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Recent Study Suggests Endoscope Infection Escapes Even Rigorous Cleaning

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Minneapolis, MNA peek into the archives of the Nursing Times (09/21/00) provides some perspective into endoscope infection, and just how long the issue of cleaning and sterilizing endoscopes sufficiently to avoid passing infections between patients, has been a concern.

The venerable publication, which serves the nursing industry, noted that transmission of infections between patients involving the reusable endoscopes have been a concern for some time, with transmissions documented (for the purposes of the 2000 report) as far back as 1976 (Chmel and Armstrong).

“It is therefore essential that endoscopes are cleaned thoroughly and correctly disinfected after each use and that the guidelines for cleaning and disinfecting flexible endoscopes are adhered to strictly,” wrote Carole Crowson, RGN, DipN, in the Nursing Times. Crowson, at the time was the endoscopy manager at Peterborough District Hospital in Peterborough, England.

That article was written and published just under 17 years ago. Since that time, not only has endoscope infection and adequate disinfection been an ongoing issue – and one that has fostered many an endoscope lawsuit – a new study suggests that even when proper cleaning protocols are followed, it is still possible for endoscopes to transfer infections, and that “current cleaning techniques prove insufficient for flexible endoscopes.”

The foregoing is the headline in a more recent issue of the Nursing Times issued this past February (02/01/17). A study conducted by researchers at the University of Minnesota Medical School and Ofstead and Associates – and recently published in the American Journal of Infection Control – current techniques for cleaning and disinfecting endoscopes are not consistently effective.

The suggestion, therefore, is that strict adherence to cleaning protocols isn’t enough. The researchers stressed the need for thorough visual inspections, together with verification tests to ensure a reusable endoscope is free from damage and debris prior to use on the next patient.

The study found that even after rigorous cleaning and reprocessing techniques were carried out according to protocol, organic residues were often left behind on the devices, from the previous patient.

Researchers undertook three separate assessments of 20 endoscopes over a seven-month period. Assessments involved visual inspections with a tiny camera, microbial cultures, and biochemical tests to detect protein and adenosine triphosphate (ATP) – a marker that identifies organic matter.

Of concern to anyone worried about endoscopic infection, is the finding by researchers that all 20 endoscopes used in the study, thoroughly reprocessed and examined, were found after the fact to have visual irregularities – including fluid, discoloration and debris left behind in the endoscope channels.

Samples from 60 percent had microbial growth, indicating a failure of the disinfection process, and 20 percent of endoscopes in each group exceeded post-cleaning benchmarks for ATP and protein residue. The findings led the researchers to surmise that something was affecting the gastroscopes during procedures that affected the surfaces in some fashion, thereby impacting the reprocessing and triggering failures.

“Even though top-notch methods were used,” said lead study author Cori Ofstead, “the endoscopes in this study had visible signs of damage and debris, and tests showed a high proportion were still contaminated.

“These findings bolster the need for routine visual inspection and cleaning verification tests recommended in new reprocessing guidelines.

“The finding of residual fluid in 95 percent of endoscopes tested was significant because moisture fosters microbial growth and the development of biofilm – which can be difficult or impossible to remove,” Ofstead said.

“This confirms the importance of cleaning, disinfecting, and drying to ensure patient safety,” she added.

Many an endoscope lawsuit has alleged grievous infections – including superbugs – stemming from a procedure employing a reusable endoscope that had not been properly cleaned and reprocessed, thereby passing on an infection from one patient to another. The subsequent endoscope negligence lawsuits brought against endoscope manufacturers and sometimes the doctors and hospitals that deploy them, seek compensation for patients or their surviving families over health issues suffered through no fault of their own.

Manufacturers of the endoscopes used in the study were not identified.

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