DE10030946A1 - Cleaning and disinfection systems for medical instruments - Google Patents

Abstract

Cleaning and disinfecting system for medical instruments, characterized in that it comprises at least one nonionic surfactant and at least one amino acid and / or an amino acid derivative and at least one disinfecting agent.

Description

The present invention relates to liquid cleaning and disinfection systems with egg content of surfactants, anti-corrosion agents and other additives that Reini strengthening and their use for cleaning and simultaneous or after following disinfection of medical instruments, especially for cleaning and simultaneous or subsequent disinfection of flexible endoscopes.

Disinfectants are substances that are used for disinfection, i.e. H. for loading control of pathogenic microorganisms (e.g. bacteria, viruses, spores, small and Mold) are suitable, generally by application to the upper surface of skin, clothing, equipment, rooms, but also of drinking water, food seeds, seed (dressing) and as a soil disinfectant.

Disinfectants to be used especially locally, e.g. B. for wound disinfection, who also known as antiseptics.

Disinfectants are defined as substances or mixtures of substances used by users on objects or surfaces put them into a state that they cannot cause an infection. Their effects must be bactericidal, fungicidal, and virucidal be sporizid (collective term: microbicidal). An effect in the sense of bacteriostasis is for Disinfectant insufficient. They are therefore generally pantoxic, i.e. H. she develop their effect against all living cells.

Depending on the intended use, the disinfectants are divided into those for laundry, Surface, instrument, skin and hand as well as for stool and sputum disinfection.  

Disinfectant cleaners are disinfectants that are also known as Cleaning agents and, if necessary, care products act.

Taking into account the diverse demands placed on disinfectants, such as. B. broad spectrum of action, short exposure times, skin compatibility, low toxicity, material compatibility, etc., only a few types of active substance are suitable for use:

• 1. The most important group of active ingredients are the aldehydes (formaldehyde, glyoxal, glutaralde hyd). They have a wide spectrum of activity including virus effectiveness and sporicidal effect with formaldehyde and glutaraldehyde.
• 2. Phenol derivatives have good bactericidal activity, but are not sporicidal. Ge They have the advantage over almost all other disinfectant agents through Dirt to be affected relatively little. They are therefore particularly suitable for Chair disinfection. Typical representatives are 2-biphenylol and p-chloro-m-cresol (4-chloro-3- methylphenol).
• 3. Alcohols are characterized by their rapid effectiveness, but only when they are relative high concentrations of approx. 40-80%.
• 4. The quaternary ammonium compounds, cationic surfactants (invert soaps) and am photenside belong to the class of surfactants. They are characterized by very good skin and material compatibility as well as odor neutrality. However, their spectrum of activity is only limited. This subheading includes: B. benzalkonium chloride, cetrimonium bromide, cetylpyridinium chloride (hexadecylpyridinium chloride) and others.
  Quaternary ammonium compounds are organic ammonium compounds with quaternary nitrogen atoms. Quaternary ammonium compounds with a hydrophobic alkyl radical are biocidal; their use is declining for toxicological reasons.
  Quaternary ammonium compounds are obtained by reacting tertiary amines with alkylating agents, such as. B. methyl chloride, benzyl chloride, dimethyl sulfate, dodecyl bromide, but also ethylene oxide. Depending on the tert used. A distinction is made between three groups:
  
  • a) Linear alkyl ammonium compounds
  • b) Imidazolinium compounds
  • c) pyridinium verb. R ¹ = CH ₃ , R ² = C _8-18 , X = halogen.
  The alkylation of tertiary amines with a long alkyl radical and two methyl groups is particularly easy, and the quaternization of tertiary amines with two long radicals and one methyl group can also be carried out using methyl chloride under mild conditions. Amines which have three long alkyl radicals or hydroxy-substituted alkyl radicals are not very reactive and are preferably quatered with dimethyl sulfate.
• 5. Of the halogens, chlorine and iodine have a certain importance as disinfectants onsmittel. Chlorine is used for water treatment and swimming pool disinfection known and therefore its unpleasant properties such as smell and corrosiveness. Despite the excellent activity against bacteria, fungi, spores and viruses chlorine-containing disinfectants in the human field for the reasons mentioned above and because of the strong chlorine consumption by organ. Substances not widely used found. In contrast, hypochlorites, chlorinated lime and chloroisocyanuric acids are considered technical disinfectants are still used extensively. Iodine tincture is used in medicine used as an antiseptic.
• 6. Disinfectants based on active oxygen (e.g. hydrogen peroxide, per oxyacetic acid) have recently gained in importance again.

In addition to the microbicide active ingredients mentioned, there are a number of microbistat. Substances and preservatives (diphenyl ether, carbonilide, acetanilide aromatic  Acids and their salts) for specific use in the market which he broader sense of disinfectants.

A uniform mode of action of the disinfectants cannot be seen. While some preparations are said to have a destructive effect on the cytoplasmic membrane of the bacteria, others irreversibly block important sulfide bonds in enzymes or from trace elements (by chelation).

Endoscopes are tubular or tubular instruments that are used for examination of body cavities and hollow organs. You are with an opti system, consisting of lens and eyepiece, a lighting device and mostly flushing and suction devices as well as channels for inserting special instru elements. Flexible endoscopes (which are also called fiber endoscopes are equipped with a glass fiber light guide, which consists of a tight ge packed bundles of hair-fine and therefore highly flexible individual fibers. By The flexibility of the glass fibers can light and image over practically any Ab be transmitted. In addition to the fiber bundles and the Bowden cables for the movement of the tip are channels for water flushing and air as well as one in the Usually larger biopsy and suction channel housed at the same time.

Endoscopy can be used on its own, for example to take tissue samples, however also in combination with other methods, such as. B. ultrasound diagnostics (Endo sonography) or X-ray diagnostics. Are in use at for example X-ray contrast images of the gallbladder and bile ducts as well of the pancreatic duct system. Here - e.g. B. as part of an endoscopic retro degree cholangiography (ERC) or an endoscopic retrograde cholangiopan Kreatikographie (ERCP) - an X-ray contrast agent under X-ray control in the to investigating duct system introduced.

X-ray contrast media are agents for improving the radiographic presentation of body spaces, hollow organs and vessels. They absorb X-rays either weaker (negative X-ray contrast media) or more strongly (positive X-ray contrast media) than the surrounding body tissue. The radio-opaque (ie radiation-impermeable) positive x-ray contrast media mainly contain elements of high atomic numbers (such as iodine and barium), since their absorption capacity for x-rays is greater. Organic iodine derivatives derived from pyridines or aromatic carboxylic acids are generally used for cholangiography. Examples of this are iodamicamic acid [3,3 '- ( 4 , 7 , 10 , 13 -Tetraoxahexadecandioyldiamino) -bis- (2,4,6-triiodobenzoic acid)] and iotroxinic acid [3,3' - ( 3 , 6 , 9 - Trioxaundecandioyldiamino) bis- (2,4,6-triiodobenzoic acid)].

Most endoscopies take place in microbially populated areas of the body. The Number of endoscopic examinations of the upper and lower gastrointestinal tract and the tracheobronchial system, often associated with invasive surgery, is very high. A transmission of pathogens through contaminated endoscopy itself and with endoscopic accessories has been proven many times.

Especially infections with a long incubation period are very difficult and in the Practice mostly not to be recorded. Furthermore, it must be expected that Patients whose disease is silent or undetected are in contact with endoscopes come. In this context, infections are particularly important Microorganisms that are transmitted through the blood and mucous membranes, such as B. tuberculosis, hepatitis, HIV infections, salmonellosis, Yersinia infections, Dysentery and the like.

A requirement for endoscopy should therefore be the unreserved compliance with all necessary protective measures to prevent infection. However, the Reini was For a long time, the step and disinfection of fiber endoscopes was a stepchild in technological Development. For example, there are problems with residual water and the like bacterial overgrowth, moreover, endoscopes are difficult to dry. Therefore, in advance of an endoscopic examination, not only the transmission has to be done from microorganisms that come from patients, but it should also a special focus on pathogens from rinsing water or stagnie water.

The prior art knows liquid disinfectant cleaners for cleaning and disinfecting flexible endoscopes, which, in addition to surfactants and disinfectants, essentially contain organic solvents, acids or alkalis, and in some cases also enzymes. However, the compounds mentioned have some disadvantages:
Solvents, acids and alkalis are suitable for cleaning in principle, but they have the disadvantage that they are too aggressive for the sensitive material and can damage the endoscopes accordingly.

The liquid disinfectant cleaners of the prior art are being removed of blood and secretions as well as in the removal of fat and other hydrocarbons Compounds containing compounds are relatively effective. However, they are not suitable to Completely remove residual X-ray contrast media.

Even the smallest amount of X-ray contrast medium left behind closes bacteria in the endoscope channels, which are no longer with the usual disinfectants can be completely eliminated. With regular use of flexible endoscopes in In practice, this builds up on the inside of the channels over time the film of the x-ray contrast medium and other residues on what result can connect the microbiological result to the cleaning even after that disinfection is no longer satisfactory.

For the patient, this means an increased risk of infection and represents accordingly represents a considerable risk. To protect against infections, only the Possibility of a repair, which is complex on the one hand and expensive on the other.

The object of the invention was therefore to provide a liquid cleaning and disinfecting Sy develop stem that does not have the disadvantages of the prior art, which So a good cleaning performance and simultaneous or subsequent disinfection at the same time shows high material compatibility and also for the removal of X-rays contrast agents, such as B. organic, aromatic iodine derivatives, in particular flexible endoscopes.

It has now surprisingly been found that all of these tasks are solved by a cleaning and disinfecting system for medical instruments, characterized in that it

• - at least one nonionic surfactant and
• - At least one amino acid and / or an amino acid derivative
• - and at least one disinfectant

includes.

It was particularly surprising that the cleaning and the infectious systems better and more gently than the preparations of the Stan of technology and that through this improved cleaning and simultaneous or subsequent disinfection with the checked flexible endoscopes the microbiologi cal problem of the prior art could be significantly reduced.

Surprisingly, with the cleaning and disinfecting agents according to the invention systems also dried on poorly soluble aromatic halogen compounds conditions such. B. X-ray contrast medium residues, completely detached from the surfaces sen, with simultaneous or subsequent disinfection.

By using the cleaning and disinfecting systems according to the invention are flexible endoscopes microbiological even after months of constant use in practice logically still perfect. This makes patient safety essential increases and extends the lifespan of these high quality medical devices.

For example, it could be demonstrated that the cleaning according to the invention and disinfectant systems, especially with duodenoscopes, using X-rays Contrast agents are preferably administered, one compared to the systems of the State of the art have significantly better cleaning and disinfection performance. This allowed the microbiological status of the duodenoscopes (after subsequent Disinfection) can be greatly improved.

The invention accordingly also relates to the use of cleaning and disinfecting systems, which

• - at least one nonionic surfactant and
• - At least one amino acid and / or an amino acid derivative
• - and at least one disinfectant

included, sensitive to cleaning and simultaneous or subsequent disinfection medical instruments, flexible endoscopes and sensitive medical Surfaces.

According to the invention, the nonionic surfactant or surfactants are advantageously selected from the group of alkyl ethoxylates, the alkyl group of which is a saturated or unsaturated, straight-chain or branched-chain alkyl group having 10 to 18, preferably 12 to 14 carbon atoms, preferably 2 to 15 , in particular, per molecule Contain 5 to 9, especially 7 ethylene oxide units. Isotridecanol ethoxylate and / or fatty alcohol polyglycol ether are very particularly preferred.

The total amount of nonionic surfactants (one or more Compounds) in the range from 1.0 to 20.0% by weight, preferably from 10.0 to 5.0 up to 15.0% by weight, each based on the total weight of the preparations.

Advantageous amino acids according to the invention are e.g. B. glutamic acid, which is characterized by the following structural formula:

and / or the pyrrolidone carboxylic acid (pyroglutamic acid), which is characterized by the following structural formula:

The total amount of amino acids (one or more compounds) is advantageous from the range from 0.1 to 10.0% by weight, preferably from 0.5 to 2.0% by weight chooses, based in each case on the total weight of the preparations.

The disinfecting agent or agents are preferably selected from the group of Aldehydes (e.g. formaldehyde, glyoxal, glutaraldehyde), the phenol derivatives (e.g. 2-bi- phenylol and p-chloro-m-cresol (4-chloro-3-methylphenol), the alcohols, the quaternary  Ammonium compounds (e.g. benzalkonium chloride, cetrimonium bromide, cetylpyridini umchloride (hexadecylpyridinium chloride). Aldehydes and quaternary ammonium compounds gen are particularly preferred.

In a particularly advantageous embodiment, the cleaning and disinfecting systems according to the invention can also contain amphoteric surfactants. Amphoteric surfactants are surfactants that have both acidic and basic hydrophilic groups and therefore behave acidic or basic depending on the condition. For the purposes of the present invention, for example, amphoteric surfactants based on aliphatic polyamines having carboxy, sulfo or phosphono side chains, such as R-NH- (CH ₂ ) _n -COOH, are advantageous.

According to the invention, z. B. amphoteric surfactants, the alkyl group of which is saturated or unsaturated, straight or branched chain alkyl group having 10 to 18, preferably Is 12 to 14 carbon atoms.

Also particularly advantageous are amphoteric surfactants from the group of Amphopropiona te, such as. B. the cocobetaine amido amphopropionate, which is characterized by the following structure:

The total amount of amphoteric surfactants (one or more compounds) is advantageous gen) from the range from 1.0 to 10.0% by weight, preferably from 2.0 to 5.0% by weight selected, each based on the total weight of the preparations.

The cleaning and disinfecting systems according to the invention can be in the form of liquid concentrates are available and, for example, packaged in dosing bags, so that a working solution can be freshly prepared. It is in particular re advantageous if the pH of the concentrate is between 4 and 10. The  liquid concentrates, preferably with water, become a working solution diluted. Preferred solutions are those containing 1.0 to 5% by weight of the invention contain cleaning and disinfecting systems. The working solution has preferably a pH between 5 and 9 in order to protect the sensitive material.

It is advantageous to carry out the dilution so that the content of the individual substances in the working solution is as follows:

• - nonionic surfactants: between 0.005 and 1% by weight
• - amino acid: between 0.0005 and 0.5% by weight
• - optionally amphoteric surfactants: between 0.005 and 0.5% by weight
• Disinfectant agents: between 0.1 and 2.0% by weight

The cleaning and disinfecting systems according to the invention can also be used some also contain conventional corrosion inhibitors, such as benzotriazole ten, especially if they are used with metallic surfaces, in particular those with non-refined steels or materials made of non-ferrous metal alloys, in can come. It is preferred to contain one or more corrosis onsinhibitoren between 0.1 and 5 wt .-%, based on the total weight of the For mulation, to choose.

The cleaning and disinfecting systems according to the invention can moreover advantageously contain additional complexing agents and / or pH regulators in order to to reduce the negative influence of fluctuating water hardness or to ensure that the pH of the cleaning and disinfecting system is in a range that does not damage the sensitive material.

In addition to the components mentioned above, the inventive cleaning and disinfecting systems for such preparations are common consumers Containing agents, dyes, fragrances and / or other customary auxiliaries. the In the majority of cases, they do not contribute to the cleaning effect, but serve storage and aesthetic purposes. However, it is also possible to use such com to use components that have a (preservative, nourishing, etc.) effect  and at the same time sor for a certain color and / or a pleasant fragrance gene.

The amounts of such carriers and perfume to be used can be in Dependent on the type of the respective product by the specialist by simple Trying out can be easily determined.

It can also be advantageous to design the cleaning and disinfecting systems according to the invention such that they

• A) a first preparation in the form of a liquid cleaning agent for medical instruments, which
  • - at least one nonionic surfactant and
  • - At least one amino acid and / or an amino acid derivative
  contains

and

• A) a second preparation, which is in a suitable carrier
  • - at least one disinfectant
  contains

include.

Such a cleaning and disinfecting system according to the invention is advantageously implemented, for example, in the form of a "set" in which the accessories Ride A) and B) separately from each other, who are kept in different containers the.

In such a case, the preparations A) can advantageously be designed such that the nonionic surfactant or surfactants are selected from the group of alkyl ethoxylates whose alkyl group is a saturated or unsaturated, straight or branched chain alkyl group having 10 to 18, preferably 12 to 14 carbon atoms, preferably containing 2 to 15 , in particular 5 to 9, especially 7 ethylene oxide units per molecule. Isotridecanol ethoxylate and / or fatty alcohol polyglycol ether are very particularly preferred.

The total amount of nonionic surfactants (one or more ver bonds) from the range of 1.0 to 20.0% by weight, preferably from 10.0 to 15.0 wt .-% selected, each based on the total weight of the preparations.

The total amount of amino acids (one or more compounds) is advantageous from the range from 0.1 to 10.0% by weight, preferably from 0.5 to 2.0% by weight chooses, based in each case on the total weight of the preparations.

In a particularly advantageous embodiment, the preparations A can also Contain amphoteric surfactants, preferably a total amount of amphoteric surfactants (one or several compounds) from the range from 1.0 to 10.0% by weight, preferably from 2.0 to 5.0 wt .-% selected, each based on the total weight of the Preparations.

The preparations A) can be in the form of liquid concentrates and be packaged in dosing bags, for example, so that a working solution in each case can be freshly prepared. It is particularly advantageous if the pH of the Concentrate is between 5 and 9. The liquid concentrates are preferred diluted with water to a working solution. Preferred solutions are the 0.5 to 5% by weight of cleaning and disinfecting systems according to the invention contain. The working solution preferably has a pH between 6 and 8 µm to achieve optimal protection of the sensitive material.

It is advantageous to carry out the dilution so that the content of the individual substances in the working solution is as follows:

• - nonionic surfactants: between 0.005 and 1% by weight
• - amino acid: between 0.0005 and 0.5% by weight
• - optionally amphoteric surfactants: between 0.005 and 0.5% by weight

Preparations A) can furthermore advantageously additionally include conventional corrosion inhibitors, such as benzotriazole, especially if they are used with metallic surfaces, especially with non-refined steels or Non-ferrous metal alloy materials can come into contact. It is preferred  the content of one or more corrosion inhibitors between 0.1 and 5 wt .-%, based on the total weight of the formulation to choose.

Preparations A) can also advantageously be additional complexing agents and / or contain pH regulators to fluctuate the negative impact Reduce water hardness or to ensure that the pH of the clean and disinfectant system is in an area that contains the sensitive material does not harm.

In addition to the components mentioned above, the preparations A) Preservatives, dyes, fragrances customary for such preparations and / or contain other customary auxiliaries.

The amounts of such carriers and perfume to be used can be in Dependent on the type of the respective product by the specialist by simple Trying out can be easily determined.

Preparations B) contain one or more disinfectant agents in one suitable carrier. They can be in the form of solid concentrates, e.g. B. in (shower) Ta in the form of pellets, powders, pellets or granules, and for example in dosing bags be packaged so that a working solution can be freshly prepared. But you can also in the form of solutions or suspensions in non-aqueous Solvents.

Preparations B) which also contain surfactants, as are customary, are preferred Find use, for example sulfobetaines, alkyl sulfonates, alkyl benzene sulfonates and / or nonionic surfactants based on ethylene oxide and / or butylene oxide.

In addition, preparations B) can advantageously additionally include conventional corrosion inhibitors, such as benzotriazole, especially if they are used with metallic surfaces, especially with non-refined steels or Non-ferrous metal alloy materials can come into contact.  

In addition to the components mentioned above, preparations B) dyes, fragrances and / or other usual auxiliaries customary for such preparations substances such as thickening, granulating, tableting or dispersing tools included. In the majority of cases, these do not contribute to disinfectant, preservative or antiseptic effect, but serve the manageable or storage and aesthetic purposes. However, it is also possible to use such To use components that have a (preservative, nourishing, etc.) effect fold and at the same time for a certain color and / or a pleasant fragrance to care.

The amounts of such carriers and perfume to be used can be in Dependent on the type of the respective product by a specialist simply by switching off try it out easily.

The following examples serve to describe the invention, of course without intending to limit the invention to these examples. All men Unless otherwise stated, the indications, shares and percentages are based on the Weight and the total amount or on the total weight of the preparations based.  

Examples example 1

15% glutardialdehyde
20% dihydroxydioxahexane
5% pyrrolidone carboxylic acid
4% isotridecanol ethoxylate
4% fatty alcohol polyglycol ether
1% corrosion protection
1% pH regulator
Rest of water

A pH of 4 is set.

Example 2

13% didecyldimethylammonium chloride
9% dodecylpropylenediamine
1% pyrrolidone carboxylic acid
3% isotridecanol ethoxylate
4% fatty alcohol polyglycol ether
2% corrosion protection
5% glycol
2% pH regulator
2% complexing agent
Rest of water

A pH of 9 is set.  

Example 3

15% glutardialdehyde
1% didecyldimethylammonium chloride
1% benzalkonium chloride
1% pyrrolidone carboxylic acid
4% isotridecanol ethoxylate
4% fatty alcohol polyglycol ether
2% corrosion protection
6% alcohols
1% pH regulator
Rest of water

A pH of 4 is set.

Example 4

15% glutardialdehyde
1% didecyldimethylammonium chloride
1% benzalkonium chloride
1% pyrrolidone carboxylic acid
4% isotridecanol ethoxylate
2% cocobetaine amido amphopropionate
4% fatty alcohol polyglycol ether
2% corrosion protection
6% alcohols
1% pH regulator
Rest of water

A pH of 4 is set.  

Example 5a

1% pyrrolidone carboxylic acid
6% isotridecanol ethoxylate
2% cocobetaine amido amphopropionate
6% fatty alcohol polyglycol ether
1% corrosion protection
10% glycol
Rest of water

A pH of 4 is set.

Example 5b

15% glutardialdehyde
20% dihydroxydioxahexane
4% isotridecanol ethoxylate
4% fatty alcohol polyglycol ether
1% corrosion protection
1% pH regulator
Rest of water

An application test was carried out with a liquid cleaning agent according to example recipe 5a. For this purpose, 129 duodenoscopes with a cleaning agent of the prior art (enzymatic cleaner) and 97 duodenoscopes with the cleaning agent according to the invention were each cleaned and then disinfected with the disinfectant preparation according to example recipe 5b; the microbiological status of the devices was then checked. The results were as follows:

Claims (15)

1. Cleaning and disinfecting system for medical instruments, characterized in that it
at least one nonionic surfactant and
at least one amino acid and / or an amino acid derivative
and at least one disinfectant
includes. 2. Cleaning and disinfecting system according to claim 1, characterized net that the or the nonionic surfactants are selected from the group of alkyl ethoxylates, the alkyl group of which is saturated or unsaturated, straight or branched chain alkyl group having 10 to 18, preferably 12 to 14 carbon atoms is. 3. Cleaning and disinfecting system according to one of claims 1 or 2, characterized in that it is an amino acid pyrrolidone carboxylic acid and / or Contains glutamic acid. 4. Cleaning and disinfecting system according to one of claims 1 to 3, characterized in that it is a nonionic surfactant isotridecanol ethoxylate and / or contains fatty alcohol polyglycol ether. 5. Cleaning and disinfecting system according to one of claims 1 to 4, characterized in that the disinfecting agent or agents are selected from the group of aldehydes (e.g. formaldehyde, glyoxal, glutaraldehyde), phenol Derivatives (e.g. 2-biphenylol and p-chloro-m-cresol (4-chloro-3-methylphenol), the alcohols, the quaternary ammonium compounds (e.g. benzalkonium chloride, Cetrimonium bromide, cetylpyridinium chloride (hexadecylpyridinium chloride). 6. Cleaning and disinfecting system according to one of claims 1 to 5, characterized in that it contains at least one ampho as a further component (s) contains surfactant.   7. Cleaning and disinfecting system according to claim 6, characterized records that the amphoteric surfactant or are selected from the group of Amphoteric surfactants whose alkyl group is a saturated or unsaturated, straight or branched chain alkyl group having 10 to 18, preferably 12 to 14 carbon atoms is. 8. cleaning and disinfecting system according to one of claims 6 to 7, characterized in that it is amphoteric surfactant cocobetaine amido amphopropionate contains. 9. Cleaning and disinfecting system according to one of claims 6 to 8, characterized in that the amount of amphoteric surfactant (one or more verbin dungen) from the range of 1.0 to 10.0 wt .-%, preferably from 2.0 to 5.0% by weight, based in each case on the total weight of the preparations, is selected. 10. Cleaning and disinfecting system according to one of claims 1 to 9, characterized in that it contains one or more nonionic surfactants in one amount from 1.0 to 20.0% by weight, preferably from 5.0 to 15.0% by weight, in each case based on the total weight of the preparations. 11. Cleaning and disinfecting system according to one of claims 1 to 10, characterized in that it contains one or more amino acids in an amount of 0.1 to 10.0 wt .-%, preferably from 0.5 to 2.0 wt .-%, each based on the Total weight of the preparations. 12. Cleaning and disinfecting system according to one of claims 1 to 11, characterized in that it has a pH between 4 and 10. 13. Cleaning and disinfecting system according to one of claims 1 to 12, characterized in that it is in the form of a concentrate which before Use is diluted with water to a working solution. 14. Cleaning and disinfecting system, which is designed so that it

• A) a first preparation in the form of a liquid cleaning agent for medical instruments, which
  at least one nonionic surfactant and
  at least one amino acid and / or an amino acid derivative
  contains

and

• A) a second preparation, which is in a suitable carrier
  at least one disinfectant
  contains

includes. 15. Use of cleaning and disinfecting systems, which
at least one nonionic surfactant and
at least one amino acid and / or an amino acid derivative
and at least one disinfectant
included, for cleaning and disinfection of medical instruments, flexible endoscopes and medical surfaces.