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Borescope Examination and Microbial Culture Findings in Endoscopes at a Tertiary Care Hospital in Pittsburgh, Pennsylvania

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      Background

      Flexible endoscopes are highly versatile and useful medical instruments, and their proper reprocessing is critical to patient health and safety. The value of routine visual inspections and surveillance of endoscopes in a tertiary care hospital was assessed by performing borescope examinations and microbial cultures on respiratory, gastro-intestinal (GI), and urological endoscopes.

      Methods

      A total of 42 endoscopes were cultured, including 18 GI endoscopes, 14 bronchoscopes, and 10 urological endoscopes. There were 36 endoscopes that underwent borescope examination, including 13 GI endoscopes, 12 bronchoscopes, and 11 urological endoscopes. The flush-brush-flush method was used to culture the endoscopes. Sample water was vortexed prior to being suctioned through a membrane filter device. The membrane was plated on a blood agar plate and incubated at 37°C for 48 hours. All colonies observed were Gram-stained. A 1.9-meter borescope with a 1.6mm diameter was used to perform borescope examinations in an antegrade and retrograde approach.

      Results

      Microbial cultures resulted in microbial growth seen in 28% of bronchoscopes, 22% of GI endoscopes, and 30% of urological endoscopes. Only gram-positive colonies were identified in endoscopes that had microbial growth. Borescope examinations revealed multiple abnormalities and damage including channel shredding, filamentous debris, water retention, discoloration, dents, and red debris found in the distal end of bronchoscopes.

      Conclusions

      The red debris found in and outside of the distal end of bronchoscopes were caused by polystyrene tip protectors used in the hospital. The red debris was deemed to be a risk to patient safety and the use of that type of tip protector was discontinued in the hospital based on this study's findings. Overall, borescope examination and microbial culturing used routinely as part of the reprocessing procedure is a highly effective way to identify endoscopes with damage, abnormalities, and microorganisms of concern that poses a risk to patient safety and public health.
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