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The Use of Rapid Indicators for the Detection of Organic Residues on Clinically Used Gastrointestinal Endoscopes with and without Visually Apparent Debris

Published online by Cambridge University Press:  10 May 2016

Kavel H. Visrodia ,
Cori L. Ofstead ,
Hannah L. Yellin ,
Harry P. Wetzler ,
Pritish K. Tosh  and
Todd H. Baron
Kavel H. Visrodia
Affiliation:
Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
Cori L. Ofstead*
Affiliation:
Ofstead and Associates, Saint Paul, Minnesota Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
Hannah L. Yellin
Affiliation:
Ofstead and Associates, Saint Paul, Minnesota
Harry P. Wetzler
Affiliation:
Ofstead and Associates, Saint Paul, Minnesota
Pritish K. Tosh
Affiliation:
Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota
Todd H. Baron
Affiliation:
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
*
Ofstead and Associates, 400 Selby Avenue, Suite V, Blair Arcade West, Saint Paul, MN 55102 ([email protected]).
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Extract

Background

Outbreaks of multidrug-resistant organisms have been linked to endoscope reprocessing lapses. Meticulous manual cleaning before high-level disinfection (HLD) is essential in reducing residual contamination that can interfere with HLD. Current reprocessing guidelines state that visual inspection is sufficient to confirm adequate cleaning.

Objective

Our aim was to evaluate contamination of clinically used endoscopes, using visual inspection and rapid indicator tests before and after manual cleaning. A second objective was to determine which rapid indicator instruments and methods could be used for quality improvement initiatives in endoscope reprocessing.

Design

Clinical use study of endoscope reprocessing effectiveness.

Setting

Tertiary care teaching hospital with an inpatient endoscopy center.

Methods

Researchers sampled endoscopes used for gastrointestinal procedures before and after manual cleaning. The external surfaces and 1 channel of each endoscope were visually inspected and tested with rapid indicators to measure protein, blood, and adenosine triphosphate (ATP) contamination levels.

Results

Multiple components were sampled during 37 encounters with 12 unique endoscopes. All bedside-cleaned endoscopes had high levels of ATP and detectable blood or protein, whether or not any residue was visible. Although there was no visible residue on any endoscopes after manual cleaning, 82% had at least 1 positive rapid indicator test.

Conclusions

Relying solely on visual inspection of endoscopes prior to HLD is insufficient to ensure reprocessing effectiveness. For quality assurance initiatives, tests of different endoscope components using more than 1 indicator may be necessary. Additional research is needed to validate specific monitoring protocols.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue 8 , August 2014 , pp. 987 - 994
Copyright
© 2014 by The Society for Healthcare Epidemiology of America. All rights reserved.

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