Endoscope reprocessing
Biofilm bacteria are major contributors to endoscope associated infections.
Biofilms and infection Delegates learned that around 65%-80% of all human infectious diseases are caused by biofilm bacteria, while biofilm formation has been associated with the infections arising from virtually all types of implantable medical devices. Biofilm bacteria are also major contributors
to endoscope associated infections and there is even experimental evidence of biofilms causing gastrointestinal (GI) cancers. Given the challenges presented by biofilms, the FDA demands that pre-market submissions of medical devices must include anti-biofilm strategies. If we stop bacteria from attaching themselves to devices, we significantly lower the chance of biofilm formation. Olegs went on to compare the differences between biofilms in the body and on instruments. Traditional biofilm develops in the body, in the water lines, in the decontamination equipment, etc. It is a thick slimy substance, with a rough surface, which dispenses individual bacteria and biofilm fragments. It is easier to remove. Cyclic build-up biofilm (CBB) is found in endoscope and instrument lumens. It develops due to cyclical exposure to wet and dry phases during usage and reprocessing. Dry surface biofilm is a reservoir for transmission of pathogens in healthcare. It has a smooth surface, produces flakes and is harder to remove. Biofilms are macroscopic (large) objects, so
a microscope is not needed to identify them. However, detection can be difficult. They can be transparent and tend to colonise lumens and hard to access surfaces such as box joints. To detect biofilms, decontamination teams may
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use borescope inspection, protein/ATP tests, UV fluorescence and/or DNA sequencing. However, Olegs pointed out that detecting some biofilms, that are transparent and deep within the channels, is particularly challenging: “Even a borescope won’t pick-up dried-up biofilm if it is less than a millimetre thick and transparent,” he asserted. “If we are talking about cyclic buildup, dry biofilms, quite often the tests are not useful.” “I was not able to find a standard test in the guidelines for looking for biofilms in endoscope channels, never mind surgical instruments…We are not looking for something which is there, and yet that ‘something’ is responsible for 80% of infections.” Olegs went on to discuss how to evaluate the anti-biofilm action of decontamination processes. The ISO 15883-4 (requirements for endoscope washers-disinfectors) states: “For chemical disinfection systems a
microbiological test shall be required. The test shall be designed to ensure that the self- disinfection cycle will disinfect contaminated tubing by evaluating the effect of the cycle against a biofilm containing Pseudomonas aeruginosa…The test on the final rinse water shall be sufficient to verify the self-disinfection cycle. “Note In order to detect any biofilm, it might be necessary to wait to take samples after the washer disinfector is left unused at least six hours after completion of the self-disinfection cycle.” So, how can we stop biofilms? Olegs explained that we can target biofilms in the body through: l Advanced antibiotic treatments. l Disrupting attachment and matrix formation.
l Breaking down communication between microorganisms.
l Consuming Omega-3 fatty acids, fish oil, lard and tallow.
l Electrical and light therapy.
We can also target biofilms on instruments by: l The use of non-adhesive materials. l Mechanical action in cleaning. l Careful inspection. l Sterilisation whenever possible.
In conclusion, Oleg raised the question: are we giving biofilms enough attention in decontamination? “We know biofilms are there, but we don’t
have tests to look for them. We know that ‘good old elbow grease’ helps a lot, before disinfection and sterilisation. But that knowledge doesn’t necessarily translate to into actions,” he commented, adding that biofilms are among the “toughest challenges in decontamination”, yet they are currently “underestimated in regulatory requirements”. “Ultimately, life finds a way and not necessarily life which is beneficial for us,” he concluded. CSJ
The Study Day took place on 30 January 2025 at the Holiday Inn Cambridge. Other topics discussed during the day included: l The Power of Plasma - Sam Nichols l Environmental and Workflow Challenges - Dan Smith
l Consideration for Ultrasound Probe l Decontamination, Simon Jarvis, Fuji.
Likhitha -
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