DECONTAMINATION
used on COVID-19 patients, or suspected COVID-19 patients, should be considered high risk. The main endoscopic challenge is minimising the risk of contamination from procedure to procedure. Endoscopy departments must now implement additional hygiene procedures while treating patients affected by COVID-19, for diseases not related to the SARS-COV2 outbreak. To ensure patient safety, proper processes must be in place to minimise the risk of cross contamination.
The importance of drying in reprocessing Research shows that to create and maintain an endoscope’s disinfected status, complete drying is an absolute necessity.8
Dr.
Kovaleva, MD, PhD, clinical microbiologist and clinical pathologist, department of laboratory medicine, AZ Rivierenland, points out that during an endoscopy, the environment provides optimal conditions for contamination and subsequent growth of biofilms. Biofilms are communities of microorganisms within extracellular polymeric material attached to different surfaces, including human tissues, medical devices, water supply systems, or endoscope channels. Development of a biofilm in endoscopes is probably associated with residual moisture in endoscope channels. This likely originates from water sources (endoscope washers disinfectors and insufficient dried endoscope channels) containing waterborne microorganisms. Microorganisms in biofilms are very resistant to antimicrobial agents, allowing pathogens to survive under conditions of drying and chemical exposure. The ability for pathogens to survive these treatments,
makes the importance of drying all the more critical. Drying the endoscope is important to the prevention of pathogen transmission and nosocomial infection. Flexible endoscopes should be dried after completion of the cleaning and disinfection process. If the endoscope is not to be reused immediately and is to be stored, the endoscope channels and outer surfaces should be dried thoroughly, in order to avoid exponential microbial growth of possible remaining bacteria.
It is crucial to remember that drying and storage, in endoscopy reprocessing, are just as important for preventing against infection as cleaning and high-level disinfection. Accurate drying greatly reduces bacterial contamination of stored endoscopes. When we discuss storage, an automated cabinet is advantageous for rapid drying of endoscope channels and in reducing the risk of microbial growth during storage.
Solutions to preventing contaminated endoscopes Appropriate endoscope reprocessing is an essential part of patient safety and quality assurance in endoscopy. Dr. Vinteler, CEO and founder of PlasmaBiotics, reiterates that appropriate drying and storage are just as important during endoscope reprocessing, as pre-cleaning, manual cleaning and disinfection. Failure of drying can result in growth of biofilms inside endoscope channels during storage, an important factor in the pathogenesis of endoscopy-related infections. Currently, some drying solutions include using storage cabinets in which the drying time can vary between 30-90 minutes, or even more depending on the manufacturer’s instruction-for-use (MIFU) and the endoscope type. The problem with a longer drying time means a possible delay in endoscope availability. For this reason, certain countries, such the UK or the Netherlands, still allow endoscopes to be used without drying after reprocessing, if they are intended to be used within three or four hours (respectively) after reprocessing. However, this can be a risk for proliferation if microorganisms and recontamination remain on the endoscope.9 As insufficient drying can be a source of microbial contamination and the transmission of infectious material, the PlasmaTyphoon is designed to reduce the risk of infection by optimising the drying of the scopes using plasma. The drying process is managed by a patented curve of pressure and temperature. The unit uses a laminar flow to eliminate the water from the endoscope channels followed by a turbulent heated flow to dry the walls. The solution is designed to a dry endoscope in one to five11
minutes (the
drying time depends on the endoscope type), and storage up to 31 days12 controlled environment.13
in a fully A perfectly dried
scope after reprocessing avoids exponential growth of pathogens that can lead to
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