Endoscope cleaning
the impact of human factors on manual cleaning quality.22–24
Manual cleaning is
dependent on the quality of staff training and motivation to achieve consistent results. Automated cleaning enables standardisation and limits variability between individual reprocessing staff.25
Less dependence on
human factors means automated cleaning is more reproducible.24,26 Reduced workloads compared to full manual cleaning could improve ergonomics for reprocessing staff.3
The entire manual cleaning
of an endoscope is usually completed by one person. If a second person takes over, they should restart cleaning from the beginning.24
exposure to cleaning products might improve occupational respiratory health.27
Decreasing In
this instance, automated cleaning could remove this redundancy altogether. At present, multiple societies and guidelines support automated cleaning.3,24–26 Reprocessing staff may not perform all manual cleaning steps. Only 1.4% of endoscopes were processed completely (all steps were performed) using manual cleaning and HLD.22
In comparison, automated endoscope
reprocessors (AERs) raised the completion of all reprocessing steps by staff to 75.4%.22 The top reason for manual cleaning non-
adherence is the pressure to work fast.21 Manual cleaning effectiveness decreases when reprocessing staff work in uncomfortable environments.21
Demands on memory to remember all
reprocessing steps also reduces manual cleaning effectiveness.21
This highlights that
manual cleaning is prone to human error and is not reproducible.
Avoid splashing or exposure to harmful cleaning products Automation holds untapped intrinsic value if it occurs in a closed system. For staff this could mean reductions in chemical, aerosol, splash and biohazard exposure.3
Reducing
staff contact with contaminated endoscopes minimises the risk of infection. There is also a lower contamination risk of the surrounding environment.3
Almost all manual cleaning activities produce splashing. Activities involving a running tap (or faucet) produced the most splashing. Researchers observed droplets 1.2–1.8 m (4–6 feet) from the decontamination sink after manual cleaning.28
Splashing exposes
staff to microbes through fluids. Aside from wet personal protective equipment (PPE) contamination, this could lead to cross contamination within decontamination units. For now, brushing and scrubbing endoscopes under water will help to reduce splash.28 Enzymatic detergents are used in precleaning and manual cleaning of GI endoscopes.29
High
exposure to enzymatic detergents increases the likelihood of poorer asthma control.27 Guidelines acknowledge splash, aerosol and vapour encountered during manual cleaning are unavoidable.3,24,26,30,31
References for this article are available upon request.
Figure 2. 8000X magnification of 1.4mm PTFE tube (to simulate air/water and auxiliary channels) with biofilm growth
The next gold standard Endoscope reprocessing, including thorough cleaning and disinfection, is essential to protect patients from cross-contamination. Any potential new approach to endoscope cleaning requires careful assessment against a number of criteria: l Rigorous efficacy data across all endoscope channels.
l Effective removal of biofilm, using the best representative biofilm models.
l Less physical discomfort for staff. l Automation of processes. l Avoids splashing or exposure to harmful cleaning agents.
It is important that any change in cleaning practice is driven by strong evidence, as the risks of an ineffective process are high. Avoiding cleaning failure should be the primary driver of change, resulting in a process that is more effective and safer for both patients and reprocessing staff.
CSJ
Staff should wear PPE to
protect themselves from direct exposure.3,24,30 Several guidelines note a preference for
automated/mechanical cleaning over manual processes.3,24,26
Automated or mechanical cleaning
could improve staff safety through reducing exposure to chemicals or infectious material.3
About the author
As Senior Medical Affairs Manager for EMEA for Nanosonics, Ellie Wishart is responsible for engaging with thought leaders and key organisations on infection prevention & decontamination and speaks at national & international conferences on such topics. Ellie has a degree in Microbiology from University College Dublin, Ireland and has been involved in the provision of infection prevention solutions to Healthcare facilities for over 20 years. Nanosonics is an Australian infection prevention
Figure 3. Occupational health issues attributed to endoscope reprocessing. Adapted from Ofstead et al. 2010.22
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www.clinicalservicesjournal.com I May 2024
company that has successfully developed and commercialised a unique automated disinfection technology, the trophon device, representing the first major innovation in high level disinfection for ultrasound probes in more than 20 years. The trophon device is fast becoming the global standard of care for ultrasound probe disinfection.
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