Cleaning Of Endoscopes Research Articles

Simulated-use evaluation of rapid ChannelCheck™ cleaning test for optimal detection of organic residues in flexible endoscope channels

The need to monitor manual cleaning of high-risk endoscopes is recommended or more so required by the current endoscope reprocessing guidelines. The objective of this study was to establish the optimal extraction volume for colonoscopes and bronchoscopes and demonstrate the extraction efficacy for the ChannelCheck™ rapid test. The test soil utilized as a positive control was ATS2015 containing 20% defibrinated bovine blood. The extraction from the instrument channel of a colonoscope and bronchoscope was evaluated to establish the optimal extraction volume and the extraction efficacy for protein, carbohydrate and haemoglobin. Of the extraction volumes tested, 10mL was optimal for both colonoscopes and bronchoscopes. The extraction efficacy was 91% for carbohydrate, 83.7% for haemoglobin and 82.4% for protein. The limit of detection for these analytes by the ChannelCheck rapid test meet or exceed the established levels that correlate with adequate manual cleaning of flexible endoscopes.

Efficacy and safety of a self-expandable retainer in endoscopic ear surgery.

During endoscopic ear surgery (EES), it is important to maintain a clear view of the endoscopic camera to achieve a clean field. In this study, a self-expandable external auditory canal (EAC) retainer was developed to enable a more efficient and safer EES. This study aimed to evaluate the retainer's efficacy and safety in EES. Among adult patients scheduled for endoscopic tympanoplasty, 50 participants were recruited. They were assigned to either the retainer or control group in a 1:1 ratio. The anatomical characteristics, number of endoscopic cleanings during surgery, surgeon's satisfaction, and other factors were evaluated. No differences were observed in the surgical direction, EAC size measured on preoperative temporal bone computed tomography scans, location and size of tympanic membrane perforation, or bleeding degree between the two groups. When comparing the surgical time, including retainer insertion and removal, the time was similar between groups (retainer group, 35min; control group, 33.2min). The frequency of endoscopic cleaning per minute was statistically significantly lower in the retainer group than in the control group (0.18 times per minute, p = 0.048). No side effects, including sensory abnormalities or allergic reactions, were reported in any patient who used the retainer. A reduction in unnecessary endoscopic cleaning during EES was observed while using the self-expandable retainer, leading to increased surgeon satisfaction and efficiency. Furthermore, as a safe method without side effects, the retainer could be widely used to various indications for EES beyond tympanoplasty.

Potential effects of aerosol generation and transmission during bedside endoscope cleaning.

Airborne transmission is among the most frequent types of nosocomial infection. Recent years have witnessed frequent outbreaks of airborne diseases, such as severe acute respiratory syndrome (SARS) in 2002, Middle East respiratory syndrome (MERS) in 2012, and coronavirus disease 2019 (COVID-19), with the latter being on the rampage since the end of 2019 and bringing the effect of aerosols on health back to the fore (Gralton et al., 2011; Wang et al., 2021). An increasing number of studies have shown that certain highly transmissible pathogens can maintain long-term stability and efficiently spread through aerosols (Leung, 2021; Lv et al., 2021). As reported previously, influenza viruses that can spread efficiently through aerosols remain stable for a longer period compared to those that cannot. The World Health Organization (WHO) has stated that aerosol-generating procedures (AGPs) play an important role in aerosol transmission in hospitals (Calderwood et al., 2021). AGPs, referring to medical procedures that produce aerosols, including dental procedures, endotracheal intubation, sputum aspiration, and laparoscopic surgeries, have been reported to be significantly associated with an increased risk of nosocomial infection among medical personnel (Hamilton, 2021).

Costs involved in compliance with new endoscope reprocessing guidelines.

In March 2022, the Association for the Advancement of Medical Instrumentation (AAMI) released the American National Standards Institute (ANSI)/AAMI ST91:2021, their latest update on comprehensive, flexible, and semirigid endoscope reprocessing. These updated standards recommend the sterilization of high-risk endoscopes when possible and provide new recommendations for the precleaning, leak testing, manual cleaning, visual inspection, automated reprocessing, drying, storage, and transport of endoscopes. ANSI/AAMI ST91:2021 was compared with ANSI/AAMI ST91:2015 for major reprocessing differences that result in either time and/or cost increases. Time estimates were captured by explicit recommendation inclusion or taken from the literature. All the costs were estimated using publicly available resources. The updated standards represent a potential 24.3-minute and 52.35 to 67.57 United States dollars increase per procedure in terms of reprocessing time and spending, respectively, not including capital investments. Capital costs per procedure were highly dependent on the procedure volume of the facility. The new AAMI standards recommend several major changes, such as sterilization, for facilities to reprocess and manage endoscopes between uses. As more facilities increase their reprocessing methods to reflect the updated standards, they do so at a cost and introduce several delays. As the reprocessing landscape evolves, facilities should consider their true costs and alternative solutions, such as single-use endoscopes.

Assessment of endoscope reprocessing at World Gastroenterology Organisation training centers using adenosine triphosphate testing.

Background and study aims Adequacy of endoscope disinfection in resource-limited settings is unknown. Adenosine triphosphate (ATP) testing is useful for evaluation of endoscope reprocessing, and ATP <200 relative light units (RLUs) after manual endoscope cleaning has been associated with adequacy of endoscope disinfection. Methods Consecutive endoscopes undergoing reprocessing at five World Gastroenterology Organisation (WGO) training centers underwent ATP testing before and after an on-site educational intervention designed to optimize reprocessing practices. Results A total of 343 reprocessing cycles of 65 endoscopes were studied. Mean endoscope age was 5.3 years (range 1-13 years). Educational interventions, based on direct observation of endoscope reprocessing practices at each site, included refinements in pre-cleaning, manual cleaning, high-level disinfection, and endoscope drying and storage. The percentage of reprocessing cycles with post-manual cleaning ATP ≧200 decreased from 21.4% prior to educational intervention to 14.8% post-intervention ( P =0.11). In multivariable logistic modelling, gastroscopes were significantly less likely (odds ratio [OR] 0.04, 95% confidence interval [CI] 0.01-0.19; P <0.001) than colonoscopes to achieve post-manual cleaning ATP < 200. No other factor (educational intervention, study site, endoscope age) was significantly associated with improved outcomes. Endoscope ID was not significantly associated with ATP values, and sites that performed manual versus automated HLD did not have significantly different likelihood of post-manual cleaning ATP <200 (OR 1.18, 95% CI 0.56-2.50; P =0.67). Conclusions In resource-limited settings, approximately 20% of endoscope reprocessing cycles may result in inadequate disinfection. This was not significantly improved by a comprehensive educational intervention. Alternative approaches to endoscope reprocessing are needed.

Latest Patents for Endoscopic Cleaning, Disinfection Devices, and Lavage Fluid Collection &amp; Filtration Devices

Background: With ageing, the population, and the increasing number of people with compromised immunity, environmental problems are becoming increasingly severe. Infants and older people are greatly affected by respiratory airway blockages, such as phlegm accumulation leading to poor breathing or foreign bodies entering the body, thereby, increasingly complicating respiratory infectious diseases, and raising the demand for endoscopes. The endoscope can observe the pathological conditions and morphological changes of human diseased tissues and carry out corresponding ‘dredging". Endoscope lavage is an essential medical means to improve dyspnea and extract foreign bodies, so it has been widely used in medicine. Objective: To review the research status of the endoscope by combining the latest developments and technologies of endoscope cleaning and disinfection systems, lavage collection, and filtration systems in recent years (from 2015 to now) to achieve the purpose of continuous improvement and optimization of the endoscope Methods: By analyzing the patent features of the endoscope in the cleaning and disinfecting system and the irrigation fluid collection and filtration system, it shows that there is a greater risk of hospital cross-infection when the endoscope uses to make a diagnosis of a disease before it is applied to the human body and under direct vision, or when biopsy of a lesion is performed to make a pathological diagnosis, which explains that it is necessary to clean and disinfect the medical endoscope and collect the irrigation fluid beforehand. At the same time, to reduce patients' pain by performing only one irrigation procedure, it is crucial to filter the irrigation fluid to achieve a more accurate examination of the irrigation fluid biopsy. Results: By comparing the main problems existing in the endoscope, to prospect the development trend of the endoscope. Conclusion: By improving and optimizing the cleaning and disinfection system, the irrigation fluid collection, and the filtration system of the endoscope, the loopholes in the current technology can be solved and made more practical.

Guidelines in Practice: Processing Flexible Endoscopes.

Flexible endoscopes allow surgeons and proceduralists to view patients' internal organs through small incisions or natural orifices. These devices may be difficult to clean and dry adequately, and the formation of biofilm can further complicate effective cleaning. The updated AORN "Guideline for processing flexible endoscopes" provides perioperative personnel with evidence-based best practice recommendations on a variety of concepts associated with this topic. This article provides an overview of the guideline and discusses recommendations for point-of-use treatment, transport, cleaning (including verification and drying), and storage of flexible endoscopes. It also includes a scenario that illustrates the importance of adequately drying and storing flexible endoscopes. When processing flexible endoscopes, personnel should adhere to the endoscope and processing equipment manufacturers' instructions for use. Perioperative nurses should review the guideline in its entirety and implement recommendations in practice settings where flexible endoscopes are used.

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.

Criteria for the Use, Processing, and Disposal of Flexible Endoscope Cleaning Brushes.

Objectives: To ensure effectiveness in the endoscope channel cleaning process, using functional brushes that are in good condition is necessary. This study sought to identify the criteria for acquiring, using, and disposing of cleaning brushes at endoscopy facilities in Brazil. We further sought to evaluate the conditions of the cleaning brushes in use in the facilities. Methods: This cross-sectional study was conducted between July 2021 and January 2022. Personnel responsible for processing endoscopes were interviewed regarding the use, processing, and disposal of flexible endoscope cleaning brushes. In addition, the brushes used to clean the equipment were inspected. Results: All participants interviewed reported the practice of brushing endoscope channels. Of them, 60% noted the use of disposable brushes, with 40% using reusable brushes. None of the facilities interviewed reported discarding disposable brushes after use. The protocols for disposal of brushes included disposing due to bristle wear (70%), disposal at the end of the day (20%), and an absence of disposal protocols (10%). In addition, 30% of facilities did not clean the bristles before reintroducing them into the channel/lumen, and no facility had an established routine for cleaning brushes between uses. Inspection of brushes revealed that only 20% of facilities had new brushes with no signs of wear or damage. Conclusion: The use of inappropriate brushes/sponges for cleaning endoscope channels and the lack of criteria for the reuse and disposal of brushes increases the risk of cross-contamination, internal damage to channels, and biofilm formation.

Mpox: What Practicing Gastroenterologists Need to Know

Mpox: What Practicing Gastroenterologists Need to Know

Continuous Improvement of Cleaning and Disinfection Quality of Soft Digestive Endoscopes

Continuous Improvement of Cleaning and Disinfection Quality of Soft Digestive Endoscopes

ST91: Extensive Updates for Endoscope Cleaning, Patient Safety

Journal of Clinical Engineering: 4/6 2022 - Volume 47 - Issue 2 - p 69-71 doi: 10.1097/JCE.0000000000000517

Cleaning of in-hospital flexible endoscopes: Limitations and challenges.

Objective: to analyze the cleaning process of gastroscopes, colonoscopes and duodenoscopes in eight in-hospital health services.Method: a cross-sectional study conducted with 22 endoscopes (eight gastroscopes, eight colonoscopes and six duodenoscopes), and microbiological analysis of 60 samples of air/water channels (all endoscopes) and elevator (duodenoscopes), in addition to protein testing. Descriptive statistics with calculation of frequencies and central tendency measures was used in data analysis.Results: the processing of 22 endoscopes was monitored with microbiological analysis for 60 channels. In the pre-cleaning procedure, in 82.3% (14/17) of the devices, gauze was used in cleaning the insertion tube. Incomplete immersion of the endoscope in detergent solution occurred in 72.3% (17/22) of the cases, and in 63.6% (14/22) there was no standardization of filling-in of the channels. Friction of the biopsy channel was not performed in 13.6% (3/22) of the devices. In the microbiological analysis, 25% (7/32) of the samples from the stored endoscopes were positive for microbial growth (from 2x101 to 9.5x104 CFU/mL), while after processing, contamination was 32% (9/28). Protein residues in the elevator channel were detected in 33% of duodenoscopes.Conclusion: the results indicate important gaps in the stages of pre-cleaning and cleaning of endoscopes that, associated with presence of protein residues and growth of microorganisms of epidemiological importance, indicate limitations in safety of the processing procedures, which can compromise the disinfection processes and, consequently, their safe use among patients subjected to such tests.

Cleaning of in-hospital flexible endoscopes: Limitations and challenges

Resumen Objetivo: analizar el proceso de limpieza de gastroscopios, colonoscopios y duodenoscopios en ocho servicios de salud intrahospitalarios. Método: estudio transversal con 22 endoscopios, de los cuales ocho eran gastroscopios, ocho colonoscopios y seis duodenoscopios, y análisis microbiológico de 60 muestras de los canales de aire/agua (todos los endoscopios) y elevador (duodenoscopios), además de prueba de proteínas. En el análisis de los datos se utilizó estadística descriptiva, con cálculo de frecuencias y medidas de tendencia central. Resultados: el procesamiento de los 22 endoscopios fue monitoreado con el análisis microbiológico de 60 canales. En la prelimpieza, en el 82,3% (14/17) de los equipos se utilizó gasa para limpiar el tubo de inserción. En el 72,3% (17/22) de los casos la inmersión del endoscopio en solución detergente fue incompleta y en el 63,6% (14/22) no hubo estandarización del llenado de los canales. La fricción del canal de biopsia no se realizó en el 13,6% (3/22) de los equipos. En el análisis microbiológico, el 25% (7/32) de las muestras endoscópicas almacenadas dio positivo para crecimiento microbiano (2x101 a 9,5x104 UFC/ml), mientras que después del procesamiento, la contaminación fue del 32% (9/28). Se detectaron residuos de proteína en el canal elevador en el 33% de los duodenoscopios. Conclusión: los resultados indican que hay importantes lagunas en las etapas de prelimpieza y limpieza de los endoscopios que, junto con la presencia de residuos de proteínas y del crecimiento de microorganismos de importancia epidemiológica, indican limitaciones en la seguridad del procesamiento, que pueden comprometer los procesos de desinfección y, por ende, el uso seguro en los pacientes que se someten a esos procedimientos.

Cleaning of in-hospital flexible endoscopes: Limitations and challenges

Resumo Objetivo: analisar o processo de limpeza de gastroscópios, colonoscópios e duodenoscópios em oito serviços de saúde intra-hospitalar. Método: estudo transversal com 22 endoscópios, sendo oito gastroscópios, oito colonoscópios e seis duodenoscópios, e análise microbiológica de 60 amostras dos canais de ar/água (todos os endoscópios) e elevador (duodenoscópios), além de teste de proteína. Na análise dos dados, utilizou-se estatística descritiva, com cálculo de frequências e medidas de tendência central. Resultados: o processamento de 22 endoscópios foi acompanhado com análise microbiológica de 60 canais. Na pré-limpeza, em 82,3% (14/17) dos equipamentos, foi utilizada gaze na limpeza do tubo de inserção. A imersão incompleta do endoscópio em solução detergente ocorreu em 72,3% (17/22) dos casos, e em 63,6% (14/22) não havia padronização do preenchimento dos canais. A fricção do canal de biópsia não foi realizada em 13,6% (3/22) dos equipamentos. Na análise microbiológica, 25% (7/32) das amostras dos endoscópios armazenados foram positivas para crescimento microbiano (2x101 a 9,5x104 UFC/mL), enquanto após o processamento, a contaminação foi de 32% (9/28). Resíduos de proteína no canal do elevador foram detectados em 33% dos duodenoscópios. Conclusão: os resultados apontam lacunas importantes nas etapas de pré-limpeza e limpeza dos endoscópios que, associadas à presença de resíduos de proteína e ao crescimento de microrganismo de importância epidemiológica, sinalizam limitações na segurança do processamento, que podem comprometer os processos de desinfecção e consequentemente seu uso seguro entre pacientes submetidos a tais exames.

Single-use Albarran module: A removable elevator system to enhance safety in biliary endoscopy?

Bacterial infections are a major burden in biliary endoscopy. Besides incomplete manual cleaning of endoscopes, hard-to-clean components of duodenoscopes are responsible for a substantial rate of bacterial contamination. A large meta-analysis showed that 15 % of duodenoscopes harbored microorganisms of gastrointestinal or oral origin, independent from the colony forming unit (CFU) count. This indicates that the current reprocessing and process control procedures, even with ethylene oxide (ETO), could be insufficient [1]. Therefore, US Food and Drug Administration (FDA) warnings led companies to redesign duodenoscopes with the aim of enhancing safety. Disposable caps or caps + elevator are available options on the market [2] [3]. Moreover, two disposable duodenoscopes models have recently been approved by the FDA: the Boston Scientifc EXALT Model D and the Ambu A/S Ambu aScope Duodeno. Studies on disposable duodenoscope feasibility and possible economic impact on the market yielded interesting results, although the data are still preliminary [4] [5] [6] [7] [8].

In vitro comparison of 3 different brushes for manual cleaning of endoscopes.

In vitro comparison of 3 different brushes for manual cleaning of endoscopes.

Risk evaluation of duodenoscope-associated infections in the Netherlands calls for a heightened awareness of device-related infections: a systematic review.

The risk of exogenous infections from endoscopic procedures is often cited as almost negligible (1 infection in 1.8 million procedures); however, this risk is based on older literature and does not seem to match the number of infectious outbreaks due to contaminated duodenoscopes reported after endoscopic retrograde cholangiopancreatography (ERCP). Using Dutch data, we aimed to estimate the minimum risk of duodenoscope-associated infection (DAI) and colonization (DAC) in patients undergoing ERCP. A systematic literature search identified all DAI outbreaks in the Netherlands reported between 2008 and 2019. Included cases were confirmed by molecular matching of patient and duodenoscope cultures. Risk ratios were calculated based on the total number of ERCPs performed during the study period. Three outbreaks were reported and published between 2008 and 2018, including 21 confirmed DAI cases and 52 confirmed DAC cases. The estimated number of ERCPs performed during the same period was 181 209-227 006. The calculated minimum estimated DAI risk was approximately 0.01 % and the minimum estimated DAC risk was 0.023 %-0.029 %. The estimated risk of DAI in Dutch ERCP practice was at least 180 times higher than previously published risk estimates. The actual risk is likely to be (much) higher due to underreporting of infections caused by multidrug-resistant organisms and sensitive bacteria. Greater awareness by healthcare personnel involved in endoscopy and endoscope cleaning is required, as well as innovative technical solutions to contain and ultimately eliminate DAIs.

Establishment of a quality control circle to reduce biofilm formation in flexible endoscopes by improvement of qualified cleaning rate.

ObjectiveIn recent years, the Emergency Care Research Institute has advised that endoscope cleaning is of considerable importance. In the present study, a quality control circle (QCC) was used to reduce the formation of biofilms in flexible endoscopes within one hospital in Guangdong Province, China.MethodsDuring reprocessing of 235 flexible endoscopes in the urology surgical suite, adenosine triphosphate (ATP) detection was used to monitor the efficacy of biofilm removal. The internal and external parts of flexible endoscopes were used as sampling sites by means of the flushing and smudge methods, respectively. When the two results reached the standard of less than 500 relative light units/piece at the same time, endoscopic biofilm clearance was considered to be qualified. A QCC was established to implement a 10-step plan-do-check-act model.ResultsThe baseline qualified rate (i.e., ATP monitoring pass rate) during reprocessing of 235 flexible endoscopes was 50%. During the study, the qualified rate increased to 85.29% after establishment of the QCC. During reprocessing of 150 flexible endoscopes in the following 6 months, the qualified rate remained at 90%.ConclusionEstablishment of the QCC improved the removal of biofilm from flexible endoscopes in the urology surgical suite.

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

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