Decontamination In Australia, The Gastroenterological Society
of Australia (GESA) recommend the shortest time span for manual cleaning of the endoscope or commencement of the AER cleaning cycle. Their guidelines state that it should occur without delay, ideally within 15 minutes, but it must be within 1 hour.9 It is evident that there are inconsistencies between continents, with some recommending time limits on reprocessing as short as 15 minutes, and others stating up to 3 hours. The brief time span of 15 minutes seems optimistic for most endoscopy units to manage a soiled endoscope from the patient to the decontamination area, and to be fully reprocessed within this time. Many units are short-staffed and have multiple daily procedures, with a time window being so small it is likely to cause significant pressure for all staff involved. A drop in staff morale could also cause more problems in getting endoscopes reprocessed as needed. Further research is needed to clarify that a standardised time limit should be in place to help healthcare providers with their workflow management. Multi-society guidelines are united in
saying that manufacturer’s guidelines should always be followed when reprocessing endoscopes. However, if we disregard the multi-society recommendations and refer to the manufacturer’s guidance there is also inconsistency. Olympus advocates a 60-minute dwell time between pre-cleaning and manual cleaning.10
Fujinon endoscopes is not currently specified.
Why is there a time limitation on endoscope reprocessing? There are multiple reasons why Olympus advocates the 1-hour time limit, including input from the FDA, the process of reprocessing instruction validation and knowledge about biofilm.10
As some Gram-negative bacteria can undergo cell division every 20-30 minutes, it is vital to perform all reprocessing steps quickly before
any bacteria can grow and begin to form a biofilm. The endoscope lumens’ moist, nutrient- rich environment creates perfect conditions for biofilm formation.11
If the endoscope
incurs any delays between patient use and reprocessing, this can hinder the efficacy of the decontamination process. The time between the procedure and cleaning
The reprocessing time for Pentax and
and reprocessing is key to controlling the risk of biofilm formation. By maintaining prompt endoscope cleaning and reprocessing protocols to include drying, biofilms will not have a chance to form. The time requirement for development of a mature biofilm will vary depending on several factors but ensuring that reprocessing has begun within an hour after the procedure would likely prevent the formation of biofilm. Bacterial biofilm starts to form by attaching
to a surface, such as the lumens in an endoscope. At this point, the biofilm attachment can be removed by following strict reprocessing protocols that begin with pre-cleaning at the bedside.10
However, if the microorganisms are
left to mature, the bacteria begin to form a protective barrier to shield it from physical and chemical damage as the upper layers protect the layers underneath. This will eventually result in the formation of a biofilm which is resistant to mechanical cleaning, high-level disinfection, and sterilisation.12
What happens after the deadline is up? Ideally, there should be minimal time delay between the pre-cleaning stage, throughout manual cleaning, and storage, but there may
54
www.clinicalservicesjournal.com I February 2025
be occurrences when this is not possible due to staff shortages, procedures performed at the weekends or inundated decontamination departments. If there is a time delay between the pre-clean and the start of manual cleaning, or if pre- cleaning was not carried out at the bedside there are some endoscope manufacturers that provide instructions on how to process the endoscope so that it can be cleaned to acceptable standards. This is often referred to as ‘delayed reprocessing’ protocol, which must be followed in accordance with the manufacturer’s IFU. The process involves soaking the endoscope
in diluted detergent solution until debris and bioburden are visibly detached from the endoscope’s external surfaces.10 Soaking times vary for different endoscopes, and scopes that are immersed in detergent for several hours may become damaged, so referring to the specific endoscope’s IFU is always best practice. A 1-hour time limit is a relatively short amount of time for an endoscope reprocessing journey. Most decontamination units are within a different area of the hospital to the procedure room, and some are sent to facilities outside of the hospital. This implores a question about how the 60-minute timeline is mandated. Each step of reprocessing requires careful communication between healthcare staff to ensure that the protocol is being followed in the correct manner. If pre-cleaning is documented by a staff member in the procedure room but that information is not effectively communicated
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65
