Accepted endoscope reprocessing regimens aren't always effective, study shows

Existing endoscope reprocessing techniques are not consistently effective, according to a study published in the American Journal of Infection Control.

Researchers used a longitudinal study design, performing three assessments of 20 endoscopes over seven months. The assessments were used to identify the scopes that needed further cleaning, and they included:

•    Visual inspections with a tiny camera
•    Microbial cultures
•    Biochemical tests to detect protein and adenosine triphosphate (a marker that identifies organic matter)

The study shows all 20 endoscopes had visual irregularities, such as fluid, discoloration and debris in channels after reprocessing. Additionally, 12 of the 20 showed microbial growth and 20 percent of each type of endoscope (gastrointestinal, urological and respiratory) exceeded the benchmarks for adenosine triphosphate and protein detection after cleaning. Also, the study shows ATP levels were higher for gastroscopes than the endoscopes used for colonoscopy.

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Significantly, the study indicates that endoscopes reprocessed using current recommended guidelines as well as those that were cleaned at least twice before high-level disinfection showed similar microbial culture results.

"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," said Cori Ofstead, the lead study author.
Endoscope reprocessing was thrown into the limelight in late 2014 and 2015 when several facilities across the country saw outbreaks of carbapenem-resistant Enterobacteriaceae infections related to duodenoscopes, including at Los Angeles-based Cedars-Sinai Medical Center and UCLA Ronald Reagan Medical Center

Additionally, another study published in the journal Infection Control and Hospital Epidemiology in October showed that removing all contamination from robotic surgical instruments, even after cleaning multiple times, is close to impossible.

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