some embodiments, the organic acid includes acetic acid, present in at least about 3 wt. % of the composition. In some embodiments (e.g., before equilibration and formation of PAA), the organic acid includes acetic acid, present in about 1-50 wt. %, 2-45 wt. %, 3-40 wt. %, 4-35 wt. %, 6-30 wt. %, 8-24 wt. %, 10-22 wt. %, 12-20 wt. %, about 14-18 wt. %, or about 4 wt. %, 5 wt. %, 6 wt. %, 7 wt. %, 8 wt. %, 9 wt. %, 10 wt. %, 11 wt. %, 12 wt. %, 13 wt. %, 14 wt. %, 15 wt. %, 16 wt. %, 17 wt. %, 18 wt. %, 19 wt. %, 20 wt. %, 21 wt. %, 22 wt. %, 23 wt. %, 24 wt. %, or about 25 wt. % of the composition. In some embodiments (e.g., after equilibration and formation of PAA), the organic acid includes acetic acid, present in about 1-20 wt. %, 2-18 wt. %, 3-17 wt. %, 4-16 wt. %, 5-15 wt. %, 6-14 wt. %, 7-13 wt. %, 8-12 wt. %, or about 9-11 wt. % of the composition. In some embodiments, the organic acid includes acetic acid, present in about 9 wt. % to about 11 wt. % of the composition. In some embodiments, the organic acid comprises acetic acid, present in about 16 wt. % of the composition.

[097] In various embodiments, the chelator effectively chelates transition metals. In some embodiments the chelator includes a polymeric sulfonic acid resin.

[098] In various embodiments, the surfactant includes a non-ionic surfactant. In various embodiments, the surfactant includes at least one of an anionic and cationic surfactant. In some embodiments the surfactant includes Pluronic® 10R5 surfactant block copolymer. In some embodiments the surfactant includes Pluronic® 10R5 surfactant block copolymer, present in at least about 0.1 wt. % of the composition. In some embodiments, the surfactant includes Pluronic® 10R5 surfactant block copolymer, present in about 0.1-8.0 wt. %, 0.3-7.0 wt. %, 0.5- 6.0 wt. %, 0.7-5.0 wt. %, 0.8-4.0 wt. %, about 1.0-3.0 wt. %, or about 0.5 wt. %, 1.0 wt. %, 1.4 wt. %, 1.8 wt. %, 2.0 wt. %, 2.2 wt. %, 2.6 wt. %, or about 3.0 wt. % of the composition. In some embodiments, the surfactant includes Pluronic® 10R5 surfactant block copolymer, present in about 2 wt. % of the composition.

[099] In various embodiments, the composition includes about 28 wt. % hydrogen peroxide, about 16 wt. % acetic acid, about 0.2 wt. % to about 2 wt. % polymeric resin chelator, optionally, about 2.0 wt. % Pluronic® 10R5 surfactant block copolymer, and about 53 wt. % deionized water.

[0100] In various embodiments, the composition includes about 20.0 to about 26.0 wt. % hydrogen peroxide, about 9.0 to about 11.0 wt. % acetic acid, about 0.2 wt. % to about 2 wt. % polymeric resin chelator, optionally, about 2.0 wt. % Pluronic® 10R5 surfactant block copolymer, about 53 wt. % deionized water and about 6.8 to about 7.5 wt. % peracetic acid.

[0101] In various embodiments, the cleaning composition includes: (a) hydrogen peroxide; (b) organic acid; (c) a polymeric sulfonic acid resin based chelator; and (d) surfactant. The composition includes less than about 1 wt. % of an anticorrosive agent. The composition can further optionally include water.

[0102] In one aspect, the hydrogen peroxide present in the composition can be from about 0.5 wt. % to about 30 wt. %, from about 0.5 wt. % to about 1.5 wt. %, from about 0.8 wt. % to about 1.2 wt. %, from about 20 wt. % to about 30 wt. % and all ranges and values from about 0.5 wt. % to about 30 wt. %.

[0103] In another aspect, the acetic acid present in the composition can be from about 1 wt. % to about 25 wt. %, from about 4 wt. % to about 20 wt. %, from about 4.5 wt. % to about 5.5 wt. %, from about 9 wt. % to about 17 wt. % and all ranges and values from about 1 wt. % to about 25 wt. %.

[0104] In still another aspect, the peracetic acid present in the composition can be from about 0.01 wt. % to about 25 wt. %, from about 0.05 wt. % to about 20 wt. %, from about 0.05 wt. % to about 0.1 wt. %, from about 3.5 wt. % to about 8 wt. % and all ranges and values from about 0.01 wt. % to about 25 wt. %.

[0105] In yet another aspect, the polymeric resin chelator present in the composition can be from about 0.1 wt. % to about 5 wt. %, from about 0.2 wt. % to about 2 wt. %, from about 0.5 wt. % to about 1.5 wt. % and all ranges and value from about 0.1 wt. % to about 5 wt. %.

[0106] Various embodiments provide for a composition that includes: (a) hydrogen peroxide, present in a concentration of about 0.5 wt. %to about 30 wt. %, e.g., about 28 wt. %; (b) acetic acid, present in a concentration of about 3 wt. % to about 25 wt. %, e.g., about 16 wt. %; (c) a sulfonic acid supported polymeric resin chelator present in a concentration of about 0.1 wt. % to about 5 wt. %, e.g., about 0.2 wt. % to about 0.7 wt. %; and, optionally, (d) Pluronic® 10R5 surfactant block copolymer, present in a concentration of about 2.0 wt. %, wherein the composition comprises less than about 0.1 wt. % of an anticorrosive agent, e.g., 0 wt. % of an anticorrosive agent. The composition can further optionally include water. In some embodiments, the hydrogen peroxide and acetic acid can combine to form peracetic acid, present in about 4 wt. % to about 8 wt. %, e.g., 6.8-7.5 wt. %.

[0107] In certain aspects, the peracetic acid/hydrogen peroxide compositions are stabilized without the need for a phosphonic based chelator, such as 1-hydroxyethylidene-l, 1,- diphosphonic acid. In other aspects, a phosphonic based chelator, such as 1-hydroxyethylidene- 1, 1,-diphosphonic acid can be included in the sterilant fluid, the cleaning composition, and therefore, component c), the polymeric sulfonic acid resin is optional.

[0108] The use of the polymeric stabilizer is detailed in pending US application

62/737,453, filed September 27, 2018, entitled“Peracetic Acid Stabilized Compositions with Polymeric Resins Chelators”, the contents of which are incorporated herein by reference. [0109] In specific embodiments, the cleaning solution(s) described herein can be formulated as, can exist as, and can be commercially available as a liquid concentrate disinfectant. The term "liquid concentrate" refers to a composition that is relatively undiluted and concentrated, having a low content of carrier, e.g., water. Having the composition be commercially available as a liquid concentrate will typically save costs associated with the manufacturing, shipping, and/or storage of the product.

[0110] When the cleaning solution(s)/composition(s) described herein is formulated as a liquid concentrate, the concentrate can subsequently be diluted with an appropriate amount of carrier (e.g., water) prior to use. Additionally, although considered to be a concentrate, when the cleaning solution(s) described herein is formulated as a liquid concentrate, a discrete and finite amount of carrier (e.g., water) can be employed.

[0111] Various embodiments provide for a one part, liquid concentrate disinfectant including about 20.0 about 26.0 wt. % hydrogen peroxide, about 9.0 to about 11.0 wt. % acetic acid, about 0.2 wt. % to about 2 wt. % polymeric resin chelator, about 2.0 wt. % Pluronic® 10R5 surfactant block copolymer, about 53 wt. % deionized water and about 6.8 to about 7.5 wt. % peracetic acid.

[0112] In various embodiments, the cleaning solution(s) described herein can be configured for use in contacting at least one of medical equipment, medical device (e.g., reusable medical device or instrument, such as an endoscope), surface in the medical industry, dental equipment, dental device, and surface in the dental industry. In some embodiments, the cleaning solution(s) described herein may be used in the reconditioning of a soiled endoscopic device. In some embodiments, the compositions described herein are useful during the disinfection step of the high level disinfection cleaning process following use of the endoscope in a medical procedure. The term "endoscopic device" includes a plurality of minimally invasive surgical devices (e.g., scopes) that have been developed for specific uses. For example, upper and lower endoscopes are utilized for accessing the esophagus/stomach and the colon, respectively, angioscopes are utilized for examining blood vessels, and laparoscopes are utilized for examining the peritoneal cavity.

[0113] In some embodiments, catalysts for the formation of peracetic acid from hydrogen peroxide and acetic acid are employed. Suitable catalysts include, for example, inorganic acids, such as sulfuric acid (H2SO4), hydrochloric acid (HC1), phosphoric acid (H3PO4), and nitric acid (HNO3).

[0114] In specific embodiments, the cleaning solution(s) described herein can be non- corrosive. The term "non-corrosive" or "noncorrosive" refers to a substance that will not destroy or irreversibly damage another surface or substance with which it comes into contact. The main hazards to people include damage to the eyes, the skin, and the tissue under the skin; inhalation or ingestion of a corrosive substance can damage the respiratory and gastrointestinal tracts. Exposure results in chemical bum. Having the composition be relatively non-corrosive will allow the user to employ the composition over a wider range of uses, exposing the composition to a wider range of substrates. For example, having the composition be relatively non-corrosive will allow the user to employ the composition as a disinfectant with certain medical devices that are highly sensitive to corrosive substances.

[0115] In specific embodiments, the cleaning solution(s) described herein can be non toxic. The term "non-toxic" refers to a substance that has a relatively low degree to which it can damage a living or non-living organism. Toxicity can refer to the effect on a whole organism, such as an animal, bacterium, or plant, as well as the effect on a substructure of the organism, such as a cell (cytotoxicity) or an organ (organotoxicity), such as the liver (hepatotoxicity). A central concept of toxicology is that effects are dose-dependent; even water can lead to water intoxication when taken in large enough doses, whereas for even a very toxic substance such as snake venom there is a dose below which there is no detectable toxic effect. Having the composition be relatively non-toxic will allow a wider range of users be able to safely handle the composition, without serious safety concerns or risks.

[0116] In specific embodiments, the cleaning solution(s) described herein can be stable over extended periods of time (i.e., has a long-term stability). The term "long-term stability" refers to a substance undergoing little or no physical and/or chemical decomposition or degradation, over extended periods of time.

[0117] In further specific embodiments, the cleaning solution(s) described herein can be stable over extended periods of time, such that at about 1 atm and about 19°C, less than about 20 wt. %, e.g., 15 wt. %, 10 wt. %, or 5 wt. %, of each component independently degrades over about one year. In additional specific embodiments, the cleaning solution(s) described herein can be stable over extended periods of time, such that at about 1 atm and about 19°C, at least about 80 wt. % of each component, e.g., 85 wt. %, 90 wt. %, 95 wt. %, is independently present after about one year.

[0118] Having the composition be relatively stable over extended periods of time will allow the composition to retain its effectiveness over that time, ensuring that it will remain useful and active for its intended purpose. In contrast, in those compositions that do not retain their effectiveness over that time, product loss can result, which can be financially costly. Additionally, risks associated with the use of a product that has lost some or all of its effectiveness for the intended purpose can be hazardous, in that the product may not effectively achieve the desired goal. For example, when used to disinfect a medical device, use of a composition that has lost some or all of its effectiveness as a disinfectant may not effectively disinfect the medical device. Medical injuries can be sustained by the patient, including serious infections.

[0119] In specific embodiments, the cleaning solution(s) described herein can be formulated as, can exist as, and is commercially available as, a one-part composition. The term "one-part composition" refers to all chemical components of a composition being present together, such that they are each in intimate and physical contact with one another, and are each present in a single container. Having the composition be commercially available as a one-part composition will be more cost effective (e.g., lower manufacturing costs associated with fewer containers), and will avoid the necessity of the user mixing or combining multiple components together, prior to using.

[0120] In specific embodiments, the cleaning solution(s) described herein can be essentially free of buffer. In further specific embodiments, the cleaning solution(s) described herein can include less than about 0.1 wt. % buffer. The term "buffer," "buffering agent," or "buffering substance" refers to a weak acid or base used to maintain the acidity (pH) of a solution at a chosen value. The function of a buffering agent is to prevent a rapid change in pH when acids or bases are added to the solution. Buffering agents have variable properties— some are more soluble than others; some are acidic while others are basic.

[0121] In specific embodiments, the cleaning solution(s) described herein can be essentially free of transition metals. In further specific embodiments, the cleaning solution(s) described herein can include less than about 0.001 wt. % transition metals. In further specific embodiments, the cleaning solution(s) described herein can include less than about 0.0001 wt. % transition metals. In further specific embodiments, the cleaning solution(s) described herein can include less than about 0.00001 wt. % transition metals. Having the composition include a minimal amount of transition metals decreases the likelihood that the transition metals will cause degradation and/or decomposition of the composition, over the extended periods of time associates with the manufacturing, shipping, and storage of the composition. This is especially so when the composition is formulated as a concentrated, one-part composition.

[0122] The term "transition metal," "transition metals" or "transition element" refers to an element whose atom has an incomplete d sub-shell, or which can give rise to cations with an incomplete d sub-shell. Transition metals include scandium (Sc), titanium (Ti), vanadium (V), chromium (Cr), manganese (Mn), iron (Fe), cobalt (Co), nickel (Ni), copper (Cu), zinc (Zn), yttrium (Y), zirconium (Zr), niobium (Nb), molybdenum (Mo), technetium (Tc), ruthenium (Ru), rhodium (Rh), palladium (Pd), silver (Ag), cadmium (Cd), hafnium (Hf), tantalum (Ta), tungsten (W), rhenium (Re), osmium (Os), iridium (Ir), platinum (Pt), gold (Au), mercury (Hg), mtherfordium (Rf), dubnium (Db), seaborgium (Sg), bohrium (Bh), hassium (Hs) and copemicium (Cn).

[0123] In specific embodiments described herein, the transition metal can be naturally occurring. Naturally occurring transition metals include scandium (Sc), titanium (Ti), vanadium

(V), chromium (Cr), manganese (Mn), iron (Fe), cobalt (Co), nickel (Ni), copper (Cu), zinc (Zn), yttrium (Y), zirconium (Zr), niobium (Nb), molybdenum (Mo), technetium (Tc), ruthenium (Ru), rhodium (Rh), palladium (Pd), silver (Ag), cadmium (Cd), hafnium (Hf), tantalum (Ta), tungsten

(W), rhenium (Re), osmium (Os), iridium (Ir), platinum (Pt), gold (Au), and mercury (Hg).

[0124] In specific embodiments, the cleaning solution(s) described herein can be essentially free of heavy metals. In further specific embodiments, the cleaning solution(s) described herein can include less than about 0.001 wt. % heavy metals. In further specific embodiments, the cleaning solution(s) described herein can include less than about 0.0001 wt. % heavy metals. In further specific embodiments, the cleaning solution(s) described herein can include less than about 0.00001 wt. % heavy metals. Having the composition include a minimal amount of heavy metals decreases the likelihood that the transition metals will cause degradation and/or decomposition of the composition, over the extended periods of time associates with the manufacturing, shipping, and storage of the composition. This is especially so when the composition is formulated as a concentrated, one-part composition. [0125] The term "heavy metal," "heavy metals" or "toxic metal" refers to metals that are relatively toxic, and mainly include the transition metals, some metalloids, lanthanides, and actinides. Examples of toxic metals include, e.g., iron (Fe), cobalt (Co), copper (Cu), manganese (Mn), molybdenum (Mo), zinc (Zn), mercury (Hg), plutonium (Pu), lead (Pb), vanadium (V), tungsten (W), cadmium (Cd), aluminium (Al), beryllium (Be), and arsenic (As).

[0126] The present embodiments also provide for kits that includes: (a) an enclosed container that includes a removable closure; (b) the cleaning solution(s) described herein as described herein, which is located inside the enclosed container; (c) delivery system(s), (d) optional peristaltic pump(s), (e) optional porous filter(s) and (f) printed indicia located on the enclosed container.

[0127] In specific embodiments, the enclosed container can be opaque. In additional specific embodiments, the enclosed container can be manufactured from high density polyethylene (HDPE), thereby providing the requisite opacity. Having the enclosed container be manufactured from high density polyethylene (HDPE) will decrease the likelihood that the composition will degrade and/or decompose over extended periods of time, due to excessive exposure to direct sunlight.

[0128] The term "high-density polyethylene" or "HDPE" refers to a polyethylene thermoplastic made from petroleum. The mass density of high-density polyethylene can range from 0.93 to 0.97 g/cm3. Although the density of HDPE is only marginally higher than that of low-density polyethylene, HDPE has little branching, giving it stronger intermolecular forces and tensile strength than LDPE. The difference in strength exceeds the difference in density, giving HDPE a higher specific strength. It is also harder and more opaque and can withstand somewhat higher temperatures (120°C/248°F for short periods, 110°C./230°F continuously). HDPE is resistant to many different solvents.

[0129] The term "solvent" as used herein refers to a liquid that can dissolve a solid, liquid, or gas. Non-limiting examples of solvents are silicones, organic compounds, water, alcohols, ionic liquids, and supercritical fluids.

[0130] The term "opaque" refers to an object that is neither transparent (allowing all light to pass through) nor translucent (allowing some light to pass through). When light strikes an interface between two substances, in general some may be reflected, some absorbed, some scattered, and the rest transmitted (also see refraction). Reflection can be diffuse, for example light reflecting off a white wall, or specular, for example light reflecting off a mirror. An opaque substance transmits no light, and therefore reflects, scatters, or absorbs ah of it. Both mirrors and carbon black are opaque. Opacity depends on the frequency of the light being considered. For instance, some kinds of glass, while transparent in the visual range, are largely opaque to ultraviolet light. More extreme frequency-dependence is visible in the absorption lines of cold gases.

[0131] To further decrease the likelihood that the composition will degrade and/or decompose over extended periods of time, the composition should avoid, when feasible: excessive exposure to direct sunlight, excessive heat and/or elevated temperatures. As such, in specific embodiments, the enclosed container of the kit can include printed indicia, with instructions to avoid excessive heat, elevated temperatures, direct sunlight, or a combination thereof.

[0132] Over extended periods of time, hydrogen peroxide and/or peracetic acid present in the composition will be susceptible to degrade or decompose (and a portion of the hydrogen peroxide may degrade or decompose), thereby evolving oxygen.

[0133] In specific embodiments, the enclosed container includes a head space, pressure valve, or combination thereof. In specific embodiments, the enclosed container includes a pressure valve, configured to release excessive gas from within the enclosed container. The presence of a head space and pressure valve in the container will allow for the escape of gas (e.g., oxygen) from the enclosed container, without the likelihood that the container will explode from the elevated pressure that would otherwise develop.

[0134] The term "head space" refers to a portion of the inside of a container that is not occupied by the liquid contents of the container. In particular, when a container includes a liquid composition, a head space can be present in the container such that a portion of the inside of the container does not include liquid composition, but instead includes a gas or vacuum. In specific embodiments, the head space can include oxygen (O2), peracetic acid and/or acetic acid vapor. In further specific embodiments, the head space can be present in up to about 20% (v/v) of the inside of the enclosed container.

[0135] The term "pressure valve" refers to a mechanical device that will permit for the passage of gas and not fluid, preferably in one direction only, for example, exiting a container housing the pressure valve, and not entering the container. [0136] The cleaning solution(s) described herein can be used to effectively reduce the number of microbes located upon a substrate. In specific embodiments, the composition can effectively kill and/or inhibit a microorganism (e.g., vims, fungus, mold, slime mold, algae, yeast, mushroom and/or bacterium), thereby disinfecting the substrate.

[0137] In additional specific embodiments, the composition can effectively sanitize a substrate, thereby simultaneously cleaning and disinfecting the substrate. In additional specific embodiments, the composition can effectively kill or inhibit all forms of life, not just microorganisms, thereby acting as a biocide.

[0138] In specific embodiments, the composition can effectively disinfectant a substrate.

In further specific embodiments, the composition can effectively disinfectant the surface of a substrate. In additional specific embodiments, the composition can effectively sterilize a substrate. In further specific embodiments, the composition can effectively sterilize the surface of a substrate.

[0139] The term "microbe," "microbes" "microorganism," or "micro-organism" refers to a microscopic organism that comprises either a single cell (unicellular), cell clusters, or no cell at all (acellular). Microorganisms are very diverse; they include bacteria, fungi, archaea, and protists; microscopic plants (green algae); and animals such as plankton and the planarian. Some microbiologists also include viruses, but others consider these as non-living. Most microorganisms are unicellular (single-celled), but this is not universal, since some multicellular organisms are microscopic, while some unicellular protists and bacteria, like Thiomargarita namibiensis, are macroscopic and visible to the naked eye.

[0140] The term "vims" refers to a small infectious agent that can replicate only inside the living cells of organisms. Virus particles (known as virions) consist of two or three parts: the genetic material made from either DNA or RNA, long molecules that carry genetic information; a protein coat that protects these genes; and in some cases an envelope of lipids that surrounds the protein coat when they are outside a cell. The shapes of viruses range from simple helical and icosahedral forms to more complex structures. The average virus is about one one-hundredth the size of the average bacterium. An enormous variety of genomic structures can be seen among viral species; as a group they contain more structural genomic diversity than plants, animals, archaea, or bacteria. There are millions of different types of viruses, although only about 5,000 of them have been described in detail. A virus has either DNA or RNA genes and is called a DNA virus or a RNA virus respectively. The vast majority of viruses have RNA genomes. Plant viruses tend to have single- stranded RNA genomes and bacteriophages tend to have double- stranded DNA genomes.

[0141] The term "fungi" or "fungus" refers to a large and diverse group of eucaryotic microorganisms whose cells contain a nucleus, vacuoles, and mitochondria. Fungi include algae, molds, yeasts, mushrooms, and slime molds. See, Biology of Microorganisms, T. Brock and M. Madigan, 6th Ed., 1991, Prentice Hill (Englewood Cliffs, N.J.). Exemplary fungi include Ascomycetes (e.g., Neurospora, Saccharomyces, Morchella), Basidiomycetes (e.g., Amanita, Agaricus), Zygomycetes (e.g., Mucor, Rhizopus), Oomycetes (e.g., Allomyces), and Deuteromycetes (e.g., Penicillium, Aspergillus).

[0142] The term "mold" refers to a filamentous fungus, generally a circular colony that may be cottony, wooly, etc. or glabrous, but with filaments not organized into large fruiting bodies, such as mushrooms. See, e.g., Stedman's Medical Dictionary, 25th Ed., Williams & Wilkins, 1990 (Baltimore, Md.). One exemplary mold is the Basidiomycetes called wood-rotting fungi. Two types of wood-rotting fungi are the white rot and the brown rot. An ecological activity of many fungi, especially members of the Basidiomycetes is the decomposition of wood, paper, cloth, and other products derived from natural sources. Basidiomycetes that attack these products are able to utilize cellulose or lignin as carbon and energy sources. Lignin is a complex polymer in which the building blocks are phenolic compounds. It is an important constituent of woody plants. The decomposition of lignin in nature occurs almost exclusively through the agency of these wood-rotting fungi. Brown rot attacks and decomposes the cellulose and the lignin is left unchanged. White rot attacks and decomposes both cellulose and lignin. See, Biology of Microorganisms, T. Brock and M. Madigan, 6th Ed., 1991, Prentice Hill (Englewood Cliffs, N.J.).

[0143] The term "slime molds" refers to nonphototrophic eucaryotic microorganisms that have some similarity to both fungi and protozoa. The slime molds can be divided into two groups, the cellular slime molds, whose vegetative forms are composed of single amoeba like cells, and the acellular slime molds, whose vegative forms are naked masses of protoplasms of indefinite size and shape called plasmodia. Slime molds live primarily on decaying plant matter, such as wood, paper, and cloth. See, Biology of Microorganisms, T. Brock and M. Madigan, 6th Ed., 1991, Prentice Hill (Englewood Cliffs, N.J.). [0144] The term "algae" refers to a large and diverse assemblage of eucaryotic organisms that contain chlorophyll and carry out oxygenic photosynthesis. See, Biology of Microorganisms, T. Brock and M. Madigan, 6th Ed., 1991, Prentice Hill (Englewood Cliffs, N.J.). Exemplary algae include Green Algae (e.g., Chlamydomonas), Euglenids (e.g., Euglena), Golden Brown Algae (e.g., Navicula), Brown Algae (e.g., Laminaria), Dinoflagellates (e.g., Gonyaulax), and Red Algae (e.g., Polisiphonia).

[0145] The term "yeast" refers to unicellular fungi, most of which are classified with the

Ascomytes. See, Biology of Microorganisms, T. Brock and M. Madigan, 6th Ed., 1991, Prentice Hill (Englewood Cliffs, N.J.).

[0146] The term "mushrooms" refer to filamentous fungi that are typically from large structures called fruiting bodies, the edible part of the mushroom. See, Biology of Microorganisms, T. Brock and M. Madigan, 6th Ed., 1991, Prentice Hill (Englewood Cliffs,

N.J.).

[0147] The term "bacterium" or "bacteria" refers to a large domain of prokaryotic microorganisms. Typically a few micrometers in length, bacteria have a wide range of shapes, ranging from spheres to rods and spirals. Bacteria are present in most habitats on Earth, growing in soil, acidic hot springs, radioactive waste, water, and deep in the Earth's crust, as well as in organic matter and the live bodies of plants and animals, providing outstanding examples of mutualism in the digestive tracts of humans, termites and cockroaches. There are typically about 40 million bacterial cells in a gram of soil and a million bacterial cells in a milliliter of fresh water; in all, there are approximately five nonillion (5 x 10 ³⁰ ) bacteria on Earth, forming a biomass that exceeds that of all plants and animals. Most bacteria have not been characterized, and only about half of the phyla of bacteria have species that can be grown in the laboratory.

[0148] The term "P. aeruginosa" or "Pseudomonas aeruginosa" refers to a common bacterium that can cause disease in animals, including humans. It is found in soil, water, skin flora, and most man-made environments throughout the world. It thrives not only in normal atmospheres, but also in hypoxic atmospheres, and has, thus, colonized many natural and artificial environments. It uses a wide range of organic material for food; in animals, the versatility enables the organism to infect damaged tissues or those with reduced immunity. The symptoms of such infections are generalized inflammation and sepsis. If such colonizations occur in critical body organs, such as the lungs, the urinary tract, and kidneys, the results can be fatal. Because it thrives on most surfaces, this bacterium is also found on and in medical equipment, including catheters, causing cross-infections in hospitals and clinics. It is implicated in hot-tub rash.

[0149] The term "S. aureus" or "Staphylococcus aureus" refers to a facultative anaerobic

Gram-positive bacterium. It is frequently found as part of the normal skin flora on the skin and nasal passages. It is estimated that 20% of the human population are long-term carriers of S. aureus. S. aureus is the most common species of staphylococci to cause Staph infections. The reasons S. aureus is a successful pathogen are a combination host and bacterial immuno-evasive strategies. One of these strategies is the production of carotenoid pigment staphyloxanthin which is responsible for the characteristic golden color of S. aureus colonies. This pigment acts as a virulence factor, primarily being a bacterial antioxidant which helps the microbe evade the host’s immune system in the form of reactive oxygen species which the host uses to kill pathogens.

[0150] S. aureus can cause a range of illnesses from minor skin infections, such as pimples, impetigo, boils (furuncles), cellulitis folliculitis, carbuncles, scalded skin syndrome, and abscesses, to life-threatening diseases such as pneumonia, meningitis, osteomyelitis, endocarditis, toxic shock syndrome (TSS), bacteremia, and sepsis. Its incidence is from skin, soft tissue, respiratory, bone, joint, endovascular to wound infections. It is still one of the five most common causes of nosocomial infections, often causing postsurgical wound infections. Each year, some 500,000 patients in American hospitals contract a staphylococcal infection.

[0151] Methicillin-resistant S. aureus, abbreviated MRS A and often pronounced "mer- sa" (in North America), is one of a number of greatly-feared strains of S. aureus which have become resistant to most antibiotics. MRSA strains are most often found associated with institutions such as hospitals, but are becoming increasingly prevalent in community-acquired infections.

[0152] The term "E. hirae" or "Enterococcus hirae" refers to a species of Enterococcus.

[0153] The term "M. terrae" or "Mycobacterium terrae" refers to a slow-growing species of Mycobacterium. It is an ungrouped member of the third Runyon (nonchromatogenic mycobacteria). It is known to cause serious skin infections, which are relatively resistant to antibiotic therapy [0154] The term "Mycobacterium avium complex," "M. avium complex" or "MAC" refers to a group of genetically related bacteria belonging to the genus Mycobacterium. It includes Mycobacterium avium and Mycobacterium intracellulare.

[0155] The term "M. avium" or "mycobacterium avium" refers to a species of

Mycobacterium.

[0156] The term "M. intracellulare" or "mycobacterium intracellulare" refers to a species of Mycobacterium.

[0157] The term“peristaltic pump” is known in the art and refers to a type of a positive displacement pump used for pumping a variety of fluids. In general,“peristaltic pump" refers to a pump that operates by compression of a flexible conduit or tube through which the fluid to be pumped passes. Peristaltic pumps are also referred to as roller pumps. The fluid is contained within a flexible tube fitted inside a circular pump casing (though linear peristaltic pumps have been made). A rotor with a number of "rollers", "shoes", "wipers", or "lobes" attached to the external circumference of the rotor compresses the flexible tube. As the rotor turns, the part of the tube under compression is pinched closed (or "occludes") thus forcing the fluid to be pumped to move through the tube. Additionally, as the tube opens to its natural state after the passing of the cam ("restitution" or "resilience") fluid flow is induced to the pump. This process is called peristalsis and is used in many biological systems such as the gastrointestinal tract. Typically, there will be two or more rollers, or wipers, occluding the tube, trapping between them a body of fluid. The body of fluid is then transported, at ambient pressure, toward the pump outlet. Peristaltic pumps may run continuously, or they may be indexed through partial revolutions to deliver smaller amounts of fluid.

[0158] The peristaltic pump may have multiple“heads”, wherein the“head” refers the circular pump with the rotor with a number of "rollers", "shoes", "wipers", or "lobes" attached to the external circumference of the rotor that compresses the flexible tube.

[0159] The tubing, a delivery system, is generally elastomeric to maintain the circular cross section after millions of cycles of squeezing in the pump. Suitable elastomers for pump tubing are nitrile (NBR), Hypalon, Viton, silicone, PVC, EPDM, EPDM+polypropylene (as in Santoprene), polyurethane and natural rubber. Of these materials, natural rubber has the best fatigue resistance, and EPDM and Hypalon have the best chemical compatibility. Silicone is popular with water-based fluids, such as in the bio-pharma industry. [0160] Extruded fluoropolymer tubes such as FKM (Viton, Fluorel, etc.) have good compatibility with acids, hydrocarbons, and petroleum fuels.

[0161] There are a couple of newer tubing developments that offer a broad chemical compatibility using lined tubing and fluoroelastomers.

[0162] It should be understood that the delivery system in certain embodiments can be a conduit capable of containing and conveying a gas or a fluid from one point to another, a proximal point to a distal point, without significant or no loss of the fluid, gas or pressure across the delivery systems length. Suitable delivery systems include, for example, flexible tubing, hose, piping, etc. depending upon the configuration of the cleaning device.

[0163] Unless defined otherwise, all technical and scientific terms used herein have the same meanings as commonly understood by one of ordinary skill in the art to which this invention belongs. All publications and patents specifically mentioned herein are incorporated by reference in their entirety for all purposes including describing and disclosing the chemicals, instruments, statistical analyses and methodologies which are reported in the publications which might be used in connection with the invention. All references cited in this specification are to be taken as indicative of the level of skill in the art. Nothing herein is to be construed as an admission that the invention is not entitled to antedate such disclosure by virtue of prior invention.

[0164] The following paragraphs enumerated consecutively from 1 through 12 provide for various aspects of the present embodiments. In one embodiment, in a first paragraph (1), the present embodiments provide a process to clean a lumen comprising the steps:

[0165] providing a cleaning solution in a first delivery means; and

[0166] providing a gas in a second delivery means, wherein the first and second delivery means are connected to a third delivery means that causes the cleaning solution and gas to combine to provide a turbulent cleaning solution that is passed through a lumen of a medical device.

[0167] 2. The process of paragraph 1, wherein each delivery means is a flexible tube.

[0168] 3. The process of either paragraph 1 or 2, wherein the cleaning solution is an aqueous cleaning solution. [0169] 4. The process of either paragraph 1 or 2, wherein the cleaning solution is an aqueous cleaning solution with a surfactant.

[0170] 5. The process of either paragraph 1 or 2, wherein the cleaning solution is an aqueous cleaning solution with acetic acid, peracetic acid and hydrogen peroxide.

[0171] 6. The process of any of paragraphs 1 through 5, wherein the first delivery means is connected to a first peristaltic pump and the second delivery means is connected to a second peristaltic pump.

[0172] 7. The process of any of paragraphs 1 through 5, wherein the first delivery means and second delivery means are connected to a peristaltic pump with two peristaltic pump mechanisms.

[0173] 8. The process of either paragraph 6 or 7, wherein the third delivery means is connected to the first and second delivery means wherein the cleaning solution and gas are combined to provide the turbulent cleaning solution.

[0174] 9. The process of any of paragraphs 1 through 8, wherein the cleaning solution is delivered at a rate of from about 100 ml/minute to about 1100 ml/minute.

[0175] 10. The process of any of paragraphs 1 through 8, wherein the gas is delivered at a rate of from about 20 ml/minute to about 400 ml/minute.

[0176] 11. The process of any of paragraphs 1 through 8, wherein the turbulent cleaning solution is delivered to the lumen at a rate of from about 100 ml/minute to about 1100 ml/minute.

[0177] 12. The process of any of paragraph 1 through 11, wherein the lumen is associated with an endoscope.

[0178] The following paragraphs enumerated consecutively from 1 through 34 provide for additional aspects of the present embodiments. In one embodiment, in a first paragraph (1), the present embodiments provide a process to clean a lumen comprising the steps:

[0179] providing a cleaning solution in a first delivery system; and

[0180] providing a gas in a second delivery system, wherein the first and second delivery systems are connected to a third delivery system, wherein the cleaning solution and gas to combine to provide a turbulent cleaning solution, wherein the third delivery system is connected to a proximal end of a lumen wherein the turbulent cleaning solution passes through the lumen to the distal end of the lumen. [0181] 2. The process of paragraph 1, wherein each delivery system is a flexible tube.

[0182] 3. The process of either paragraph 1 or 2, wherein the cleaning solution is an aqueous cleaning solution.

[0183] 4. The process of either paragraph 1 or 2, wherein the cleaning solution is an aqueous cleaning solution with a surfactant.

[0184] 5. The process of either paragraph 1 or 2, wherein the cleaning solution is an aqueous cleaning solution with acetic acid, peracetic acid and hydrogen peroxide.

[0185] 6. The process of any of paragraphs 1 through 5, wherein the first delivery system is connected to a first peristaltic pump and the second delivery system is connected to a second peristaltic pump.

[0186] 7. The process of any of paragraphs 1 through 5, wherein the first delivery system and second delivery system are connected to a peristaltic pump with two peristaltic pump mechanisms.

[0187] 8. The process of either paragraph 6 or 7, wherein the third delivery system is connected to the first and second delivery system wherein the cleaning solution and gas are combined to provide the turbulent cleaning solution.

[0188] 9. The process of any of paragraphs 1 through 8, wherein the cleaning solution is delivered at a rate of from about 100 ml/minute to about 1100 ml/minute.

[0189] 10. The process of any of paragraphs 1 through 8, wherein the gas is delivered at a rate of from about 20 ml/minute to about 400 ml/minute.

[0190] 11. The process of any of paragraphs 1 through 8, wherein the turbulent cleaning solution is delivered to the lumen at a rate of from about 100 ml/minute to about 1100 ml/minute.

[0191] 12. The process of any of paragraphs 1 through 11, wherein the lumen is associated with an endoscope.

[0192] 13. A process to clean a lumen comprising the steps:

[0193] providing a cleaning solution in a delivery system, wherein the delivery system comprises a proximal portion and a distal portion, wherein the proximal portion of the delivery system or proximal portion of a porous filter accepts the cleaning solution; and [0194] providing the porous filter, wherein the porous filter has a proximal portion and a distal portion, wherein the distal portion of the porous filter is connected to or inserted into a portion of the delivery system, wherein as the cleaning solution passes through the delivery system, gas is aspirated into the cleaning solution via the porous filter to provide a turbulent cleaning solution, wherein the turbulent cleaning solution is passed through the lumen to the distal end of the lumen.

[0195] 14. The process of paragraph 13, wherein the porous filter is partially submerged in the cleaning solution in a delivery vessel that contains the cleaning solution.

[0196] 15. The process of either paragraph 13 or 14, wherein the distal portion of the lumen is connected to a vacuum system to draw the turbulent cleaning solution and gas through the lumen.

[0197] 16. The process of any of paragraphs 13 through 15, wherein the delivery system is a flexible tube.

[0198] 17. The process of any of paragraphs 13 through 16, wherein the cleaning solution is an aqueous cleaning solution.

[0199] 18. The process of any of paragraphs 13 through 16, wherein the cleaning solution is an aqueous cleaning solution with a surfactant.

[0200] 19. The process of any of paragraphs 13 through 16, wherein the cleaning solution is an aqueous cleaning solution with acetic acid, peracetic acid and hydrogen peroxide.

[0201] 20. The process of any of paragraphs 13 through 19, wherein the delivery system is connected to a peristaltic pump.

[0202] 21. The process of any of paragraphs 13 through 20, wherein the turbulent cleaning solution is delivered to the lumen at a rate of from about 100 ml/minute to about 1100 ml/minute.

[0203] 22. The process of any of paragraphs 13 through 21, wherein the lumen is associated with an endoscope.

[0204] 23. A process to clean a lumen comprising the steps:

[0205] providing a cleaning solution;

[0206] providing an aerator with a proximal portion and a distal portion;

[0207] providing a delivery system with a proximal portion and a distal portion, wherein the distal portion of the aerator is connected to the proximal portion of the delivery system; and [0208] a lumen with a proximal portion and a distal portion, wherein the proximal portion of the lumen is connected to the distal portion of the delivery system, wherein pouring of the cleaning solution into the proximal portion of the aerator through the aerator provides a turbulent cleaning solution which passes through the delivery system and through the distal portion of lumen.

[0209] 24. The process of paragraph 23, wherein the aerator comprises a screen, mesh, or filter with micron sized holes.

[0210] 25. The process of paragraph 24, wherein the aerator is in the form of a container, cup or crucible comprising the screen, mesh or filter.

[0211] 26. The process of paragraph 25, wherein the aerator is formed from ceramic, metal, plastic or glass.

[0212] 27. The process of any of paragraphs 23 through 26, wherein the distal portion of the lumen is connected to a vacuum system to draw the turbulent cleaning solution and gas through the lumen.

[0213] 28. The process of any of paragraphs 23 through 27, wherein the delivery system is a flexible tube.

[0214] 29. The process of any of paragraphs 23 through 28, wherein the cleaning solution is an aqueous cleaning solution.

[0215] 30. The process of any of paragraphs 23 through 28, wherein the cleaning solution is an aqueous cleaning solution with a surfactant.

[0216] 31. The process of any of paragraphs 23 through 28, wherein the cleaning solution is an aqueous cleaning solution with acetic acid, peracetic acid and hydrogen peroxide.

[0217] 32. The process of any of paragraphs 23 through 26 and 28 through 31, wherein the delivery system is connected to a peristaltic pump.

[0218] 33. The process of any of paragraphs 23 through 32, wherein the turbulent cleaning solution is delivered to the lumen at a rate of from about 100 ml/minute to about 1100 ml/minute.

[0219] 34. The process of any of paragraphs 23 through 33, wherein the lumen is associated with an endoscope.

[0220] The embodiments will be further described with reference to the following non limiting Examples. It will be apparent to those skilled in the art that many changes can be made in the embodiments described without departing from the scope of the present invention. Thus the scope of the present invention should not be limited to the embodiments described in this application, but only by embodiments described by the language of the paragraphs and the equivalents of those embodiments. Unless otherwise indicated, all percentages are by weight.

[0221] Examples

[0222] The cleaning solutions described throughout can be flushed through a medical device, such as an endoscope via one or more lumens. In one aspect, a first delivery system, such as flexible tubing, is in contact with a container of cleaning solution. The first delivery system, e.g., the flexible tube, is in contact with a head of a peristaltic pump. The first delivery system has a proximal portion and a distal portion. The proximal portion is in contact with the cleaning solution. The cleaning solution passes through the delivery system to the distal portion via pressure produced by a system, such as a peristaltic pump and/or can be delivered as a pressurized liquid.

[0223] A second delivery system, such as a flexible tube, is either open to the atmosphere and/or can be pressurized and attached to a source for a gas, such as oxygen, nitrogen, helium, argon, etc. The second delivery system has a proximal portion and a distal portion.

[0224] The second delivery system, such as the second flexible tube, is in contact with a head of a second peristaltic pump (or a peristaltic pump with multiple heads).

[0225] The first and second delivery systems are then connected to a third delivery system, e.g., a flexible tube (or the two tubes are constructed in a“Y” so that there is a branch point), so that the cleaning solution and the gas, which is now pressurized by the peristaltic motion and/or by the pressurized gas, are combined. The third delivery system also has a proximal portion and a distal portion. In one configuration, the distal portion of the first delivery system is connected to a proximal portion of the third delivery system and a distal portion of the second delivery system is connected to a proximal portion of the third delivery system.

[0226] The distal portion of the third delivery system is in contact with a proximal portion of a medical device. In one embodiment, the medical device includes one or more lumen that are connected to the distal portion of the third delivery system.

[0227] In the event that the delivery system does not completely cover the proximal or distal portions of the first, second, or third delivery systems and/or the lumen, an adapter can be placed appropriately so that a snug connection can be maintained between the delivery systems and the surface to be treated with the turbulent solution. The adapter would fit within or about (e.g., around, such as an O-ring) the portions of the delivery systems and/or the proximal portion of the medical device, e.g., lumen.

[0228] Alternatively, proximal and distal portions of the delivery systems and/or lumen can be connected via quick connects, male/female connections or can be threaded to connect to each other.

[0229] The term“connect” should be understood so that the delivery systems and the medical device lumen can be releasably attached and reattached as desired. The connection should ensure that there is not a significant loss of fluid, gas or pressure between the various components that make up the cleaning system

[0230] When the peristaltic pump (or pumps) are in operation, the cleaning solution and gas are combined to provide a turbulent solution.

[0231] In another embodiment, a process to clean a lumen comprises the steps:

[0232] providing a cleaning solution in a delivery system, wherein the delivery system comprises a proximal portion and a distal portion, wherein the proximal portion of the delivery system or a porous filter accepts the cleaning solution; and

[0233] the porous filter, wherein the porous filter has a proximal portion and a distal portion. The distal portion of the porous filter is connected to or inserted into a portion of the delivery system. As the cleaning solution passes through the delivery system, gas is aspirated into the cleaning solution via the porous filter to provide a turbulent cleaning solution. The turbulent cleaning solution is passed through the lumen to the distal end of the lumen.

[0234] In one embodiment, the porous filter can be partially submerged in the cleaning solution in a delivery vessel that contains the cleaning solution.

[0235] In another embodiment, the distal portion of the lumen is connected to a vacuum system to draw the turbulent cleaning solution and gas through the lumen.

[0236] In still another embodiment, the delivery system is connected to a peristaltic pump. The action of the peristaltic pump helps to draw the cleaning solution and gas through the delivery system and lumen while participating in forming the turbulent cleaning solution.

[0237] In still yet another embodiment, the turbulent cleaning solution is delivered to the lumen at a rate of from about 100 ml/minute to about 1100 ml/minute. [0238] In another embodiment, a process to clean a lumen comprises the steps:

[0239] providing a cleaning solution;

[0240] providing an aerator with a proximal portion and a distal portion;

[0241] providing a delivery system with a proximal portion and a distal portion, wherein the distal portion of the aerator is connected to the proximal portion of the delivery system; and

[0242] a lumen with a proximal portion and a distal portion, wherein the proximal portion of the lumen is connected to the distal portion of the delivery system, wherein pouring of the cleaning solution into the proximal portion of the aerator through the aerator provides a turbulent cleaning solution which passes through the delivery system and through the distal portion of lumen.

[0243] In one embodiment, the aerator comprises a screen, mesh, or filter with micron or

“mesh” sized holes.

[0244] The term aerator includes devices that mix air into a fluid as it flows through or over a mesh, screen or filter material with micron sized holes, increasing exposure to oxygen and causing aeration of the fluid. The aerator can be in the form of, for example but not limited to, a container, cup or crucible comprising the screen, mesh or filter with micron sized holes (e.g., a sintered metal filter) which is usually located at the bottom of the container, cup, or crucible. The aerator can be formed from ceramic, metal, plastic or glass.

[0245] Suitable mesh sizing includes mesh sizes of from about 16 mesh to about 200 mesh.

[0246] Suitable micron sized holes in a porous filter include porosity sizing of 0.1 microns to about 1000 microns.

[0247] In another embodiment, the distal portion of the lumen is connected to a vacuum system to draw the turbulent cleaning solution and gas through the lumen.

[0248] In still another embodiment, the delivery system is connected to a peristaltic pump. The action of the peristaltic pump helps to draw the cleaning solution and gas through the delivery system and lumen while participating in forming the turbulent cleaning solution.

[0249] In still yet another embodiment, the turbulent cleaning solution is delivered to the lumen at a rate of from about 100 ml/minute to about 1100 ml/minute. Typically, the cleaning solution is passed through a first delivery system at a rate of about 100 mL/minute to about 1100 mL/minute, for example, from about 150 mL/minute to about 1000 mL/minute, from about 200 mL/minute to about 800 mL/minute, from about 300 mL/minute to about 700 mL/minute, from about 500 mL/minute to about 750 mL/minute or from about 600 mL/minute to about 700 mL/minute.

[0250] In particular embodiments, the gas is delivered via a second delivery system, if present, at a rate of about 20 mL/minute to about 400 mL/minute, for example, from about 40 mL/minute to about 300 mL/minute, from about 75 mL/minute to about 250 mL/minute, from about 100 mL/minute to about 200 mL/minute or from about 150 mL/minute to about 175 mL/minute.

[0251] The resultant turbulent solution is passed through the one or more lumens of the medical device to remove unwanted contaminants from the surfaces of the device.

[0252] The process can be run from about 1 minute to about 5 minutes, more particularly from about 2 minutes to about 3 minutes, depending upon the diameter(s) of the lumen.

[0253] Although the present invention has been described with reference to preferred embodiments, persons skilled in the art will recognize that changes may be made in form and detail without departing from the spirit and scope of the invention. All references cited throughout the specification, including those in the background, are incorporated herein in their entirety. Those skilled in the art will recognize, or be able to ascertain, using no more than routine experimentation, many equivalents to specific embodiments of the invention described specifically herein. Such equivalents are intended to be encompassed in the scope of the following paragraphs.