Dataset Information

Comparison of automated and manual drying in the elimination of residual endoscope working channel fluid after reprocessing (with video).

ABSTRACT:

Background and aims

Residual fluid within endoscope working channels after reprocessing may promote growth of pathogens. Current reprocessing guidelines therefore recommend endoscope drying with administration of forced filtered air; however, the duration and modality of administered air are not specified. The new DriScope Aid device enables automated administration of filtered air at controlled pressure through all internal endoscope channels. We systematically compared, for the first time, the impact of manual drying and automated drying on retained working channel fluid and bioburden after reprocessing.

Methods

We assessed for residual working channel fluid after reprocessing and/or drying by using the SteriCam borescope. Drying was performed either manually (forced filtered air) or was automated (DriScope Aid) for either 5 or 10 minutes. Adenosine triphosphate (ATP) bioluminescence testing was performed on working channel rinsates after drying, to evaluate for residual bioburden.

Results

Significantly more fluid droplets were evident after manual drying (4.55 ± 6.14) than with automated device-facilitated drying for either 5 minutes (0.83 ± 1.29; P = .007) or 10 minutes (0 ± 0; P = .001). ATP bioluminescence values were higher for manual drying compared with automated drying at 48 hours (P = .001) and 72 hours (P = .014) after reprocessing.

Conclusions

We demonstrate significantly fewer water droplets and delayed ATP bioluminescence values within endoscope working channels after automated drying compared with manual drying. In particular, virtually no retained fluid was evident within endoscope working channels after automated drying for 10 minutes. These findings support recommendations for automation of as many reprocessing steps as possible. Automated drying may decrease the risk of transmission of infection related to endoscopy.

SUBMITTER: Barakat MT

PROVIDER: S-EPMC6748329 | biostudies-literature | 2019 Jan

REPOSITORIES: biostudies-literature

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Publications

Comparison of automated and manual drying in the elimination of residual endoscope working channel fluid after reprocessing (with video).

Barakat Monique T MT Huang Robert J RJ Banerjee Subhas S

Gastrointestinal endoscopy 20180825 1

<h4>Background and aims</h4>Residual fluid within endoscope working channels after reprocessing may promote growth of pathogens. Current reprocessing guidelines therefore recommend endoscope drying with administration of forced filtered air; however, the duration and modality of administered air are not specified. The new DriScope Aid device enables automated administration of filtered air at controlled pressure through all internal endoscope channels. We systematically compared, for the first t ...[more]

PMID: 30148992

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Project description:BackgroundDespite endoscope reprocessing, residual droplets remain in gastrointestinal endoscope working channels. Inadequate drying of gastrointestinal endoscope working channels may promote microbial reproduction and biofilm formation, increasing the risk of infection in patients. This review was designed to provide the current status of gastrointestinal endoscope drying, emphasize the importance of gastrointestinal endoscope drying, and evaluate the effectiveness of different drying methods of gastrointestinal endoscope in reducing residual droplets and microbial growth risk.MethodsA systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting checklist. The PubMed, Web of Science, Medline, EMBASE, EBSCO, CNKI, CQVIP, and Wanfang Data databases were searched from 2010 to 2020 to identify eligible articles focused on methods of gastrointestinal endoscope drying and the status of endoscope drying. The following key points were analyzed: type of intervention, amount of residual droplets, major microbial types, and effectiveness of biofilm intervention. JBI quality assessment tool was used to determine bias risk for inclusion in the article.ResultsThis review included twelve articles. Two of the articles reported lack of drying of gastrointestinal endoscopes while the other ten reported residual droplets, microbial growth, and biofilm formation after different methods of drying. Four articles reported 0 to 4.55 residual droplets; four articles reported that the main microbial types were cocci and bacilli, most commonly Staphylococcus, Escherichia coli, Bacillus maltophilia, and Pseudomonas aeruginosa; and two reported that drying could effectively reduce biofilm regeneration. The type of intervention is as follows: automatic endoscopy reprocessor (AER), manual compressed air drying, and the Dri-Scope Aid for automatic drying and drying cabinet.ConclusionsWhile endoscope reprocessing may not always be effective, an automatic endoscope reprocessor plus the Dri-Scope Aid with automatic drying over 10 min or storage in a drying cabinet for 72 h may be preferred.

Project description:Background and aimsStudies from our group and others demonstrate residual fluid in 42% to 95% of endoscope working channels despite high-level disinfection and drying. Additionally, persistent simethicone has been reported in endoscope channels despite reprocessing.MethodsEndoscopy was performed by using water or varied simethicone concentrations (0.5%, 1%, 3%) for flushing. After high-level disinfection/drying, we inspected endoscope working channels for retained fluid by using the SteriCam borescope. Working channel rinsates were evaluated for adenosine triphosphate (ATP) bioluminescence. Fourier transform infrared spectroscopy was performed on fluid droplets gathered from a colonoscope in which low-concentration simethicone was used.ResultsUse of medium/high concentrations of simethicone resulted in a higher mean number of fluid droplets (13.5/17.3 droplets, respectively) and ATP bioluminescence values (20.6/23 relative light units [RLUs], respectively) compared with that of procedures using only water (6.3 droplets/10.9 RLUs; P < .001). Two automated endoscope reprocessing cycles resulted in return of a fluid droplet and ATP bioluminescence values to ranges similar to that of procedures that used only water (P = .56). Low-concentration simethicone did not increase the mean residual fluid or ATP bioluminescence values compared with procedures that used only water (5.8 droplets/15.6 RLUs). Fourier transform infrared analysis revealed simethicone in the endoscope working channel after use of low-concentration simethicone.ConclusionsUse of medium/high concentrations of simethicone is associated with retention of increased fluid droplets and higher ATP bioluminescence values in endoscope working channels, compared with endoscopes in which water or low concentration simethicone was used. However, simethicone is detectable in endoscopes despite reprocessing, even when it is utilized in low concentrations. Our data suggest that when simethicone is used, it should be used in the lowest concentration possible. Facilities may consider 2 automated endoscope reprocessor cycles for reprocessing of endoscopes when simethicone has been used.

Project description:ObjectiveThis study aims to provide additional support for the equipment needed in hospitals and medical practices for reprocessing transvaginal ultrasound probes (TVUS) through an economic analysis comparing manual and automated reprocessing methods. A questionnaire survey was also conducted in hospitals and medical practices to analyze the current practice of TVUS reprocessing.MethodsThe economic analysis compared four manual reprocessing methods using disinfection wipes and one automated device-based disinfection method using hydrogen peroxide vapor. The working times were measured with a stopwatch and complemented by passive working time (disinfection exposure time or machine cycle duration). The personnel costs for the working time were calculated and combined with the calculated acquisition and material costs to determine the total process costs.ResultsThe economic analysis revealed that machine disinfection is not only time-saving but also more cost-effective per reprocessing cycle compared to two manual methods using wipes for cleaning and disinfection, where the disinfectant is applied to the wipe before use. However, two methods using ready-to-use (rtu) disinfection wipes from a container were more cost-effective. It is important to note that all wipe disinfection methods would incur additional costs due to the lack of validation. The additional costs for validation could not be calculated due to a lack of experience, making a final cost assessment for wipe disinfection methods currently impossible.Despite extensive efforts to send the survey to hospitals and medical practices through three professional societies and attempts to acquire participants via a publication, only 35 institutions participated. Except for one case, all reprocessed manually. The survey revealed a deficit in knowledge regarding TVUS reprocessing. Manual reprocessing had not been validated despite national legal requirements existing since 2002.ConclusionAs long as manual reprocessing is not validated in all steps, only machine reprocessing is ethically acceptable for patient safety. Even if manual wipe disinfection is validated, machine reprocessing offers higher patient safety, since deviations from the validated SOP cannot be excluded during manual execution. Machine reprocessing should always be preferred for occupational safety reasons.Since the process costs for methods involving the application of the disinfectant to the wipe before disinfection were higher than for the machine method, the latter is preferred in this comparison. It is not possible to determine whether the overall process is economically superior to machine reprocessing because the cost calculation for rtu disinfection wipes does not include the entire process of reprocessing, including the legally required validation. Due to the better standardization of the machine reprocessing process, along with increased procedural, worker, and patient safety, machine reprocessing should be preferred regardless of process costs, especially if the economic difference is not significant. Additionally, avoiding disposable wipes is beneficial in terms of sustainability.The lack of knowledge regarding national legal requirements and recommendations for TVUS reprocessing is a reason why the principles of reprocessing were not adhered to in several practices. Therefore, it is necessary to convey the basic knowledge of reprocessing during medical studies, followed by further training during specialization. Persons tasked with reprocessing must have the required education or participate in specialized training to demonstrate current knowledge (§ 8 Sect. 7 Medical Device Regulation).

Dataset Information

Comparison of automated and manual drying in the elimination of residual endoscope working channel fluid after reprocessing (with video).

Background and aims

Methods

Results

Conclusions

Publications

Comparison of automated and manual drying in the elimination of residual endoscope working channel fluid after reprocessing (with video).

Similar Datasets

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