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Current methods for cleaning endoscopes not always effective
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The methods used for cleaning endoscopes for reuse are not consistently effective, according to findings published in the American Journal of Infection Control.
Researchers recommend new reprocessing guidelines that include routine visual inspections and cleaning verification tests.
“Guidelines for reprocessing flexible endoscopes currently permit reuse following cleaning and high-level disinfection, which theoretically eliminates all bioburden except small numbers of bacterial spores,” Cori L. Ofstead, MSPH, of Ofstead & Associates, St. Paul, Minnesota, and colleagues wrote. “However, organic residues often remain after manual cleaning and endoscope contamination has persisted in institutions with documented adherence to reprocessing guidelines.”
Ofstead and colleagues carried out a longitudinal study, performing three assessments of 20 different endoscopes over the course of 7 months. Researchers inspected the instruments at baseline, 2 months and end of study, photographing the external surfaces and comparing the endoscopes’ appearances over time.
All endoscopes in the study showed visual irregularities, Ofstead and colleagues wrote. Those irregularities included discoloration, fluid and debris in channels. The researchers reported “scaly deposits” and buckling, as well as yellow and orange staining of insertion tubes. Sixty percent (n = 12) showed microbial growth. Ofstead and colleagues reported evidence of “accumulation of biofilm,” judging by the increased staining and debris. Furthermore, residual fluid buildup suggested insufficient drying methods. Researchers reported no statistical differences in positive bacterial cultures among different types of endoscopes. However, in each study group, about 20% of instruments exceeded the benchmarks set for adenosine triphosphate, an indicator of organic matter, and protein residue.
“This study demonstrated that more rigorous reprocessing practices may not be sufficient to ensure that patient-ready endoscopes are free from residual contamination, particularly when the endoscope has defects that could harbor organic debris and biofilm,” the researchers wrote. “Visual inspection and routine monitoring for biochemical markers of residual contamination may be essential to identify suboptimal reprocessing and proactively identify endoscopes in need of repair or refurbishment.” – by Andy Polhamus
Disclosure: Ofstead is employed by Ofstead & Associates, which has received honoraria and research funding from the 3M Company, Boston Scientific, HealthMark Industries, Invendo Medical, Medivators and the STERIS Corporation for research related to infection control.
Perspective
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Studies like this help us to identify and understand the major gaps in reprocessing techniques and signal where improvements are needed. Patient safety is at stake, which is why having strong infection prevention and control programs at all health care facilities is essential. Additional research is needed to determine better methods for reprocessing endoscopes.
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