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News Americas

Researchers examined endocopes and found bacteria on a number of devices. (Photo courtesy of luchschen/Shutterstock)
Jul 4, 2013 | News Americas

Endoscopes not always cleaned properly

by Surgical Tribune

FORT LAUDERDALE, Fla., USA: Three out of 20 flexible gastrointestinal endoscopes used for screening were found to harbor unacceptable levels of biodirt (cells and matter from a patient’s body that could pose potential infection risk) in a study of endoscopes from five hospitals across the U.S.

In the study, which was presented at the 40th annual conference of the Association for Professionals in Infection Control and Epidemiology, researchers in the 3M Infection Prevention Division analyzed 275 flexible duodenoscopes, gastroscopes, and colonoscopes, and found that 30 percent, 24 percent and 3 percent, respectively, failed the cleanliness rating.

"Three out of 20 is an unexpectedly high number of endoscopes failing a cleanliness criterion," said Dr Marco Bommarito, lead investigator and lead research specialist at the 3M Infection Prevention Division.

More contaminated endoscopes than any other medical device

In the last several years, there have been reports of improperly cleaned endoscopes at health care facilities across the country, including the Veterans Health Administration, in which thousands of patients required testing for HIV, as well as hepatitis B and C. According to the Centers for Disease Control and Prevention, who published guidelines for reprocessing endoscopes in 2008, more health care-associated outbreaks have been linked to contaminated endoscopes than to any other medical device. In addition, cross-contamination from flexible endoscopes has been identified by the ECRI Institute, an independent organization that researches medical procedures, devices, drugs and processes to improve patient care, as a leading health hazard.

Annually, between 15 and 20 million endoscopy procedures are conducted with reusable endoscope devices to screen various parts of a patient’s gastrointestinal tract. These devices allow health care providers to investigate the surface of this organ and identify issues such as polyps or colon cancer. Duodenoscopes, gastroscopes and colonoscopes are used to examine the duodenum (or the first section of the small intestine), the stomach and the colon, respectively.

Contamination invisible to the naked eye

After an endoscope has been used for a procedure, it is sent for cleaning before being reused for another patient. This reprocessing involves two steps: manual cleaning with an enzymatic cleaner and flushing by a hospital technician, followed by soaking the device in a high-level disinfectant. The first step is vital to ensuring that the disinfection process is effective. After manual cleaning has been completed, the technician visually inspects the instrument to ensure cleanliness. However, the study found that contamination can remain on the device and may be invisible to the naked eye.

In the study, after the manual cleaning step of the decontamination and disinfection process, cleaning technicians at five hospitals across the U.S. were asked to flush the scopes with sterile water, and this sample was analyzed by researchers for adenosine triphosphate – a marker of biocontamination. The amount of this compound, in relative light units (RLUs), was measured with a handheld luminometer. Based on previously published clinical data, a pass/fail threshold was set at 200 RLUs. Any instrument with a score of more than 200 RLUs was identified as having failed the cleanliness rating.

"The cleaning protocols for flexible endoscopes need improvement, such as guidelines tailored to the type of scope or identifying if there is a critical step missing in the manual cleaning process, and documented quality control measures," said Bommarito. "These types of improvements could have a positive impact on patient safety."

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