ENDOSCOPY
by Ofstead et al1
which observed
the reprocessing methods for flexible bronchoscopes including the assessment of storage conditions. It also included the visual inspection of ports and channels performed with light magnification and borescopes. Contamination was detected using microbial cultures and tests for protein, haemoglobin, and ATP.
The researchers examined 24 bronchoscopes in three different centres and residual contamination was detected in 100% of the scopes after manual cleaning. Microbial growth (including mould, Stenotrophomonas maltophilia,
E.coli and Shigella spp, was found in 58% of the scopes after full reprocessing. Visible irregularities were found in 100% of the scopes. “This is not just a problem with bronchoscopes. This is a problem associated with every type of flexible endoscope,” he added.
Highlighting some of the literature,
Prof. Trisolini pointed out that flexible ureteroscopes, gastroscopes and colonoscopes can all develop defects over a relatively short period of time,2
highlighting
the importance of ongoing maintenance programmes.
He suggested that drying, storage and
transport are also neglected phases. However, drying and storage are particularly neglected, in his view. Drying is key to remove residual moisture which facilitates microbial growth and to avoid biofilm formation. “At our centre, we use the
PlasmaTYPOON+ and PlasmaBAG – a certified, ultra-fast and complete drying method for endoscopes. Scopes can be stored in the PlasmaBAG for up to 31 days.3
At every step, we have a high carbon footprint. To put this into perspective, the waste volume associated with endoscopic procedures undertaken annually, in the US alone, would cover the equivalent of 117 soccer fields (with waste at 1 metre in depth), and would weigh
the equivalent of 24,900 passenger cars. Professor Shaji Sebastian, consultant gastroenterologist, Hull University Teaching Hospitals.
he explained. The process is also very quick, with the new PlasmaTYPHOON+ taking 1-3 minutes depending on the type of endoscope.
It offers improved patient safety by eliminating the risk of cross-contamination or recontamination during storage or transport,”
A laminar flow eliminates most of the residual fluid in the channels. A turbulent flow with heated medical air then eliminates the remaining droplets on the channel walls. Finally, the scope is placed in the bag and the latter is then connected to the PlasmaTYPOON+ for six seconds, inflating the bag with 4-6ppm of ozone. He pointed out that there is underreporting of the rate of infections; reprocessing guidelines are far too complex and poorly known; surveillance (scopes and patients) is warranted – as infections can occur even when reprocessing is carried out according to guidelines; and manufacturers should consider alternative designs to facilitate effective reprocessing. However, he also raised the question: is sterilisation the answer, when scope damage still occurs? Furthermore, should we move to single-use bronchoscopes?
He pointed out that manufacturers have now developed semi-disposable options to
help reduce the infection risks associated with fully reusable scopes – including single- use suction control valves and single-use cleaning brushes. Much of the attention in recent years has been on the development of single-use bronchoscopes, however. Before the COVID-19 pandemic, single-use scopes were used mostly by intensivists and anaesthetists for intubation. In the anaesthesia setting, micro-costing suggests that single-use scopes reduce costs compared with reusable scopes.3
However,
the pandemic has now boosted their use and the reasons for this, he explained, include: l There is no risk of contamination for healthcare workers (no cleaning or reprocessing, and less handling for clinicians);
l The availability of scopes inside ICU and restricted areas;
l They can be brought in and out of restricted areas very easily, as there is no need to bring a big cart in and out of the area.
Several manufacturers have developed single-use bronchoscopes – including the Pentax ONE Pulmo. The latter offers sterility with HD visualisation, broadening the clinical applications beyond the standard disposable scope. It is also designed to mimic the ergonomics of a reusable endoscope. So, are single-use scopes ready for prime-time use in pulmonology? Prof. Trisolini pointed out that there are some hurdles to overcome: l Most endoscopy centres have already heavily invested in reusable bronchoscopes, automated endoscope reprocessors and personnel dedicated to reprocessing. For most centres, single-use scopes are, initially, an added cost.
l Many manufacturers have developed improvements to single-use scopes, in terms of handling, performance, reliability, image quality and increasing channel size, but there is room for further improvement if they are to completely replace reusable scopes.
JUNE 2022
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