ENDOSCOP E R E P ROCES S ING
Improving hygiene in endoscopy
At ESGE Days 2021*, Pentax Medical hosted a symposium to hear from key opinion leaders on Scientific Perspectives on Hygiene Innovation in Endoscopy. The majority of the insights shared in this article were presented during this symposium.
Flexible endoscopes are still predominantly reusable devices. During their use, they can become heavily contaminated with the patient’s microbial flora. To ensure patient safety, meticulous cleaning and high-level disinfection is needed to guarantee clean and safe use on subsequent patients. Continuously working to improve patient safety and infection prevention is therefore at the forefront of endoscopists, nurses and reprocessing personnel’s focus. “Infections caused by endoscopes can have an incredible impact both on patients and staff,” commented Prof. Marco Bruno, head of gastroenterology and hepatology, Erasmus University Medical Centre, Rotterdam. “I have had personal experience with infections at my hospital, involving 30 patients. However, solutions have been created to improve patient safety and infection prevention, over the years.”1
The importance of drying in endoscope reprocessing Appropriate endoscope reprocessing is an essential part of patient safety and quality assurance in endoscopy. Research shows that to create and maintain an endoscopes’ disinfected status, complete drying is an absolute necessity.2
Dr. Julia
Kovaleva, MD, PhD, clinical microbiologist and clinical pathologist department of laboratory medicine, AZ Rivierenland, explained 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.
MAY 2021
This is likely to originate from water sources (endoscope washers disinfectors and insufficient dried endoscope channels) containing waterborne microorganisms. Dr. Kovaleva went on to explain that microorganisms in biofilms are very resistant to antimicrobial agents and allow 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. Dr. Kovaleva further explained that drying and storage in endoscopy reprocessing
are just as important for preventing against infection as cleaning and high- level disinfection. Effective drying greatly reduces bacterial contamination of stored endoscopes.
Solutions to prevent contaminated endoscopes Dr. Vinteler, CEO and founder of PlasmaBiotics, reinforced the message that failure of drying can result in growth of biofilms inside channels, during storage, an important factor in the pathogenesis of endoscopy-related infections. Currently, some solutions include storage cabinets in which the drying time can vary between 30-90 minutes or even more, depending on the manufacturer’s instruction-for-use and the endoscope type. The problem with a longer drying time is that it can result in a 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
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