DECONTAMINATION & STERILISATION
Steps to more effective endoscope reprocessing
With concern in recent years over inadequate reprocessing of endoscopes, a look at some of the key steps and measures that can be taken to tackle the issue, and thus reduce the risk of infection from contaminated devices.
there have been four types of microorganisms which have merited particular attention during the last two decades: n Mycobacteria: the emergence of multi- drug resistant strains of Mycobacterium tuberculosis, and the high incidence of infections with M. avium intracellulare among HIV-infected patients-led to a greater awareness of the risk of transmission of Mycobacteria during bronchoscopy. Mycobacteria in general, and especially waterborne mycobacteria (such as M. chelonae), are extremely resistant to glutaraldehyde.
Concerns have been raised over inadequate reprocessing of scopes in recent years, and there is growing evidence of infections arising from contaminated devices. According to the British Society of Gastroenterology (BSG),1
n Bacterial spores (Bacillus and Clostridium): spores from these organisms can be isolated from endoscopes, but there are no reported cases of transmission of these infections by endoscopy. Studies have shown that Clostridium difficile spores can be completely inactivated by a standard decontamination procedure.2
n Multi-drug-resistant gram-negative bacilli: These have been linked to transmission during ERCP, particularly in the US. There is no evidence to suggest that these bacteria are resistant to the commonly used endoscope disinfectants, but they are more likely to be linked to the design complexity of the duodenoscopes and the quality of reprocessing.3
n Pathological Prions (including Creutzfeldt Jakob Disease and vCJD): These infectious particles are extremely resistant to standard decontamination procedures.
The BSG guidance1
highlights the fact that
most flexible endoscopes are classed as ‘semi-critical devices’, as they come into contact with mucous membranes during use, and present ‘a moderate degree of infection risk if contaminated at the time of use’. The Health and Social Care Act: Code of Practice on the prevention and control of infections and related guidance (published in England in 2008, and updated in 2015)4
emphasises the need
for staff to be trained in decontamination processes, and to hold appropriate competencies for their role. It stresses the need for monitoring systems to ensure that decontamination processes are fit for purpose and meet required standards, and also requires a system to be in place for tracking devices throughout the decontamination process. The law states that the Code must be taken into account
This article, entitled ‘Scoping the problem: Tackling infection risk’, first appeared in a special Decontamination & Sterilisation supplement published by HEJ’s sister magazine, The Clinical Services Journal, in April this year. HEJ thanks the magazine’s editor, and the author, for allowing its reproduction here in slightly edited form.
by the Care Quality Commission when it makes decisions about registration.
Failures in decontamination Failures in scope reprocessing have come under increasing scrutiny across the globe in recent years, and one of the most high-profile investigations has been led by the Food and Drug Administration (FDA). In 2013, the US Centers for Disease Control and Prevention (CDC) alerted the FDA to a potential association between multi-drug- resistant bacteria and duodenoscopes. Further investigation discovered that these infections had occurred despite users following the manufacturers’ reprocessing instructions.
The FDA subsequently ordered the manufacturers of the devices to conduct post-market surveillance studies (‘522 study’) to better understand how these devices are reprocessed in real-world settings, and their impact on duodenoscope-transmitted infections. At this time, the FDA issued advice on supplemental measures to help further reduce the risk of infection transmission
October 2019 Health Estate Journal 95
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