Automated Endoscope Reprocessors Research Articles

Institutional Micro-Cost Comparative Analysis of Reusable vs Single-use Cystoscopes With Assessment of Environmental Footprint

ObjectiveTo conduct a comparative cost analysis between single-use and reusable cystoscopes from a national healthcare system perspective and assess the environmental footprint. MethodsSingle-center micro-cost analysis of reusable versus single-use cystoscopes used institutional data. The cost breakdown included capital, reprocessing, repair, procedure, and environmental impact expenses. Data collection occurred in 2022, utilizing register data, observations, and expert opinions. Depreciation was applied over 5 years for reusable cystoscopes and 8 years for the automated endoscope reprocessor. Deterministic sensitivity analyses gauged result robustness to input variations. Lastly, an assessment of the environmental footprint, focusing on water consumption and waste generation, was conducted. ResultsPer-procedure cost associated with reusable cystoscopes was €332.46 versus €220.19 associated with single-use, resulting in savings of €112.27. When projecting these costs per procedure with the no. procedures performed in 2022 (1186), comparing the costs of procedures performed in one year with reusable endoscopes (€394,295.86) to the costs of the exact no. procedures performed with disposable endoscopes (€261,149.37), a saving of €133,146.49 could be achieved. Additionally, after continuous use of single-use endoscopes, procedures were scheduled every 20 instead of every 30 minutes. This adjustment allowed for 15 daily procedures instead of 10 while maintaining the same shift. This suggests potential advantages in terms of improved organizational impact and reduced waiting lists. Ultimately, the decreased environmental impact favored the adoption of single-use cystoscopes. ConclusionsOur study presents an opportunity for organizational development in response to the evolving external environment, considering user needs, market dynamics, and competition with other facilities.

Fluid retention in endoscopes: A real-world study on drying effectiveness

Outbreaks linked to inadequate endoscope drying have infected numerous patients, and current standards and guidelines recommend at least 10minutes of forced air for drying channels. This study evaluated a new forced-air drying system (FADS) for endoscopes. Drying was assessed using droplet detection cards; visual inspection of air/water connectors, suction connectors, and distal ends; and borescope examinations of endoscope interiors. Assessments were performed after automated endoscope reprocessor (AER) alcohol flush and air purge cycles and after 10-minute FADS cycles. Researchers evaluated drying during encounters with 22 gastroscopes and 20 colonoscopes. After default AER alcohol and air purge cycles, 100% (42/42) of endoscopes were still wet. Substantial fluid emerged from distal ends during the first 15seconds of the FADS cycle, and droplets also emerged from air/water and suction connectors. Following FADS cycle completion, 100% (42/42) were dry, with no retained fluid detected by any of the assessment methods. Multiple endoscope ports and channels remained wet after AER cycles intended to aid in drying but were dry after the FADS cycle. This study reinforced the need to evaluate the effectiveness of current drying practices and illustrated the use of practical tools in a real-world setting.

Unveiling 8 years of duodenoscope contamination: insights from a retrospective analysis in a large tertiary care hospital

ObjectiveContaminated duodenoscopes caused several hospital outbreaks. Despite efforts to reduce contamination rates, 15% of patient-ready duodenoscopes are still contaminated with gastrointestinal microorganisms. This study aimed to provide an overview of...

Bronchoscopy-related outbreaks and pseudo-outbreaks: A systematic review.

To identify and report the pathogens and sources of contamination associated with bronchoscopy-related outbreaks and pseudo-outbreaks. Systematic review. Inpatient and outpatient outbreaks and pseudo-outbreaks after bronchoscopy. PubMed/Medline databases were searched according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, using the search terms "bronchoscopy," "outbreak," and "pseudo-outbreak" from inception until December 31, 2022. From eligible publications, data were extracted regarding the type of event, pathogen involved, and source of contamination. Pearson correlation was used to identify correlations between variables. In total, 74 studies describing 23 outbreaks and 52 pseudo-outbreaks were included in this review. The major pathogens identified in these studies were Pseudomonas aeruginosa, Mycobacterium tuberculosis, nontuberculous mycobacteria (NTM), Klebsiella pneumoniae, Serratia marcescens, Stenotrophomonas maltophilia, Legionella pneumophila, and fungi. The primary sources of contamination were the use of contaminated water or contaminated topical anesthetics, dysfunction and contamination of bronchoscopes or automatic endoscope reprocessors, and inadequate disinfection of the bronchoscopes following procedures. Correlations were identified between primary bronchoscope defects and the identification of P. aeruginosa (r = 0.351; P = .002) and K. pneumoniae (r = 0.346; P = .002), and between the presence of a contaminated water source and NTM (r = 0.331; P = .004) or L. pneumophila (r = 0.280; P = .015). Continued vigilance in bronchoscopy disinfection practices remains essential because outbreaks and pseudo-outbreaks continue to pose a significant risk to patient care, emphasizing the importance of stringent disinfection and quality control measures.

Comparison of quantification methods for an endoscope lumen biofilm model

Biofilm has been implicated in multi-drug resistant organism outbreaks following endoscopic procedures. Automated Endoscope Reprocessors (AER) are devices validated to clean and disinfect endoscopes per applicable standards. The ISO 15883 part 4 standard guides performance testing validation of AERs, including cleaning performance using a biofilm test soil. The standard recommends assessment of biofilm reduction using protein or carbohydrate quantification methods. The aim of this study was to assess the suitability of various quantification methods using the ISO biofilm model.The ISO 15883 part 5 biofilm test soil method was used to grow biofilm within lumens representative of endoscopes channels. The biofilm was then quantified using five methods: Crystal Violet (CV), Colony Forming Units (CFU), Total Organic Carbon (TOC), protein assay with Orthophtalaldehyde (OPA), and protein assay by micro bicinchoninic acid (μBCA). The five methods were statistically analyzed for their ability to assess biofilm reduction on samples accurately and precisely. In addition, the quantification methods were compared to demonstrate statistical equivalency, and thus their suitability for assessing biofilm cleaning performance testing of AERs.

Are single-use flexible cystoscopes environmentally sustainable? A lifecycle analysis

Objective: Single-use flexible cystoscopes provide a safe and cost-effective evolution to current practice. However, the environmental impact of single-use devices needs to be considered in a healthcare system that is being increasingly scrutinised for its carbon footprint. We performed a single-centre simplified lifecycle analysis to compare the carbon footprint of the single-use Ambu® aScope™ 4 Cysto System (Ambu®) with the reusable Olympus CYF-VH flexible video-cystoscope (Olympus). Methods: Manufacturing, transportation and waste costs were calculated for the Ambu® cystoscope. Manufacturing costs incorporating the average lifecycle of the reusable cystoscope was included in the carbon footprint calculation for the Olympus reusable cystoscope as were waste costs and re-processing costs using the Soluscope 3 automatic endoscope re-processor that is used in our centre. Results: Results demonstrate that Ambu® cystoscopes are a carbon-friendly alternative to reusable Olympus cystoscopes, with a 36% lower carbon footprint. The carbon footprint of the Ambu® scope is 1.43 kg CO2 compared with 2.22 kg CO2 for the reusable Olympus cystoscope. These results may vary from centre to centre depending on the cystoscope re-processor used. Conclusion: The Ambu® single-use flexible cystoscopes provide a carbon-friendly alternative to Olympus CYF-VH reusable cystoscopes. Level of evidence: IV

How effective are the alcohol flush and drying cycles of automated endoscope reprocessors? Stripped endoscope model

BackgroundEffective drying of the internal channels of endoscopes is essential to prevent the growth of water-borne pathogens and to assure adequate sterilization with vaporized hydrogen peroxide or ethylene oxide. The aim of this study was to evaluate the dryness of endoscopes after a routine disinfection process in an automated endoscope reprocessor. MethodsStripped endoscopes (SE) that allow for visual inspection of the inside channels were reprocessed per protocol in a large urban medical center, with a 3-minute or 10-minute air flush following reprocessing. SE was hung and observed for any water within the channels after reprocessing and after a week of ambient storage. Ready-for-use endoscopes were also randomly spot-checked for moisture visually and with moisture detection paper. ResultsAll SE were grossly wet after HLD with a 3-minute air flush, despite alcohol flush and drying cycle. The 10-minute air flush was effective at drying the biopsy/suction channel, but not the air/water channels. Hanging had limited effect, being most effective in the biopsy/suction channels. Of the 77 ready-for-use respiratory and gastrointestinal endoscopes assessed, 37 (48.1%) showed evidence of retained moisture. ConclusionsAir flush cycles commonly used in the final steps of automated endoscope reprocessing may not adequately dry endoscope channels, particularly the narrower diameter air/water channels. An extended 10-minute air flush appears effective at drying the larger biopsy/suction channel, but has limited effect on the air/water channels.

SG-APSIC1058: Microbiological surveillance of endoscopes in a Singapore tertiary-care academic hospital: A retrospective study from 2018 to 2021

Objectives: Improper reprocessing of endoscopes may result in healthcare-associated infections. Regular microbiological surveillance is an important means of evaluating the quality of endoscope reprocessing. We evaluated the effectiveness of reprocessing endoscopes (including the protocols on steps to be taken in the event of any positive microbiological results) in a sterile supply unit (SSU) and an endoscopy unit in a Singapore tertiary-care academic hospital. Methods: Singapore General Hospital (SGH) is a 1,750-bed, tertiary-care, academic medical center in Singapore with 2 main SSUs: 1 inpatient endoscopy unit and 1 outpatient endoscopy unit. We reviewed microbiological surveillance results from endoscopes following reprocessing from January 2018 to December 2021. In total, 160 endoscopes (27 bronchoscopes, 58 gastroscopes, 52 colonoscopes, 6 duodenoscopes, 5 echoscopes, 5 cystoscopes, 5 rhinolaryngoscopes, and 5 enteroscopes) and 15 automated endoscope reprocessors (AERs) were evaluated for the presence of microorganisms. Samples were obtained by swabbing the tip of the scope and the biopsy channel. Fluid was flushed from the biopsy channel after reprocessing, and this water from the AERs was sampled after waterline disinfection. Results: Of the 15,783 samples collected, 15,667 (99.3%) yielded no growth; 36 (0.2%) were positive for gut and environmental flora; and 80 (0.5%) were positive for low-concern organisms such as skin flora. Conclusions: Microbiological surveillance yielded a high percentage of negative results confirming the effectiveness of endoscope reprocessing. This quality-assurance process is necessary and beneficial in achieving patient safety.

Effectiveness of adenosine triphosphate to monitor manual cleaning and disinfection efficacy of flexible endoscopes in Hong Kong.

Adenosine triphosphate (ATP) bioluminescence assay is widely adopted in the West to allow rapid evaluation of endoscopes for bacteriologic/biologic residue, but this practice is rarely adopted in Asia. In this continuous quality improvement program, we evaluated the utility of ATP in bacteriologic surveillance on endoscope reprocessing. A total of 456 samples (304 ATP samples and 152 culture samples) of 38 flexible endoscopes were assessed after routine clinical use in a private hospital in Hong Kong. Endoscopes were assessed with an ATP system and bacterial cultures at different time points during the reprocessing. After pre-cleaning, the ATP values ranged from 228 to 65 163 relative light units (RLU) through all endoscope types. After manual cleaning, ATP values were decreased to 7-81 RLU (median, 19 RLU) for endoscope surface and 3-671 RLU (median, 12 RLU) for channel rinsate. There was a significant reduction in ATP levels between pre-cleaning and after manual cleaning. One of the 38 (2.6%) endoscopes (a duodenoscope) had an ATP value of 671 RLU from channel rinsate, which exceeded the benchmark for cleanliness of >200 RLU, and was sent back for re-cleaning. All endoscopes cultured no bacteria after high-level disinfection (HLD) by automated endoscope reprocessor (AER) and storage up to 24 h. ATP values were <200 RLU for all endoscopes after HLD and storage. Adenosine triphosphate bioluminescence assay offers a rapid, practical, and cost-effective alternative for detection of endoscope microbial residue as well as a routine monitoring tool for endoscope cleanliness in the clinical setting.

Environmental impact of single-use and reusable flexible cystoscopes.

To compare the carbon footprint and environmental impact of single-use and reusable flexible cystoscopes. We analysed the expected clinical lifecycle of single-use (Ambu aScope™ 4 Cysto) and reusable (Olympus CYF-V2) flexible cystoscopes, from manufacture to disposal. Performance data on cumulative procedures between repairs and before decommissioning were derived from a high-volume multispecialty practice. We estimated carbon expenditures per-case using published data on endoscope manufacturing, energy consumption during transportation and reprocessing, and solid waste disposal. A fleet of 16 reusable cystoscopes in service for up to 135 months averaged 207 cases between repairs and 3920 cases per lifecycle. Based on a manufacturing carbon footprint of 11.49 kg CO2 /kg device for reusable flexible endoscopes and 8.54 kg CO2 /kg device for single-use endoscopes, the per-case manufacturing cost was 1.37 kg CO2 for single-use devices and 0.0017 kg CO2 for reusable devices. The solid mass of single-use and reusable devices was 0.16 and 0.57 kg, respectively. For reusable devices, the energy consumption of reusable device reprocessing using an automated endoscope reprocessor was 0.20 kg CO2 , and per-case costs of device repackaging and repair were 0.005 and 0.02 kg CO2 , respectively. The total estimated per-case carbon footprint of single-use and reusable devices was 2.40 and 0.53 kg CO2 , respectively, favouring reusable devices. In this lifecycle analysis, the environmental impact of reusable flexible cystoscopes is markedly less than single-use cystoscopes. The primary contributor to the per-case carbon cost of reusable devices is energy consumption of reprocessing.

1194. Efficacy of shortened high-level disinfection (HLD) protocols for GI duodenoscopes with disposable tips used for endoscopic retrograde cholangiopancreatography (ERCP)

Abstract Background The most efficient combination of manual washes (MW) and high-level disinfection (HLD) cycles for the reprocessing of duodenoscopes used for ERCP is unknown. The FDA recently announced the national recommendation for transition to duodenoscopes with disposable components. Methods We studied contamination of Pentax Medical duodenoscopes with disposable tips used for ERCP. Duodenoscopes were cleaned and disinfected following removal of the disposable tip. First, one manual wash was performed with detergent and brushes that fit into the suction channel, air/water valves, cylinder, and elevator chamber. Afterward, the duodenoscope underwent HLD with an automated endoscope re-processor. Our study evaluated the success of an abbreviated cycle of one MW followed by one HLD (MW-HLD) cycle compared to a pair of MW-HLD cycles. Each duodenoscope was sampled in 4 locations after the first MW-HLD cycle and the second: 1) The elevator tab, 2) elevator channel distal opening, 3) composite duodenoscope tip, and 4) the elevator channel (Figure 1). Samples 1-3 were collected with flocked swabs. Swabs were plated on routine medias for relevant enteric pathogens. The 4th was collected by flushing 25 mL of neutralizing buffer through the elevator channel, then scrubbing the channel with a brush, followed by another 25 mL flush. The 50 mL eluent was vacuum filtered through a 0.22-micron filter and plated on TSA. Antibiotic resistance was assessed via PCR. CFU and proportion of contaminated scopes were compared between MW-HLD cycles. Results 46 duodenoscopes were sampled from September 2021 through March 2022 resulting in 92 sample events and 368 total samples. After one MW-HLD cycle, 19 of 46 (41%) duodenoscopes remained contaminated, including 5 (11%) with VRE (Table 1). After two MW-HLD cycles, 11 (24%) remained contaminated and 0 (0%) with VRE (p=0.08, 0.02, respectively). Results were similar at the sample location level (p=0.03, 0.01, respectively). Proportion of duodenoscopes contaminated with any flora and Vancomycin-resistant Enterococcus spp. Conclusion Our data demonstrate that 1 MW-HLD cycle is insufficient at decontaminating duodenoscopes with disposable tips but do support the use of two MW-HLD cycles. VRE was identified after one MW- HLD cycle, but not after two MW-HLD cycles. Further studies are needed to determine the optimal combination of MWs and HLDs while minimizing HLD staff time. Disclosures All Authors: No reported disclosures.

Splash generation and droplet dispersal in a well-designed, centralized high-level disinfection unit

Sterile processing personnel routinely decontaminate medical devices that are heavily soiled with blood, tissue, and secretions. Contamination may spread throughout processing areas, potentially exposing personnel and patient-ready devices, especially when there is insufficient separation between the dirty and clean areas. This study aimed to identify activities that generate splash, determine how far droplets travel during manual cleaning, characterize the impact of practices on splash generation, and assess effectiveness of personal protective equipment (PPE) at preventing splash exposure to technicians and visitors in the decontamination unit. Moisture-detection paper was affixed to PPE and environmental surfaces in a new processing department designed to optimize workflow and prevent cross-contamination. Droplet generation and dispersal were assessed during manual cleaning of a colonoscope and a transvaginal ultrasound probe. Splash was generated by most activities and droplets were detected up to 7.25 feet away. Transporting wet endoscopes dispersed droplets on a 15-foot path from the sink to the automated endoscope reprocessor. Extensive droplets were detected on PPE worn by technicians at the sink and observers 3-4 feet away. Manual cleaning of devices generated substantial splash, drenching technicians and the environment with droplets that traveled more than 7 feet. Engineering controls and better PPE are needed to reduce personnel exposure and risks associated with the potential dispersal of contaminated fluids throughout the facility.

S1071 Assessment of Pathogenic Enteric Flora Contaminating Novel Duodenoscopes With Disposable Tips

Introduction: The FDA has advised that endoscopy units use duodenoscopes with disposable components to minimize the risk of duodenoscope-associated infections. Data are emerging on the effectiveness of disposable tips in preventing contamination of the duodenoscope with high-risk organisms. We hypothesize that disposable tips will not eliminate high-risk bacterial contamination. Methods: We conducted a prospective observational study from October 2021 to March 2022 to speciate and quantify the bacterial contamination rate of 46 Pentax Medical ED34-i10T2 duodenoscopes with disposable tips. After disposal of the tip, the duodenoscope was cultured after one manual wash (MW) and one cycle of high-level disinfection (HLD) in an automated endoscope re-processor, and then again after two MW and an additional cycle of HLD. Each duodenoscope was sampled in 4 locations after the first MW-HLD cycle and the second: 1) elevator tab, 2) instrument channel distal opening, 3) composite duodenoscope tip, 4) instrument channel (Figure). Bacterial pathogenicity was classified by the FDA 1 as high-concern (any CFU) and low/moderate-concern organisms ( >100 CFU). Clostridium difficile and Enterococcus faecalis were classified as high-concern organisms. We compared contamination rates to historical data from the FDA surveillance study of Pentax reusable duodenoscopes that demonstrated contamination rates of 6.0% high-concern organisms and 8.2% low/moderate-concern organisms. Results: 46 Duodenoscopes were sampled resulting in 368 sample events. After one MW-HLD cycle, 8 of 46 duodenoscopes remained contaminated with any organism. After the full HLD, 5 of 46 duodenoscopes remained contaminated with any organism. Low/moderate concern organisms were isolated in 2.7% of samples (95% CI 0.9%, 6.2%). High concern organisms were isolated in 0% of samples (95% CI 0%, 2.0%). (Table) Conclusion: Compared to historical FDA data from reusable Pentax duodenoscopes, the rate of low/moderate-concern organism contamination of duodenoscopes with disposable tips was lower, and the confidence interval excluded the historical rate. The rate and confidence interval limits for high-concern organism contamination in our study were also lower than FDA data1. Our results suggest that disposable tips decrease but do not eliminate duodenoscope bacterial contamination. 1 522 postmarket surveillance studies database: pilot phase (phase 1) of the Sampling and Culturing Study for Pentax. accessdata.fda.gov. 2020.Figure 1.: Each duodenoscope was sampled in 4 locations: 1) elevator tab, 2) instrument channel distal opening, 3) composite duodenoscope tip, 4) instrument channel. Samples 1-3 were collected with flocked swabs. Swabs were plated on routine medias for relevant enteric pathogens. The 4th was collected by flushing 25mL of neutralizing buffer through the elevator channel, then scrubbing the channel with a brush, followed by another 25mL flush. The 50mL eluent was vacuum filtered through a 0.22-micron filter and plated on TSA. Antibiotic resistance was assessed via PCR. CFU and proportion of contaminated scopes were compared between MW-HLD cycles. Table 1. - Descriptive Table comparing sample rates to historical FDA reported rates of contamination Outcome Historical Rate Summarized Rate across all Sites (95% CI) Raw sample total low-concern organism >100 CFU presence 8.2% 2.7% (0.9%, 6.2%) Raw sample total high-concern organism (Enterococcus and C difficile) >1 CFU presence 6.0% 0% (0%, 2.0%)

Infection Control of Gastrointestinal Endoscopic Procedures Performed by Nurses at Hawler and Rizgary Teaching Hospitals in Erbil City /Iraq

Background and objectives: Gastrointestinal endoscopy is a valuable diagnostic and therapeutic tool for the care of patients with gastrointestinal and pancreaticobiliary disorders. Compliance with accepted guidelines for the reprocessing of gastrointestinal endoscopes between patients is critical to the safety and success of their use. This study aimed to assess the nurses' infection control practice and identify the prevalence of fungal and bacterial growth on gastroscopy and colonoscopy instruments. Methods: A descriptive study was carried out on a purposive (non-probability) sample of all nurses who worked in the gastrointestinal endoscopy units at Hawler and Rizgari Teaching Hospitals in Erbil City from January to June 2016 from where the sample specimens were also taken. The questionnaire consisted of three parts. The first part included sociodemographic data, the second part contained nurses' infection control practice before, during and after the endoscopy procedure including pre-cleaning, leak testing, manual cleaning rising, disinfection, rinsing, drying and storing instruments. The third part of the questionnaire was used to document 80 endoscopic specimens, which were collected from the endoscopic instruments. Results: The findings of the study revealed that the majority of nurses (38.5%) were within the 25-35 years age group, 61.5% were males and having less than 5 years experience. The infection control practices for endoscopy procedure showed that a majority (69.2%) of nurses practised at a fair level. The Grams stain smear results showed positivity of 65.62% for fungus and 34.375% for bacteria. All the fungi isolated belonged to the Candida species. Conclusion: The study concluded that the infection control of endoscopic procedures performed by nurses was inadequate. The swab cultures from the automated endoscope reprocessors, in combination with other bacterial isolates, showed that the Candida species were present in the endoscopic specimens.

Both microbiological surveillance and audit of procedures improve reprocessing of flexible bronchoscopes and patient safety.

Microbiological surveillance of bronchoscopes and automatic endoscope reprocessors (AERs)/washer disinfectors as a quality control measure is controversial. Experts also are divided on the infection risks associated with bronchoscopic procedures. We evaluated the impact of routine microbiological surveillance and audits of cleaning/disinfection practices on contamination rates of reprocessed bronchoscopes. Audits were conducted of reprocessing procedures and microbiological surveillance on all flexible bronchoscopes used from January 2007 to June 2020 at a teaching hospital in France. Contamination rates per year were calculated and analyzed using a Poisson regression model. The risk factors for microbiological contamination were analyzed using a multivariable logistical regression model. In total, 478 microbiological tests were conducted on 91 different bronchoscopes and 57 on AERs. The rate of bronchoscope contamination significantly decreased between 2007 and 2020, varying from 30.2 to 0% (P < .0001). Multivariate analysis confirmed that retesting after a previous contaminated test was significantly associated with higher risk of bronchoscope contamination (OR, 2.58; P = .015). This finding was explained by the persistence of microorganisms in bronchoscopes despite repeated disinfections. However, the risk of persistent contamination was not associated with the age of the bronchoscope. Our results confirm that bronchoscopes can remain contaminated despite repeated reprocessing. Routine microbial testing of bronchoscopes for quality assurance and audit of decontamination and disinfection procedures can improve the reprocessing of bronchoscopes and minimize the rate of persistent contamination.

Development of a checklist as self-assessment tool to evaluate the reprocessing of endoscopic instruments in an Italian teaching hospital.

The present study aims to develop a checklist, as a self-assessment tool, for evaluating all the items involved in the endoscope reprocessing that could be useful for the improvement and/or development of a safety endoscope reprocessing system. A three-step modified Delphi method, with an embedded qualitative component, was adopted to develop the checklist. According to it, corrective actions were performed before its further re-administration. Contextually, the microbiological surveillance of the endoscopes and of the wash disinfector machine was carried out. Five areas were included in the checklist. After the 1st checklist application, only one of three wards reached the excellent scores in all the items. The other two wards showed an improvement in the Traceability and Endoscope Reprocessing areas after corrective actions. The McNemar's test reported significant difference in the proportion of satisfactory results before and after the 1st and 2nd checklist application. The microbiological surveillance, conducted after the 1st administration, showed unsatisfactory results for the 2 bronchoscopes available in the Intensive Care Unit and for 2 automated endoscope reprocessors. The analysis performed after the 2nd administration showed good results. The periodic administration of the checklist is functional for a self-assessment of quality reprocessing procedures carried out in the large endoscopic services and in the wards occasionally providing those services, according to the good practice guidelines and for any corrective actions to increase the safety.

The Effectiveness of Drying on Residual Droplets, Microorganisms, and Biofilms in Gastrointestinal Endoscope Reprocessing: A Systematic Review.

Background Despite endoscope reprocessing, residual droplets remain in gastrointestinal endoscope working channels. Inadequate drying of gastrointestinal endoscope working channels may promote microbial reproduction and biofilm formation, increasing the risk of infection in patients. This review was designed to provide the current status of gastrointestinal endoscope drying, emphasize the importance of gastrointestinal endoscope drying, and evaluate the effectiveness of different drying methods of gastrointestinal endoscope in reducing residual droplets and microbial growth risk. Methods A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting checklist. The PubMed, Web of Science, Medline, EMBASE, EBSCO, CNKI, CQVIP, and Wanfang Data databases were searched from 2010 to 2020 to identify eligible articles focused on methods of gastrointestinal endoscope drying and the status of endoscope drying. The following key points were analyzed: type of intervention, amount of residual droplets, major microbial types, and effectiveness of biofilm intervention. JBI quality assessment tool was used to determine bias risk for inclusion in the article. Results This review included twelve articles. Two of the articles reported lack of drying of gastrointestinal endoscopes while the other ten reported residual droplets, microbial growth, and biofilm formation after different methods of drying. Four articles reported 0 to 4.55 residual droplets; four articles reported that the main microbial types were cocci and bacilli, most commonly Staphylococcus, Escherichia coli, Bacillus maltophilia, and Pseudomonas aeruginosa; and two reported that drying could effectively reduce biofilm regeneration. The type of intervention is as follows: automatic endoscopy reprocessor (AER), manual compressed air drying, and the Dri-Scope Aid for automatic drying and drying cabinet. Conclusions While endoscope reprocessing may not always be effective, an automatic endoscope reprocessor plus the Dri-Scope Aid with automatic drying over 10 min or storage in a drying cabinet for 72 h may be preferred.

819. How effective is alcohol flush and drying cycle of automatic endoscope reprocessor (AER): Stripped Endoscope (SE) model

BackgroundEndoscopic designs are more ergonomic and technically sophisticated than ever. Endoscope transmitted infections continues despite scrutiny and optimization of disinfection processes. Effective endoscopic dryness has been largely overlooked, even though it is paramount for prevention of water-borne pathogens accumulating after high level disinfection (HDL). Additionally, complete dryness is required to achieve sterilization. The aim of this study is to evaluate the dryness of the endoscopes after routine a routine disinfection process.MethodsThree endoscopes were stripped from their outer sheaths to allow for visual inspection of the inside channels. SE were processed as per usual practice. After HLD in an automatic endoscope reprocessor (AER) that included an alcohol flush and drying cycle, SE were hung and observed for any water within the channels. SE were flushed with filtered compressed air. Dryness was monitored visually and by feeling for the impact of water spray at the distal tip of SE. Dryness of the channels before and after air flush was observed for the three SE for three trials each.ResultsAll the SE were grossly wet after HLD despite the AER’s alcohol flush and drying cycle. Hanging vertically had no effect on the narrow diameter channels. Applying compressed air to each channel was effective for drying the channels based on visual inspection and water emission from the distal tip of the SE. The filtered compressed air had a flow rate of 20 L/minute for an average of 2 minutes to assure complete dryness. The nozzle for applying the filtered compressed air was ill-fitting to the openings of the cylinders and ports on the control handle, making it difficult to get a good seal for applying the filtered compressed air.ConclusionThe AER’s drying cycle was not effective for drying endoscope channels. Vertical hanging had limited efficacy on endoscopic dryness. The application of filtered compressed air to individual channels was effective for drying the channels. This SE model was useful and direct for assessing the degree of moisture inside the channels. The application of filtered compressed air should be an essential step in endoscopic reprocessing regardless of the need for sterilization.Disclosures All Authors: No reported disclosures

Two novel protocols for cleaning residual simethicone and fluid in patient‐ready duodenoscopes

Approximately 42-95% of working channels have been reported to show the presence of residual fluid despite endoscope reprocessing. The aim of this study was to design two novel protocols for cleaning residual simethicone and demonstrate its efficiency by evaluating the residual fluid and cleanliness in the working channels of patient-ready duodenoscopes. The designed protocol for cleaning residual simethicone was implemented in manual cleaning and/or high-level disinfection (HLD). The residual fluid inside the working channels was estimated by visual inspection. Adenosine triphosphate (ATP) values were evaluated to determine cleanliness after manual cleaning. Manual cleaning with novel simethicone cleaning protocol demonstrated a significant decrease in fluid droplets (14.6±29.9 vs 0±0, P<0.001) and ATP values (157±196 relative light units [RLUs] vs 52±41 RLUs, P=0.031). HLD with simethicone cleaning protocol, using either enzymatic detergent with effective for cleaning simethicone or cleaning time set in the automatic endoscope reprocessor program for 8min, demonstrated significant decrease in the number of fluid droplets. Follow-up after the implementation of the simethicone cleaning protocol showed a significant decrease in fluid droplets (37.4±41.0 vs 2.1±5.5, P=0.003) and ATP values (271±268 RLUs vs 82±136 RLUs, P=0.021). Simethicone cleaning protocol is advantageous for significantly decreasing fluid droplets and ATP values within endoscope working channels. After manual cleaning with the simethicone cleaning protocol, in particular, no retained fluid droplet was observed in patient-ready duodenoscopes.

Analysis: Overcoming Human Factors Challenges of Endoscope Culturing with Turbulent Fluid Flow.

Analysis: Overcoming Human Factors Challenges of Endoscope Culturing with Turbulent Fluid Flow.