Endoscope cleaning
Evaluating new approaches to endoscope cleaning
Effective removal of biofilm and contamination from endoscopes is vital to ensure patient safety. Ellie Wishart, says that new endoscope cleaning approaches are required and outlines the key criteria required to assess their potential.
Flexible endoscopes have been associated with more outbreaks of infection than any other reusable medical or surgical device.1
More
than 200 journal articles have been published in the last decade involving contamination, cleaning failure, or infections associated with endoscopes, with incidents of contamination reported for all major endoscope types. As flexible endoscopes that contact mucosa
are semi-critical devices, they must undergo thorough cleaning and high-level disinfection after each use.2
This is a highly complicated
process that can include dozens of individual steps. Of these steps, the manual brushing and flushing of endoscope channels is recognised as the most critical for successful reprocessing.3 Nevertheless, manual cleaning has its limitations. There is a need for new approaches, therefore, but they must be carefully assessed against a set of criteria to ensure they are an improvement on current methods. Here, we propose a framework to guide
the critical evaluation and assessment of new endoscope cleaning approaches.
Rigorous head-to-head efficacy data It is well known that disinfection or sterilisation of a medical device can fail if pre-cleaning is not carried out.4–6
Failure of reprocessing puts
patients at risk, as it can result in transmission of pathogens and the potential development of infectious complications.7,8
recognise the manual brushing and flushing of channels as the most important step in endoscope reprocessing.3 Any change in cleaning practice should
therefore be driven by robust, peer-reviewed efficacy data, given the large risks of an ineffective process. It is essential that well- designed studies are undertaken, including head-to-head comparisons with manual cleaning. Without data showing equivalent or better efficacy compared to manual cleaning, a new endoscope cleaning process cannot be considered. As part of this demonstration of efficacy, new
approaches must have data showing removal of the toughest artificial test soils, removal of soil
This is why guidelines
from clinically used endoscopes, and efficacy against the toughest biofilm models. These must be demonstrated in all endoscope channels, including those that cannot be brushed. One of the key challenges of endoscope
cleaning is the inaccessibility of smaller channels, such as air/water and auxiliary channels. These channels have very narrow diameters, meaning they are inaccessible to brushes and can only be cleaned by manual flushing.3
This makes narrow channels
particularly susceptible to the development of biofilm.7,11
An ideal solution to replace manual
cleaning would need to involve mechanical action in all channels, regardless of diameter.
Effective removal of biofilm When assessing a potential replacement for manual cleaning, an equivalence in efficacy to current methods is the minimum criteria. Beyond this, a replacement approach should include new capabilities that enhance efficacy but are not possible with today’s methods, such as removal of biofilm from narrow channels. Biofilms are communities of organisms that attach to surfaces, creating a protective structure that can be resistant to detergents, drying and other stresses.12
If not removed
promptly, a biofilm can mature and form strong attachments to the surface, allowing bacteria to proliferate.12 Biofilm forms readily in the channels of endoscopes. A clinical study found that the majority of gastroscopes had biofilm detected in multiple channels after only 60 days of patient use/reprocessing cycles.13 Removal of biofilm during reprocessing is essential, as studies have found that persistently contaminated endoscopes can act as reservoirs and harbour biofilm, even with adherence to reprocessing guidelines.13,14
Table 1: Principles for improved cleaning. 54
www.clinicalservicesjournal.com I May 2024
In one example, a single endoscope infected multiple patients with the same strain of Pseudomonas aeruginosa.15
The endoscope was
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 |
Page 66 |
Page 67 |
Page 68
