Endoscope Decontamination Research Articles

Endoscopic decontamination of massive, modified release venlafaxine overdose

Pharmacobezoars, which are bezoars comprised of medications, are considered a rare phenomenon encountered in overdose patients.

Evaluating Cold Atmospheric Plasma for Endoscope Decontamination: Feasibility and Impact Analysis on PTFE Surfaces

Evaluating Cold Atmospheric Plasma for Endoscope Decontamination: Feasibility and Impact Analysis on PTFE Surfaces

Evaluation of cold atmospheric plasma for the decontamination of flexible endoscopes

Despite adherence to standard protocols, residues including live microorganisms may remain on the various surfaces of reprocessed flexible endoscopes. Prions are infectious proteins notoriously difficult to eliminate. We tested the potential of cold atmospheric plasma (CAP) for the decontamination of flexible endoscope various surfaces, measuring total proteins and prion-residual infectivity as an indicator of efficacy. New PTFE endoscope channels and metal test surfaces spiked with test soil or prion-infected tissues were treated using different CAP-generating prototypes. Surfaces were then examined for the presence of residues using very sensitive fluorescence epi-microscopy. Prion residual infectivity was determined using the wire implant animal model and a new, more sensitive cell infectivity assay. A CAP jet applied perpendicularly at close range on flat test surfaces removed soil within 3 minutes but left microscopic residues and failed to eliminate prion infectivity according to the wire implant animal assay. The longitudinal gas flow from CAP prototypes developed for the treatment of long channels led to the displacement and sedimentation of residual soil towards the distal end, when applied alone. Observations of the plasma inside glass tubes showed temporal and spatial heterogeneity within a limited range. After standard enzymatic manual pre-wash, "CAP-activated" gas effluents prevented prion transmission from treated endoscope channels according to our prion infectivity cell assay. CAP shows promising results as a final step for surgical surfaces decontamination. Optimising CAP delivery could further enhance CAP efficacy, offering a safe, chemical-free alternative for the reprocessing of all luminal flexible endoscope surfaces.

Final rinse water quality for flexible endoscopy to minimize the risk of post-endoscopic infection. Report from Healthcare Infection Society Working Party

Endoscopic procedures in diagnostic and surgical settings are performed routinely and the number of patients undergoing these procedures is progressively increasing. Outbreaks and sporadic cases of infection associated with the use of endoscopes have decreased due to improvements in endoscope decontamination. The majority of infections occur due to the failure in endoscope reprocessing; however, microbial contamination of the final rinse water has been implicated in some outbreaks and pseudo-outbreaks.

A Cost-Effectiveness Analysis of Exalt Model D Single-Use Duodenoscope Versus Current Duodenoscope Reprocessing Methods

Background and AimsThe spread of duodenoscope-related infections has led to the recognition that reprocessing of duodenoscopes using high-level disinfection (HLD), if done perfectly, narrowly meets the advised thresholds of endoscope decontamination. In 2019, the US Food and Drug Administration (FDA) recommended a transition to duodenoscopes designed to pose less risk, including the use of disposable duodenoscopes. The Exalt Model D (Boston Scientific Corp, Marlborough, MA) single-use duodenoscope (EXALT) has been shown to be substantially equivalent to reusable duodenoscopes for clinical use. The aim of this study was to estimate the cost-effectiveness of EXALT in the United States healthcare system. MethodsA cost-effectiveness model was developed comparing HLD, culture-and-quarantine (CQ), Ethylene oxide sterilization (ETO), and EXALT in a simulated cohort undergoing Endoscopic Retrograde Cholangiopancreatography (ERCP) for choledocholithiasis. Published information was leveraged describing clinical estimates, infectious outbreaks, and hospital costs. ResultsIn a base analysis, HLD was the least costly ($962), and EXALT was the costliest ($3000), but yielded the most QALYs (0.0172 incremental QALYs). The incremental cost-effectiveness ratio was $38,461 for ETO gas sterilization and $62,185 for EXALT. However, with the availability of device-specific reimbursement for EXALT in the US in the form of transitional pass-through payment (TPT) and new technology add-on payment (NTAP), EXALT provided the highest cost-savings to the hospital versus alternative strategies by maintaining QALY gains while decreasing estimated net costs. Probabilistic sensitivity analyses showed EXALT to be preferred compared to HLD over a range of willingness-to-pay. ConclusionEXALT is a viable and cost-effective strategy that should be strongly considered for ERCP.

The global impact of COVID-19 on gastrointestinal endoscopy units: An international survey of endoscopists

Background & study aimsCorona virus disease-19 (COVID-19) pandemic has markedly impacted routine medical services including gastrointestinal (GI) endoscopy. We aim to report the real-life performance in high volume GI endoscopy units during the pandemic. Patients and methodsA web-based survey covering all aspects of daily performance in GI endoscopy units was sent to endoscopy units worldwide. Responses were collected and data were analyzed to reveal the effect of COVID-19 pandemic on endoscopy practice. ResultsParticipants from 48 countries (n = 163) responded to the survey with response rate of 67.35%. The majority (85%) decreased procedure volume by over 50%, and four endoscopy units (2.45%) completely stopped. The top three indications for procedures included upper GI bleeding (89.6%), lower GI bleeding (65.6%) and cholangitis (62.6%). The majority (93.9%) triaged patients for COVID-19 prior to procedure. N95 masks were used in (57.1%), isolation gowns in (74.2%) and head covers in (78.5%). Most centers (65%) did not extend use of N95 masks, however 50.9% of centers reused N95 masks. Almost all (91.4%) centers used standard endoscopic decontamination and most (69%) had no negative pressure rooms. Forty-two centers (25.8%) reported positive cases of SARS-CoV-2 infection among patients and 50 (30.7%) centers reported positive cases of SARS-CoV-2 infection among their healthcare workers. ConclusionsMost GI endoscopy centers had a significant reduction in their volume and most procedures performed were urgent. Most centers used the recommended personal protective equipment (PPE) by GI societies however there is still a possibility of transmission of SARS-CoV-2 infection in GI endoscopy units.

Endoscope decontamination: making the guidance work in practice

Endoscope decontamination prevents cross-infection and misdiagnosis. Legislation and guidance exist to ensure this, and Joint Advisory Group (JAG) accreditation is dependent on correct adherence. Due to their cost and complex construction, endoscopes have to be decontaminated between patients. Manual cleaning is an integral part of the decontamination process and helps ensure prions, which can transmit Creutzfeldt-Jakob disease (CJD), are cleared. Guidelines and standards include Medicines and Healthcare products Regulatory Agency (MHRA) Top Ten Tips, British Society of Gastroenterology (BSG) guidance, Department of Health and Social Care (DHSC) advice and the health technical memorandum, MTH-01-06. Over recent years, guidance has been updated. Changes incorporate tracking and traceability, levels of essential practice and best practice requirements, time from bedside clean to endoscope washer disinfection processing and issues around CJD. Guidance includes following the manual decontamination process, use of endoscope washer disinfectors, choice of disinfectants, rinse-water quality, safety, endoscope storage, operational management, environmental design and training. By following the most up-to-date guidance and legislation, nurses can ensure the safety of both patients and staff.

Occupational asthma caused by peracetic acid-hydrogen peroxide mixture.

Healthcare practice in the UK has moved away from using aldehyde disinfectants for the decontamination of endoscopes, in part due to the risk of respiratory sensitization. Peracetic acid (PAA) in combination with hydrogen peroxide (HP) is a commonly used alternative. We describe a case of occupational asthma (OA) diagnosed at our specialist occupational lung disease clinic and caused by occupational exposure to PAA-HP mixture, used as a disinfectant in an endoscope washer-disinfector machine. A 48-year-old man employed as a mycologist and environmental microbiologist at a Birmingham city hospital, UK, presented following an acute exposure to PAA-HP mixture causing lacrimation, burning optic pain and headache. He had also experienced symptoms suggestive of OA for the preceding 10 months, and the diagnosis was confirmed through OASYS analysis of serial peak expiratory flow measurements. He had been exposed to PAA-HP mixture whilst working in the endoscopy department for 12 months prior to the acute episode, and a subsequent specific inhalation challenge test was positive with a late asthmatic response to PAA-HP mixture. This case provides evidence for a sensitization mechanism in OA caused by PAA-HP mixture.

Transmission of multi-drug resistant Pseudomonas aeruginosa between two flexible ureteroscopes and an outbreak of urinary tract infection: the fragility of endoscope decontamination

Flexible endoscopes are difficult to decontaminate, and endoscope-associated infections are increasing. This report describes an outbreak of multi-drug resistant Pseudomonas aeruginosa identified following an increase in incidence of clinical infections associated with flexible ureteroscopy at a tertiary care centre in the UK. Clinical, laboratory and central decontamination unit (CDU) records were reviewed to determine the extent of the problem, and links to the used endoscopes. Audits of the ureteroscopy procedure, endoscopy unit and CDU were performed. Endoscopes were sampled, cultured and examined for structural integrity. All available isolates were typed. Thirteen patients developed clinical infections linked to two flexible ureteroscopes. The first ureteroscope was likely colonized from a known infected patient and the second ureteroscope after use on another patient infected by the first. Risk factors identified include surface cuts, stretching and puckering of the outer cover in both ureteroscopes, absence of bedside cleaning, overnight delay between the ureteroscopy and decontamination, inadequate drying after decontamination and non-traceability of connector valves. The adequacy of flexible endoscope decontamination depends on numerous steps. With the increasing global incidence of multi-drug resistant organisms, stringent monitoring of the flexible endoscopy process by users and decontamination units is essential.

Determination of bacterial species present in biofilm contaminating the channels of clinical endoscopes.

Outbreaks of endoscopy-related Carbapenem-resistant Enterobacteriaceae has highlighted failures in endoscope decontamination resulting in biofilm formation. Biofilms are tolerant to detergents and disinfectants. We evaluated decontaminated endoscope channels for residual bacterial contamination and biofilm presence. 64 channels were collected from 12 gastroscopes and 11 colonoscopes. Aerobic bacteria were isolated from inside the endoscope tubing by scrapping, sonication, and aerobic plate culture. Total number of contaminating bacteria was determined by quantitative real-time PCR with 16s rRNA eubacterial universal primers. Microbial diversity was assessed using next generation DNA sequencing. Biofilm presence was visually confirmed by confocal laser scanning and scanning electron microscopy. 47% of channels were culture positive, with α-haemolytic Streptococci from gastroscopes and coliforms from colonoscopes the most frequently isolated species. Sphingomonas spp., Staphylococcus spp., Streptococcus spp., and Pseudomonas aeruginosa were also isolated. An average of 1.2×103 bacteria/cm contaminated air-water channels, 2.8×102 and 6.6×102 bacteria/cm contaminated gastroscope and colonoscope working channels, respectively. Biofilm was on all 39 channels examined and was principally composed of environmental bacteria, although all samples contained potential pathogens. Biofilm is present on many endoscope channels obtained from Australian hospitals. Any soil including biofilm can compromise disinfectant action.

Transmission of Salmonella enteritidis after endoscopic retrograde cholangiopancreatography because of inadequate endoscope decontamination.

We report a historic nosocomial outbreak of Salmonella enteritidis affecting 4 inpatients who underwent endoscopic retrograde cholangiopancreatography. The cause was attributed to inadequate decontamination of an on-loan endoscope used over a weekend. This report highlights the risks of using on-loan endoscopes, particularly regarding their commissioning and adherence to disinfection protocols. In an era of increasing antibiotic resistance, transmission of Enterobacteriaceae by endoscopes remains a significant concern.

A critical guideline appraisal overview: Choice Framework for local Policy and Procedures (CFPP) 01-06 Decontamination of flexible endoscopes 2013. Part 1: Policy and management and Part 3: Operational management manual.

Inadequate decontamination of flexible endoscopes potentially exposes patients and staff to pathogenic bacteria and blood borne-viruses. In the UK there have been 176 deaths from definite or probable cases of variant Creutzfeldt-Jakob Disease (vCJD). The peak year of deaths was 2000, since then numbers of cases have fallen (DH 2013a). Effective decontamination removes surface contaminants, organisms and organic matter such as grease or dirt, which may otherwise inactivate the disinfection process (Weston 2008). There are 1134 hospitals listed in the UK (Hospitals Worldwide 2013) of which 215 acute units, 162 independent sector, 49 community units and 6 paediatric units are engaged with Joint Advisory Group in England (JAG 2013). Currently there are several pertinent regulatory British (BS), European (EU) and International (ISO) decontamination standards which are intended to prevent contact transmission and environmental contamination. The Department of Health aims to empower individual departments to be more proactive in their own local decision-making processes by setting standards in the form of CFPP 01–06 (DH 2013a).

Reusable surgical instruments: a guide to two standards

Journal of Operating Department PractitionersVol. 1, No. 1 CommentReusable surgical instruments: a guide to two standardsAngela CobboldAngela CobboldSearch for more papers by this authorAngela CobboldPublished Online:18 Nov 2013https://doi.org/10.12968/jodp.2013.1.1.50AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View articleReferencesCentral Sterilising Club (2013) What's Happening-Documents, Guidelines and Standards. http://tinyurl.com/o3gusjx (accessed 8 October 2013) Google ScholarDepartment of Health (2004) The planning and design of sterile services departments. http://tinyurl.com/q9jhujw (accessed 8 October 2013) Google ScholarDepartment of Health (2009) Health Technical Memorandum 01-01 Decontamination of reusable medical devices Parts B, C and D. http://tinyurl.com/pz9mw2c (accessed 8 October 2013) Google ScholarDepartment of Health (2013a) Choice Framework for local Policy and Procedures 01-01 – Management and decontamination of surgical instruments (medical devices) used in acute care. Part A: The formulation of local policy and choices. http://tinyurl.com/nvms5g3 (accessed 27 September 2013) Google ScholarDepartment of Health (2013b) Choice Framework for local Policy and Procedures 01-06 –Decontamination of flexible endoscopes: Operational management. http://tinyurl.com/qy68jvt (accessed 27 September 2013) Google ScholarHospitals Worldwide (2013) UK Hospitals and Health Clinics. http://tinyurl.com/6xfol5p (accessed 27September 2013) Google ScholarJoint Advisory Group \9jag on GI and Endoscopy (2013) Frequently asked questions. http://tinyurl.com/nabzo8q (accessed 27September 2013) Google ScholarMedicines and Healthcare products Regulatory Agency (2012a) Medical Device Alert: Reusable transoesopha-geal echocardiography, transvaginal and transrectal ultrasound probes (transducers). http://tinyurl.com/nv5k2v8 (accessed 8 October 2013) Google ScholarMedicines and Healthcare products Regulatory Agency (2012b) Top ten tips on endoscope decontamination. http://tinyurl.com/3ysdvs8 (accessed 8 October 2013) Google ScholarNational Institute for Health and Care Excellence (2006) Patient safety and reduction of risk of transmission of Creutzfeldt-Jakob disease (CJD) via interventional procedures. www.nice.org.uk/ipg196 (accessed 27 September 2013) Google Scholar FiguresReferencesRelatedDetails 1 October 2013Volume 1Issue 1ISSN (print): 2053-3292ISSN (online): 2053-3306 Metrics History Published online 18 November 2013 Published in print 1 October 2013 Information© MA Healthcare LimitedPDF download

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.

Identifying Gaps in After-Hours Endoscopic Practices

Identifying Gaps in After-Hours Endoscopic Practices

Compiling the international standard EN ISO 15883 for washer-disinfectors

The modern flexible endoscope, in all its various guises, has revolutionized the diagnosis and treatment of many conditions, notably in gastrointestinal medicine. Its success has led to a rapid growth in endoscopy services in our hospitals and an increasing focus on the equipment used to decontaminate the devices. John Crispin is a UK representative on the EU Working Group which compiled the international standard BS EN ISO 15883 for washer-disinfectors and Ronald Wassenburg sits as a Dutch representative on the same group. In this article, they will explain some the challenges they faced helping the European Union to develop part 4 of the new standard (which relates specifically to flexible endoscope washers), explain its legal status and reveal the key role played by the humblest component of endoscope decontamination—water.

The principles of decontamination in gastrointestinal endoscopy

Modern endoscopes can be used to examine the whole of the gastrointestinal (GI) tract. During these examinations, biopsies may be taken, or treatment provided via working channels in the endoscope. Demand for GI endoscopy is increasing because of the National Bowel Cancer Screening Programme and a rise in dyspepsia. Endoscopes are complex and expensive, so are reused. To prevent cross-infection and cross contamination, endoscopes need to be adequately decontaminated between patients; there are specific concerns around transmission of variant Creuztfeldt-Jakob disease. Endoscopes are sensitive to heat and cannot be autoclaved, so other methods of decontamination are needed. This article looks at endoscope decontamination processes, and the systems and management that need to be in place.

Impact of a Continuous Quality Improvement Program on Infection Control of Endoscopes

Bolak Eldakror Hospital is a secondary care governmental hospital in Giza, Egypt. the Gastrointestinal endoscopy unit was founded in 1999. A written protocol for endoscope decontamination based on international standards was implemented and an ongoing quality assurance program was established in 2003 when we commenced bacteriological monitoring of endoscopes. Pseudomonas aeruginosa was found in a specimen obtained from a colonoscope. the unit guidelines were reviewed. the cause of contamination was a breach in reprocessing technique. A nurse admitted that she did not remove or clean the cap in the distal tip of the colonoscope at the end of a long busy day. We reprocessed and sampled the colonoscope. the new specimen yielded no growth. the staffing system was changed to secure a balance between the number of cases and work hours. A disinfection logbook and reprocessing checklists were provided for the nurses to record decontamination procedures.

Re: Gastrointestinal Nursing (2008) vol 6 no 7

A great, informative edition covering many aspects of endoscopy care, including endoscope decontamination, the National Nurse Endoscopist Project, capsule endoscopy, and patient education and endoscopy.

Endoscope decontamination: would you pass a JAG visit?

Effective decontamination is the cornerstone of the endoscopy service and is essential in maintaining patient and staff safety. This article outlines the recommendations of the National Endoscopy Programme, which aimed to develop a document that would encompass all the current guidance on endoscope decontamination into a relevant and easy−to−use format. The article provides advice on aspects of infection control and important areas to address before an inspection, and describes some of the positive results of the project.