ENDOSCOPY
surfaces are contaminated because of a lack of attention to the condition of the gloved hands touching them, typically relating to distal tip scope protectors and other items. Recontamination may occur when the person who handles these protectors is contaminated. The porous protector can then become a medium for bacteria growth.9 In addition, the British Society of Gastroenterology (BSG) noted that: “If endoscopes are hung vertically care should be taken to ensure that the height of the cabinet is sufficient to avoid the distal tip ‘touching’ or curling up on the ‘floor’ of the cabinet. The use of pads on the base of the cabinet to protect the tip and collect moisture must NOT be used.”
They go on to say that “damage to the outer surface could allow body fluids or
chemicals into the internal workings of the endoscope.” This could lead onto the need for loan scopes of course, which pose their own set of issues. Again, the BSG noted: “The handling of loan endoscopes requires special consideration. Loan scopes need to be reprocessed prior to first patient use and incorporated within the tracking and traceability process”.10
The Society of Gastroenterology Nurses and Associates (SGNA) investigated this back in 2010, due to the rationale of “any retained fluid may get trapped in the sponge and then become a breeding ground for bacteria”.11
At their 41st Annual Course in Nashville, the SGNA presented evidence on sponge tip protectors and whether they encouraged microbial growth on endoscopes.12
Images
Fig 2: New designs of endoscope tip protectors allow the scope to aerate while still covering the tip.
were presented that showed that these sponge tip protectors should be placed about 1/2” to 1” back from the endoscope distal tip to prevent them from trapping moisture from the scope (see figure 1). Should residual moisture drain out onto these sponges they could then become magnets for bacterial growth. This method of sponge placement is also reinforced by some sponge manufacturers who state in their instructions for use: “The protector should be placed onto the distal end of the endoscope. The placement should ensure the distal tip of the endoscope is left uncovered.”13
The use of the Protech scope tip protection device resulted in a 53.8% decrease in overall repairs and a 66.7% reduction in loan scopes required. Over an extended nine-month evaluation period endoscope tip damage was also reduced by 66.7%.
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Fig 1: Scope sponges now have to be placed about 1/2” to 1” back from the endoscope distal tip.
that these sponge tip protectors are no longer protecting the actual endoscope distal tip. Sponge tip protectors should also, of course, only be placed on when the endoscope is dry and after forced air and alcohol flushes, which are part of standard drying processes. However, the recent paper published in AJIC14
found that researchers The issue with this of course, is
observed fluid in 19 of 20 patient-ready endoscopes (95%), discoloration, and debris in channels. The fluid was observed in scopes which were stored vertically after reprocessing. The presence of residual fluid could foster the growth of bacteria and fungi. Residual fluid found inside endoscopes indicated that current industry standards do not effectively dry endoscopes, which is essential to minimise growth of environmental contaminants and potential pathogens.
Latest developments in tip protection devices
There are now specific products designed for endoscope tip protection which allow the scope to properly aerate while still covering the tip and still providing shock absorbency. These provide good ventilation, encourage continued air drying of the surfaces and prevents undue moisture build-up, thus
NOVEMBER 2020
©Gallay Medical aand Scientific.)
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