DECONTAMINATION
COVID-19: ensuring safety in endoscopy
Devices such as flexible endoscopes can be used for treatment and management of COVID-19 patients. Although endoscopies remain safe and provide clinicians with a significant diagnostic and therapeutic utility, they may present a potential risk of infection. To prevent such infections, products and processes have been made available to protect patient safety. Professor Didier Lepelletier, Paul Caesar and Dr. Daniel Vinteler provide an insight.
Professor Lepelletier, Centre Hospitalier Universitaire de Nantes, points out that healthcare professionals are at increased risk of infection by COVID-19 from inhalation of airborne droplets, conjunctival contact, and faeces contamination. The virus has been found to live in patient stool and angiotensin-converting enzyme II (ACE2), the receptor used by the virus to enter human cells, is widely expressed in the intestinal tract. Healthcare workers may transmit the infection to their patients as hospital-based epidemics have been reported. The virus seems to be transmitted mainly via small respiratory droplets through sneezing, coughing or when people interact with each other for some time in close proximity.1
The droplets can then be
inhaled, or they can land on surfaces that others may come into contact with. Individuals can then become infected when they touch their nose, mouth or eyes.
The virus can survive on different
surfaces such as copper and cardboard for several hours, and plastic and stainless steel for up to a few days.2
However, the amount
of viable virus declines over time and may not always be present in sufficient number to cause infection.3,4 Transmission by surfaces can occur between healthcare workers and patients during endoscopy activity if the environment is contaminated and undisinfected. Enveloped viruses such as COVID-19 can easily be inactivated by commonly used disinfectants. The coronavirus can remain infectious on inanimate surfaces for up to 9 days. Surface disinfection with 0.1% sodium hypochlorite or 62 to 71% ethanol significantly reduces coronavirus infectivity on surfaces. Due to these concerns, when endoscopes have been used, they should be considered at risk of contamination.5
Endoscopy departments must implement additional hygiene procedures
Consequences of contaminated endoscopes
The use of endoscopes for diagnosis and/or intubation of patients suggests the importance of endoscopes’ function to patient health. Yet in a study by Bang JY, et al, “22% of the ‘ready for patient use’ duodenoscopes were found contaminated.”6
Concerns for patient
health stem from carbapenem-resistant Enterobacteriaceae (CRE) and other infections, which may also be linked to improper cleaning and/or disinfection of endoscopes. In 2018, the Erasmus University indicated: “Increasing numbers of outbreaks caused by contaminated duodenoscopes used for Endoscopic Retrograde Cholangiopancreatography
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(ERCP) procedures have been reported, some with fatal outcomes.”7
This research
indicates that it can be difficult to properly reprocess endoscopes. However, what has yet to be demonstrated are the solutions available to ensure patient safety using reusable endoscopes. Due to the important function of these devices, an emphasis on improved products and processes is crucial to reducing the risk of infection. Establishing greater measures and solutions to prevent contamination of endoscopes may help prevent fatal outcomes.
While the concern of contaminated endoscopes has been apparent for years, additional challenges related to the COVID-19 virus, present an even greater risk of life-threatening infections. All endoscopes
OCTOBER 2020
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