Disinfection Of Endoscopes Research Articles

Residual bioburden in reprocessed side-view endoscopes used for endoscopic retrograde cholangiopancreatography (ERCP).

Background and study aim: Worldwide some endoscopy units routinely continue to use manual reprocessing techniques for disinfection of side-view endoscopes. The aim of this study was to evaluate the outcome quality of manual reprocessing techniques for removal and inactivation of the bioburden from side-view endoscopes used for endoscopic retrograde cholangiopancreatography (ERCP) in a tertiary referral endotherapy unit in Sri Lanka. Methods: 102 samples obtained from two different flexible side-view endoscopes (Olympus TJF Q 180V and Olympus TJF 160 R) were tested for microbial growth. Three samples were collected each time; one swab from the tip before and another after manual reprocessing. The third sample was collected by flushing the working channel with sterile normal saline after manual reprocessing. Microorganisms were identified by culturing the samples. Result:: After reprocessing, culture-positive rates were 20 % and 9 % for the samples obtained from the tip and the working channel of the side-view endoscopes, respectively. Klebsiella spp. and Candida spp. were found to be the commonest microorganisms in the samples from the tips and from the working channels, respectively, of the reprocessed side-view endoscopes. Conclusion: There is a high culture-positive rate after reprocessing of the side-view endoscopes using the manual reprocessing procedure, despite strict adherence to the protocol for reprocessing.

Efficacy of ATP Bioluminescence as an Evaluation Method of Endoscopic Disinfection

The endoscopy has a higher risk of cross infection and due to its delicate structure and the nature of the material, the cleaning and disinfection process requires careful reprocessing to prevent cross infection. Recently, the ATP bioluminescence has been used to monitor the cleaning management in the medical environment. The ATP bioluminescence, therefore, may have a potential role in monitoring the reprocessing of endoscopes. The purpose of this study is to evaluate efficacy of ATP tracer as the method in the management of the endoscope reprocessing.

Disinfection and sterilization: An overview

All invasive procedures involve contact by a medical device or surgical instrument with a patient's sterile tissue or mucous membranes. The level of disinfection or sterilization is dependent on the intended use of the object: critical (items that contact sterile tissue such as surgical instruments), semicritical (items that contact mucous membrane such as endoscopes), and noncritical (devices that contact only intact skin such as stethoscopes) items require sterilization, high-level disinfection, and low-level disinfection, respectively. Cleaning must always precede high-level disinfection and sterilization.

Disinfection of flexible fibre-optic endoscopes out-of-hours: confidential telephone survey of ENT units in England – 10 years on

To audit out-of-hours flexible endoscope disinfection practice in England and compare the findings with a previously published first audit cycle, with the 2005 ENT UK guidelines as the key intervention. A telephone survey of the 104 ENT units in England was conducted out-of-hours, replicating the first cycle. The on-call clinician answered questions concerning access to flexible endoscopes, training, disinfection procedures and record keeping. Information regarding the clinician's trainee grade and their cross-covering duties was also acquired. Responses were compared to the first cycle results and published guidance. In total, 72 of the 104 units agreed to participate. The on-call clinician cleaned the flexible endoscope in 43 per cent of units. However, adequate training in disinfection only occurred in a minority of units (37 per cent), though this was an improvement from the first cycle (12 per cent). Furthermore, 27 per cent of units used an inadequate method of disinfection out-of-hours. One confounding factor may be the increase in cross-cover out-of-hours, with 68 per cent of respondents covering one or more other specialties. An overall moderate improvement in the safety of out-of-hours endoscopy in the past 10 years cannot obscure the urgent need for universal compliance with national guidelines.

Sterile water in endoscopy: habit, opinion, or evidence

Should sterile or tap water be used in irrigation bottles during endoscopy? The use of sterile water obviously increases the cost of endoscopy, not only in terms of actual costs, but also in terms of the costs to society and the environment because the plastic containers it comes in are discarded. Given the recent focus on the skyrocketing cost of health care and on the environment, this issue, although raised before, seems to be more controversial than ever. The American Society for Gastrointestinal Endoscopy (ASGE), the Society of Gastroenterology Nurses and Associates (SGNA), and The Society for Healthcare Epidemiology of America” (SHEA) have recommended using sterile water in sterile bottles during endoscopy. These recommendations form the basis of “standard protocol” at most endoscopy units. Herein, we discuss the evidence behind these recommendations. In their practice guidelines on infection control, the ASGE states that “water bottles should be disinfected or sterilized, and sterile water should be used in the water bottle.” However, the basis for this recommendation seems to stem from a study that addresses the importance of endoscope drying after endoscope reprocessing rather than the use of sterile water in bottles. This was confirmed with a personal communication with the author (LF Muscarella, February 16, 2010). The SGNA, in their position statement, comments that “sterile water should be used in the water bottle for all endoscopic procedures.” They reference the ASGE guidelines and the Association for Professionals in Infection Control (APIC) guidelines from 2000. The APIC guidelines recommend sterile water in bottles because “the water bottle and connecting tubes are difficult to clean and disinfect and are often colonized with Pseudomonas species and may serve as important reservoirs of crossinfection.” The 2000 APIC guidelines’ references include 2 articles on disinfection of endoscopes, from 1974 and 1978. In 1 study, the efficacy of ethyl alcohol and glutaraldehyde to disinfect fiberoptic endoscopes was compared. The wash bottles were disinfected by soaking them in the disinfectant for 10 minutes. The study was not designed to assess the use of sterile water, nor does it conclude anything about the use of sterile water. Interestingly, the tap water that was used in this study did not grow any bacteria. The second study addressed the efficacy of a 2-stage disinfecting procedure for the endoscopes, a short intermediate disinfection using polyvidoneiodine between 2 procedures and a main disinfection at the end of a series of procedures using glutaraldehyde. After disinfection with polyvidone-iodine (but not after glutaraldehyde), Pseudomonas aeruginosa was grown from the channels of the endoscope. The bacteria were also grown from the water bottle and the connection tube. The source was ultimately traced to a contaminatedmovable water tap. So this also is not pertinent to our question. Case reports from the 1970s and 1980s have reported Pseudomonas infections after ERCP and EUS. In these cases, although Pseudomonas was cultured from the endoscopy water bottles, it was unclear whether the source of infection was the endoscope or the water bottle. This study also predated current endoscope reprocessing guidelines. The above studies are all many years old, used dated disinfection techniques, and did not establish tap water or the bottle as the source of infection. We have gained valuable knowledge about disinfection in the past few years and have far better technology Abbreviations: APIC, Association for Professionals in Infection Control; ASGE, American Society for Gastrointestinal Endoscopy; SGNA, Society of Gastroenterology Nurses and Associates; SHEA, Society for Healthcare Epidemiology of America.

VOC Contamination in Hospital, from Stationary Sampling of a Large Panel of Compounds, in View of Healthcare Workers and Patients Exposure Assessment

BackgroundWe aimed to assess, for the first time, the nature of the indoor air contamination of hospitals.Methods and FindingsMore than 40 volatile organic compounds (VOCs) including aliphatic, aromatic and halogenated hydrocarbons, aldehydes, alcohols, ketones, ethers and terpenes were measured in a teaching hospital in France, from sampling in six sampling sites – reception hall, patient room, nursing care, post-anesthesia care unit, parasitology-mycology laboratory and flexible endoscope disinfection unit – in the morning and in the afternoon, during three consecutive days. Our results showed that the main compounds found in indoor air were alcohols (arithmetic means ± SD: 928±958 µg/m3 and 47.9±52.2 µg/m3 for ethanol and isopropanol, respectively), ethers (75.6±157 µg/m3 for ether) and ketones (22.6±20.6 µg/m3 for acetone). Concentrations levels of aromatic and halogenated hydrocarbons, ketones, aldehydes and limonene were widely variable between sampling sites, due to building age and type of products used according to health activities conducted in each site. A high temporal variability was observed in concentrations of alcohols, probably due to the intensive use of alcohol-based hand rubs in all sites. Qualitative analysis of air samples led to the identification of other compounds, including siloxanes (hexamethyldisiloxane, octamethyltrisiloxane, decamethylcyclopentasiloxane), anesthetic gases (sevoflurane, desflurane), aliphatic hydrocarbons (butane), esters (ethylacetate), terpenes (camphor, α-bisabolol), aldehydes (benzaldehyde) and organic acids (benzoic acid) depending on sites.ConclusionFor all compounds, concentrations measured were lower than concentrations known to be harmful in humans. However, results showed that indoor air of sampling locations contains a complex mixture of VOCs. Further multicenter studies are required to compare these results. A full understanding of the exposure of healthcare workers and patients to complex mixtures of chemical compounds can then be related to potential health outcomes.

内視鏡洗浄スタッフへのアンケート調査実施による内視鏡清浄度改善への取り組み

内視鏡洗浄スタッフへのアンケート調査実施による内視鏡清浄度改善への取り組み

耳鼻咽喉科領域における内視鏡の洗浄・消毒を考える

耳鼻咽喉科領域における内視鏡の洗浄・消毒を考える

Mycobactericidal activity of hydrogen peroxide activated by a novel heterogeneous Fentons-like catalyst system

To investigate the potential activation of hydrogen peroxide by a novel catalyst, reducing the concentration of hydrogen peroxide required and the time taken for mycobactericidal activity. The mycobactericidal properties of an iron-based novel heterogeneous-modified polyacrylonitrile (PAN) catalyst in combination with hydrogen peroxide were examined against Mycobacterium chelonae using a modified version of the European suspension test. Mycobactericidal activity was significantly increased when the modified PAN catalyst was combined with hydrogen peroxide. The 0·5% w/v hydrogen peroxide and 2-g catalyst system resulted in average Log reductions of >5·80 for Myco. chelonae at 30-min exposure at room temperature. This was a significant increase in activity (P < 0·01) compared to 0·5% w/v hydrogen peroxide alone. This study has expanded on previous work and knowledge of the modified PAN catalyst and hydrogen peroxide system, by providing evidence for mycobactericidal activity when the novel PAN catalyst is combined with hydrogen peroxide.

Surveillance cultures of samples obtained from biopsy channels and automated endoscope reprocessors after high-level disinfection of gastrointestinal endoscopes

BackgroundThe instrument channels of gastrointestinal (GI) endoscopes may be heavily contaminated with bacteria even after high-level disinfection (HLD). The British Society of Gastroenterology guidelines emphasize the benefits of manually brushing endoscope channels and using automated endoscope reprocessors (AERs) for disinfecting endoscopes. In this study, we aimed to assess the effectiveness of decontamination using reprocessors after HLD by comparing the cultured samples obtained from biopsy channels (BCs) of GI endoscopes and the internal surfaces of AERs.MethodsWe conducted a 5-year prospective study. Every month random consecutive sampling was carried out after a complete reprocessing cycle; 420 rinse and swabs samples were collected from BCs and internal surface of AERs, respectively. Of the 420 rinse samples collected from the BC of the GI endoscopes, 300 were obtained from the BCs of gastroscopes and 120 from BCs of colonoscopes. Samples were collected by flushing the BCs with sterile distilled water, and swabbing the residual water from the AERs after reprocessing. These samples were cultured to detect the presence of aerobic and anaerobic bacteria and mycobacteria.ResultsThe number of culture-positive samples obtained from BCs (13.6%, 57/420) was significantly higher than that obtained from AERs (1.7%, 7/420). In addition, the number of culture-positive samples obtained from the BCs of gastroscopes (10.7%, 32/300) and colonoscopes (20.8%, 25/120) were significantly higher than that obtained from AER reprocess to gastroscopes (2.0%, 6/300) and AER reprocess to colonoscopes (0.8%, 1/120).ConclusionsCulturing rinse samples obtained from BCs provides a better indication of the effectiveness of the decontamination of GI endoscopes after HLD than culturing the swab samples obtained from the inner surfaces of AERs as the swab samples only indicate whether the AERs are free from microbial contamination or not.

Reported Endoscope Reprocessing Breaches, Minnesota, 2010-2011

Background/Objectives: Endoscopic diagnostics and therapeutics increasingly are replacing invasive surgical procedures and are being performed in ambulatory and inpatient settings. Cleaning and disinfection of endoscopes and their accessories is complex and must be performed according to U. S. Food and Drug Administration (FDA) labeling and manufacturer instructions. Breaches in endoscope reprocessing can expose patients to viral and bacterial pathogens andmust be addressed on a case-by-case basis. Infection preventionists (IPs) play a fundamental role in identifying and investigating such breaches. State health departments have an expanding role in healthcare-associated infection prevention and consultation separate from regulatory functions. We discuss a state health department infectious disease epidemiology program's experience of providing public health consultation to guide the investigation of endoscope reprocessing breaches. Methods: Over the past 18 months, IPs from several healthcare facilities requested assistance after identifying incidents of inadequate endoscope reprocessing. In each situation, IPs collected information on the nature of the breach, facility type, clinical practices, endoscope/endoscopic accessories used, and cleaning/ disinfection procedures. In consultation with Centers for Disease Control and Prevention (CDC), the risk to patients, including pathogen transmission, was evaluated. Interventions such as patient notification, internal facility communication, and FDA notification were assessed and implemented as appropriate. Results: From 5/2010-9/2011, 7 endoscope reprocessing breaches were reported from 5 healthcare facilities (1 clinic, 1 ambulatory surgical center, 3 hospitals) and involved various endoscope types (upper GI endoscope [3], cystoscope [1], hysteroscope [1], colonoscope [1], transesophageal echocardiography scope [1]). Breaches were recognized by technicians (blood in the scope after reprocessing, scope occlusion due to broken accessory piece) or by IPs (cluster of bacterial infections post-endoscopic procedure, observation/audit of technician practices). These incidents resulted from incorrect use of endoscopic accessories, reprocessing of single use devices, or failure to follow FDA labeling and/or manufacturer reprocessing instructions. Four breaches were reported to FDA because the manufacturer and/or vendor representative provided incorrect instructions. To assist future breaches, we developed an endoscope breach assessment tool and list of resources. Conclusions: IPs associated with healthcare facilities where endoscopic procedures are performed should be familiar with national endoscope reprocessing guidelines. Reprocessing protocols and procedures must be assessed regularly, particularly when implementing equipment or procedure changes, and all staff involved with endoscopic procedures and/or reprocessing must receive regular education, training, and competency testing. State health departments should also be aware of national endoscope reprocessing guidelines and other resources in order to assist healthcare facilities in investigating breaches, including notifying patients, and reporting to FDA. IPs should be aware that the

A new peracetic acid solution for disinfection of digestive endoscope

Objective To evaluate the disinfective effect of a new peracetic acid solution for diges- tive endoscope. Methods Forty endoscopes were divided into experimental group and control group, 10 gas- troscopes and 10 enteroscopes in each group, the experimental group was disinfected with the new peracetic acid solution for 10 min, the control group was disinfected with 2% glutaral for 10 min, the disinfection effect was compared. Subsequently, 80 other endoscopes were divided into 4 groups, 10 gastroscopes and l0 enteroscopes in each group, each group was disinfected for 2 min, 3 rain, 4 min and 5 min, the disinfec- tion efficiency was evaluated. Results The disinfection rates of gastroscopes and enteroscopes in the control were 100% （10/10）and 90% （9/10）respectively. Bacteria were found in both endoscopes. In the experi- mental group, disinfection rates of both gastroseopes and enteroscopes were 100% （10/10）, and no bacteri- um was found, which was superior to the control, disinfection rates of gastroscopes of 3 min, 4 min and 5 min were all 100% （ 10/10）, which were higher than that of 2 min group （ 30% ） （ P 〈 O. 05 ）. Bacteria were found in 3 min group. Disinfection rates of 4 min and 5 min group were 100% （ 10/10）, which were higher than that of 3 min group （80%） （ P 〈 0. 05 ）. Bacteria were found in 4 min group, and 2 min group was not disinfected. Conclusion The new peraeetic acid solution is effective for clinic digestive endoscope disinfection, and is superior to 2% glutaral. Key words: Endoscopy; Disinfection ; Peroxyacetic acid; Glutaral

Aldehyde-resistant mycobacteria bacteria associated with the use of endoscope reprocessing systems

Bacteria can develop resistance to antibiotics, but little is known about their ability to increase resistance to chemical disinfectants. This study randomly sampled 3 automated endoscope reprocessors in the United States using aldehydes for endoscope disinfection. Bacterial contamination was found after disinfection in all automated endoscope reprocessors, and some mycobacteria isolates demonstrated significant resistance to glutaraldehyde and ortho-phthaldehyde disinfectants. Bacteria can survive aldehyde-based disinfection and may pose a cross-contamination risk to patients.

Reprocessing practice in digestive endoscopy units of district hospitals

An inadequate disinfection of endoscopes and associated accessories can result in the transmission of infections to patients. The aim of this study was to access reprocessing practice in the endoscopy units of Portuguese district general hospitals. An anonymous questionnaire on cleaning and disinfection methods was sent to all endoscopy units of Portuguese district general hospitals. A total of 25 units responded (93%). All endoscopy units performed manual cleaning (including brushing of accessible channels) before disinfection. Automated endoscope reprocessing machines were available in all units. Manual disinfection was performed in only one unit. In 48% of the surveyed units, endoscopes were systematically disinfected before each session, whereas in 16% this was performed only occasionally. The most commonly used disinfectant was peracetic acid (32%). Disposable papillotomes, biopsy forceps, and polipectomy snares were used in nine (36%), six (24%), and 14 (56%) units, respectively. Disposable papillotomes, forceps, and snares were reused in three (12%), two (8%), and three (12%) units, respectively, always after sterilization. Most units did not perform regular evaluation of reprocessing staff competence (60%), regular microbiological inspection (56%), or registry of reprocessing (56%). The data collected suggest that there is a good compliance with standard guidelines. Nevertheless, there is still room for improvement mainly in quality assurance.

Research on failure mode and effect analysis in endoscope disinfection management

Objective To identify and investigate the cause of the unacceptable bacteria level inside the lumen of fiberendoscope during monitoring so as to increase the pass rate of its cleaning and disinfection. Methods A failure mode effect analysis of the cause was done and the workflow was thereafter improved. Meanwhile, pre and post bacteriological monitor was applied to the fiberendoscope lumen samples. Results The number of scrubbing times while manual cleaning affected the monitoring results. The scrubbing times was amended and the pass rate increased from 84.15% to 98.65%. The results were significantly different The failure mode risk index of endoscope cleaning and disinfection was calculated, and the highest two items were: The number of scrubbing times the operators execute RPN=640, the method of lumen cleaning RPN=480. These were the key factors of qualification of monitoring. Conclusions After the amendment, no less than 5 times' scrubbing was required and the bacteriological monitoring method was used to analyze the effects,thereafter the pass rate of lumen bacteria monitoring can be increased significantly. Key words: Fiberendoscope; Lumen; Failure mode and effective analysis; Bacteriology monitor

The management of potential exposures to Cretuzfeld-Jakob Disease (CJD) via endoscopy

We describe the case of a 68-year-old male with autopsy-confirmed sporadic CJD (CJDs) who had undergone 2 colonoscopies prior to this diagnosis. The involved endoscopy centre had multiple colonoscopes and gastroscopes that are cleaned and disinfected in the same automatic washers/disinfectors (AWD). There was no system in place to track the use and disinfection of individual endoscopes. Four questions arise: - Is it necessary to dispose of colonoscopes potentially contaminated by CJDs? - Is it necessary to dispose of the AWD where the endoscopes were washed? - Is it necessary to dispose gastroscopes at risk of contamination during the disinfection process in the AWD? - Is it necessary to inform the patients who were exposed to these endoscopes ?

Current status of cleaning and disinfection for gastrointestinal endoscopy in China: A survey of 122 endoscopy units

Background Adequate compliance with the existing guidelines for cleaning and disinfection of gastrointestinal endoscopes and accessories is necessary to obtain high-level disinfection and prevent pathogen transmission. Aim To investigate cleaning and disinfection practice in China. Methods A questionnaire with 21 questions concerning gastrointestinal endoscopy reprocessing was sent by e-mail to 189 endoscopy units in China. Results One hundred and twenty-two (80.39%) of the 189 units responded. Compared with the low-workload units (<5000 procedures/year), the high-workload units (≥5000 procedures/year) had a significantly higher number of gastrointestinal endoscopes (25.8 ± 3.6 vs. 4.7 ± 1.8, p < 0.01) and the higher possessing rate of automated endoscope reprocessors (43.9% vs. 3.1%, p < 0.01). Glutaraldehyde was the most commonly employed disinfectant (88.5%) in all the units. In 23/122 (18.8%) units, the exposure time to glutaraldehyde was <45 min in the case of infectious disease patients. Eighty-six of 122 (70.5%) units reused disposable materials, of which 21/86 (24.4%) reused disposable forceps and disposable polypectomy hooks, and 2/86 (1.6%) reused disposable injection needles intermittently. Conclusion Although gastrointestinal endoscopy has developed rapidly in China in the past decade, there is still room for improvement in the practice of endoscopy reprocessing, especially in middle-sized and small cities.

Contrôles microbiologiques des endoscopes au centre hospitalier régional de Brest du 1 er janvier 2007 au 31 décembre 2009

Objectives The aim of this study is to evaluate the quality of disinfection of endoscopes at Brest hospital over a period from 2007 to 2009. Patients and methods Retrospective study of microbiological investigations of endoscopes done at Brest hospital from 2007 to 2009. The interpretation of the microbiological investigations is based on the recommendations of the Comité technique national des infections nosocomiales et infections liées aux soins (CTINILS) of 2007. Results Most of the controls realized over the period deal with gastroenterological endoscopes (63.4 %) and bronchial endoscopes (21.8 %). Most of the controls (66.8 %) are conformed to the target level. Only 26.7 % of the controls get the level of action. Globally, the rate of level of action significantly increases ( p = 0.004) from 2007 (21.2 %) to 2009 (35.6 %). This increase is relatively important in gastroenterology endoscopy (46.8 % in 2009 versus 24.1 % in 2007) whereas the rate decreases in bronchial endoscopy (14.8 % in 2009 versus 25.9 % in 2007). In gastroenterological endoscopy, rates vary with the type of endoscopes and the context of controls, but there is no significant difference between manual disinfection and automated disinfection. The most frequent germ found in gastroenterological and bronchial endoscopies is Pseudomonas aeruginosa. Conclusion Our results show that it is very difficult to insure a perfect disinfection of endoscopes. Difficulties met are certainly related with the complexity of the endoscopes and of the techniques of disinfection. Infections of patients are very infrequent in endoscopy, which takes the question of the pertinence of the threshold used for microbiological investigations.

A Study of Infection Control and Prevention Related to Cleaning and Disinfection of Nasopharyngeal Endoscopes

A Study of Infection Control and Prevention Related to Cleaning and Disinfection of Nasopharyngeal Endoscopes

Computer-aided recording of automatic endoscope washing and disinfection processes as an integral part of medical documentation for quality assurance purposes.

BackgroundThe reprocessing of medical endoscopes is carried out using automatic cleaning and disinfection machines. The documentation and archiving of records of properly conducted reprocessing procedures is the last and increasingly important part of the reprocessing cycle for flexible endoscopes.MethodsThis report describes a new computer program designed to monitor and document the automatic reprocessing of flexible endoscopes and accessories in fully automatic washer-disinfectors; it does not contain nor compensate the manual cleaning step. The program implements national standards for the monitoring of hygiene in flexible endoscopes and the guidelines for the reprocessing of medical products. No FDA approval has been obtained up to now. The advantages of this newly developed computer program are firstly that it simplifies the documentation procedures of medical endoscopes and that it could be used universally with any washer-disinfector and that it is independent of the various interfaces and software products provided by the individual suppliers of washer-disinfectors.ResultsThe computer program presented here has been tested on a total of four washer-disinfectors in more than 6000 medical examinations within 9 months.ConclusionsWe present for the first time an electronic documentation system for automated washer-disinfectors for medical devices e.g. flexible endoscopes which can be used on any washer-disinfectors that documents the procedures involved in the automatic cleaning process and can be easily connected to most hospital documentation systems.