Endoscopy


and still contain bacteria and microbes after an extensive cleaning process.2


There is growing


concern of cross-contamination due to evidence that even the most robust and rigorous reprocessing of a reusable bronchoscope won’t remove all contaminants and even with the most stringent high-level disinfection procedures, sterility cannot be assured, potentially putting patients at risk and leading to infectious outbreaks. Reusable endoscopes come with complex


cleaning instructions, which can be up to 100 steps and take more than two hours, increasing the risk of human error, particularly in fast-paced healthcare environments. Flexible endoscopes cannot be heat sterilised either, as they are designed with multiple channels, which are difficult to clean, disinfect and present challenges around the removal of biofilm.3 Studies have found that 8% of reusable


bronchoscopes are contaminated, and 20% of those bronchoscopes lead to cross-infection.4 Whether the evidence is clinical, economic, or tragic, it makes for a very compelling case, especially for the immunosuppressed patient. In June 2021, the FDA recommended the use of single-use bronchoscopes5


, especially in


situations with an increased risk of infection transmission, such as treating COVID-19 patients. The communication urged healthcare facilities to prioritise sterilisation over high- level disinfection for flexible bronchoscopes and suggested opting for single-use bronchoscopes if immediate reprocessing support is lacking. The FDA’s concern about the microbial transmission risk associated with bronchoscopes was highlighted in a 2015 communication, where it emphasised the


3.5 3


2.5 2


1.5 1


0.5 0


Materials


Use (cleaning of RBs) End-of-life potential


Production


Disposal (handling) Incineration


Birgitte LilholtSørensen, Henrik Grüttner. (2018) Comparative Study on Environmental Impacts of Reusable and Single-Use Bronchoscopes Environmental impact (kg CO2 ) 50 www.clinicalservicesjournal.com I August 2024


There is growing concern of cross-contamination due to evidence that even the most robust and rigorous reprocessing of a reusable bronchoscope won’t remove all contaminants.


high risk if bronchoscopes are not adequately reprocessed. The Centers for Disease Control and Prevention (CDC) also cited there are ‘More nosocomial infection and pseudo- infection outbreaks linked to contaminated endoscopes than to any other medical device.’ In April 2021, the FDA investigated medical


device reports describing patient infections and potential contamination issues linked to reprocessed urological endoscopes. In 2020, updated guidance urged a transition to duodenoscopes with lower risk, and in August 2019, the FDA recommended a shift to partially or fully single-use duodenoscopes. In 2020, Ambu aScope range received the Infection Prevention Society (IPS) Industry Insights endorsement.6


IPS commended the


ability to: l Negate infection risks and outbreaks associated with patients being exposed to contaminated scopes.


l Reduce cross-contamination risks associated with scope reprocessing (to patients, healthcare workers, equipment, and other scopes).


l Reduce infection risks associated with healthcare workers being exposed during aerosol-generating procedures to e.g., Mycobacterium tuberculosis and SARS-CoV-2


l Reduce environmental contamination. l Reduce the need for antibiotics and the


One reprocessing cycle of reusable bronchoscopes


pressures associated with antibiotic- resistant organisms.


The human cost of reprocessing In addition to the physical and environmental costs of reprocessing endoscopes, the human cost must be considered. In 2019, it was estimated there were 17,0007


new cases of self-


reported ‘breathing or lung problems’ caused or made worse by work, in the UK alone. Healthcare workers reprocessing endoscopes are often having to manage and handle high-level disinfectants (HLDs), in order to minimise cross- contamination. In doing so, staff are continually exposed to HLDs, day after day, increasing their risk of developing occupational asthma (OA). Glutaraldehyde, a well-known asthmagen,


was withdrawn from the UK market, with the aim of eliminating OA. However, alternative reprocessing chemicals used in NHS endoscopy units, including ortho-phthalaldehyde, are also capable of causing OA. In addition, Peracetic Acid (PA) is associated with further occupational hazards.7


Single-use alternatives eliminate


exposure to these harmful chemicals and protect the welfare of endoscopy staff.


Budget One aScope 4 Broncho


In a complex and diverse medical market with increased pressure on hospital budgets, it’s fair to assume a product must demonstrate more than classical virtues such as clinical relevance, innovation and functionality, to accomplish it’s expected life cycle. A product in this era must also demonstrate good value for money. Many hospitals believe the biggest investment, in regard to the use of endoscopes, is the purchase of the equipment. However, this is a common misconception. The capital costs represent under one-third


of the total cost per procedure. Ongoing costs like repair and reprocessing costs represent more than two-thirds. The cost burden repair and reprocessing represents results in an often forgotten charge, each time reusable scopes are used. Single-use scopes in this matter seem to


provide an effective solution – with only one endoscope per procedure, the total cost of ownership can easily be calculated. An added bonus for procurement and management departments is that it reduces financial uncertainty, because the customer only pays


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