Highlights
- •Endoscopes accumulated contamination, visible damage, and debris over time.
- •Examination of internal components detected damage or fluid inside every endoscope.
- •Routine cleaning verification tests identified endoscopes requiring re-reprocessing.
- •Microbial culture incubation >48 hours fostered growth and pathogen identification.
- •Microbial growth was found in samples from 60% of gastrointestinal endoscopes.
Background
Flexible endoscopes are currently reused following cleaning and high-level disinfection.
Contamination has been found on endoscopes, and infections have been linked to gastrointestinal,
respiratory, and urologic endoscopes.
Methods
This longitudinal study involved visual inspections with a borescope, microbial cultures,
and biochemical tests for protein and adenosine triphosphate to identify endoscopes
in need of further cleaning or maintenance. Three assessments were conducted over
a 7-month period. Control group endoscopes reprocessed using customary practices were
compared with intervention group endoscopes subjected to more rigorous reprocessing.
Results
At final assessment, all endoscopes (N = 20) had visible irregularities. Researchers
observed fluid (95%), discoloration, and debris in channels. Of 12 (60%) endoscopes
with microbial growth, 4 had no growth until after 48 hours. There were no significant
differences in culture results by study group, assessment period, or endoscope type.
Similar proportions of control and intervention endoscopes (~20%) exceeded postcleaning
biochemical test benchmarks. Adenosine triphosphate levels were higher for gastroscopes
than colonoscopes (P = .014). Eighty-five percent of endoscopes required repair due to findings.
Conclusions
More rigorous reprocessing was not consistently effective. Seven-day incubation allowed
identification of slow-growing microbes. These findings bolster the need for routine
visual inspection and cleaning verification tests recommended in new reprocessing
guidelines.
Key Words
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Article Info
Footnotes
Supported in part by research grants from 3M Company , Medivators Inc , and HealthMark Industries , who were not involved in designing the study, collecting data, interpreting results, or preparing the manuscript. In accordance with the study protocol, the research site received a new automated endoscope reprocessor and reprocessing materials from Medivators and supplies for conducting adenosine triphosphate tests from 3M Company.
Conflicts of interest: CLO is employed by Ofstead & Associates, Inc, which has received research funding and speaking honoraria related to infection prevention from 3M Company, Medivators, HealthMark Industries, STERIS Corporation, Boston Scientific, and Invendo Medical. HPW, OLH, EAJ, and JEE, are employed by Ofstead & Associates, Inc.
Identification
Copyright
© 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
