Existing reprocessing techniques prove insufficient for flexible endoscopes

January 31, 2017

Arlington, VA, January 31, 2017 - Current techniques used to clean endoscopes for reuse are not consistently effective, according to a study published in the February issue of the American Journal of Infection Control, the official journal of the Association for Professionals in Infection Control and Epidemiology (APIC). The findings of this study support the need for careful visual inspection and cleaning verification tests to ensure that all endoscopes are free of damage and debris before they are high-level disinfected or sterilized and used on another patient.

"APIC is concerned about the risk of infections related to endoscopic procedures," said Linda Greene, RN, MPS, CIC, FAPIC, 2017 APIC president. "This study reinforces the importance of having strong infection prevention and control programs at all types of facilities, led by highly trained infection preventionists, to ensure that facilities are following the latest evidenced-based guidance."

Currently, flexible endoscopes, including gastrointestinal, urological, and respiratory endoscopes, are reused following cleaning and high-level disinfection. However, results from the new study conducted by Ofstead & Associates, Inc., suggest that even more rigorous reprocessing techniques of endoscopes are not consistently effective, and organic residues often remain.

"Understanding issues with the effectiveness of reprocessing techniques is critically important as institutions seek to improve the quality of endoscope cleaning and disinfection," said lead study author Cori L. Ofstead, MSPH, Ofstead & Associates, Inc. "Even though top-notch methods were used, the endoscopes in this study had visible signs of damage and debris, and tests showed a high proportion were still contaminated."

Using a longitudinal study design, Ofstead, et al. performed three assessments of 20 endoscopes over a seven-month period. The assessments involved visual inspections with a tiny camera, microbial cultures, and biochemical tests to detect protein and adenosine triphosphate (ATP) - a marker that identifies organic matter. These assessments were used to identify endoscopes that required further cleaning and maintenance.

During the final assessment, the researchers found that all 20 endoscopes examined had visual irregularities, such as fluid, discoloration, and debris in channels. Furthermore, samples from 12 of 20 reprocessed endoscopes (60 percent) had microbial growth, indicating a failure of the disinfection process. Of note, endoscopes reprocessed using current recommended guidelines and those that were cleaned at least twice before high-level disinfection exhibited similar culture results.

Further results indicated that about 20 percent of endoscopes in each group exceeded post-cleaning benchmarks for ATP and protein residue. Moreover, ATP levels were higher for gastroscopes, which are used for upper GI procedures, than the endoscopes used for colonoscopy. "Since the same technicians used the same techniques to clean and disinfect these scopes, the findings and our visual observations suggest that something is happening to gastroscopes during procedures that changes the surfaces and causes reprocessing failures," says Ofstead.

This study comes on the heels of a 2015 report of Carbapenem-resistant Enterobacteriaceae (CRE) infections related to Endoscopic Retrograde Cholangio-Pancreatography (ERCP) duodenoscopes--devices that are threaded through the mouth, throat, and stomach into the top of the small intestine (duodenum) for examinations and treatment. No breaches in reprocessing were identified and yet infections related to the duodenoscopes were uncovered, raising concerns that current reprocessing techniques were ineffective, and illuminating the challenges in reprocessing of such intricate medical devices.

"The finding of residual fluid in 95 percent of endoscopes tested was significant because moisture fosters microbial growth and the development of biofilm--which can be difficult or impossible to remove," said Ofstead. "This confirms the importance of cleaning, disinfecting, and drying to ensure patient safety."
-end-
Visit http://www.apic.org for resources on reprocessing reusable medical devices.

Elsevier Health Sciences

Related Infection Control Articles from Brightsurf:

The Lancet Respiratory Medicine: Rapid bedside testing is faster than standard centralised PCR testing for COVID-19, and may improve infection control in hospital
An interventional study tracking SARS-CoV-2 testing on admission to a UK hospital finds that the wait for results was just 1.7 hours using point-of-care testing (POCT) close to the patient's bedside, compared with 21.3 hours using the standard process of PCR testing in a centralised lab within the hospital.

Driving immunometabolism to control lung infection
When drugs to kill microbes are ineffective, host-directed therapy uses the body's own immune system to deal with the infection.

AJR details COVID-19 infection control, radiographer protection in CT exam areas
In an open-access article published ahead-of-print by the American Journal of Roentgenology (AJR), a team of Chinese radiologists discuss modifications to the CT examination process and strict disinfection of examination rooms, while outlining personal protection measures for radiographers during the coronavirus disease (COVID-19) outbreak.

How blocking iron drives the lung immune system to control infection
Scientists at Trinity College Dublin and St James's Hospital, Dublin have discovered how the iron chelator, DFX, which functions by attaching to iron, drives the immune system to deal with tuberculosis (TB).

COVID-19 infection prevention and control in long-term care facilities
Dr. John W. Rowe is a member of a WHO Expert Panel on Care of the Elderly which just released guidance for prevention and management of COVID-19 among elderly in long term care facilities.

Is infection after surgery associated with increased long-term risk of infection, death?
Whether experiencing an infection within the first 30 days after surgery is associated with an increased risk of another infection and death within one year was the focus of this observational study that included about 660,000 veterans who underwent major surgery.

HIV: Reprogramming cells to control infection
Following research on cohorts, scientists from the Institut Pasteur have described the characteristics of CD8 immune cells in these 'HIV controller' subjects.

UK study shows most patients with suspected urinary tract infection and treated with antibiotics actually lack evidence of this infection
New research presented at this week's European Congress of Clinical Microbiology & Infectious Diseases (ECCMID) in Amsterdam, Netherlands (April 13-16, 2019) shows that only one third of patients that enter the emergency department with suspected urinary tract infection (UTI) actually have evidence of this infection, yet almost all are treated with antibiotics, unnecessarily driving the emergence of antimicrobial resistance.

Subsidies for infection control to healthcare institutions help reduce infection levels
Researchers compared three types of infection control subsidies and found that under a limited budget, a dollar-for-dollar matching subsidy, in which policymakers match hospital spending for infection control measures, was the most effective at reducing the number of hospital-acquired infections.

Infection control technique may reduce infections in patients with catheters, drains
Each year, approximately 5 million patients in the United States receive treatment that includes the insertion of a medical device such as a catheter, which puts them at increased risk of potentially life-threatening infection.

Read More: Infection Control News and Infection Control Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.