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Casini B, Tuvo B, Marciano E, Del Magro G, Gemignani G, Luchini G, Cristina ML, Costa AL, Arzilli G, Totaro M, Baggiani A, Privitera G. Improving the Reprocessing Quality of Flexible Thermolabile Endoscopes: How to Learn from Mistakes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052482. [PMID: 33802350 PMCID: PMC7967619 DOI: 10.3390/ijerph18052482] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 02/24/2021] [Accepted: 02/26/2021] [Indexed: 11/29/2022]
Abstract
Background: Failure in the reprocessing of thermolabile flexible endoscopes has been reported as one of the most important threats to patient health. Method: A case report and observational study was conducted, from August 2014 to December 2019, in the Digestive Endoscopy Unit of a University Hospital in Italy, where two cases of Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae infections in patients undergoing endoscopic retrograde cholangio-pancreatography were observed. Following the risk/safety management practices, an epidemiological investigation was started, duodenoscopes were removed from use and the reprocessing practices reviewed. Moreover, microbiological surveillance of endoscopes was carried out according to the CDC guidelines. Results: In the first phase of sampling, 10/10 (100%) endoscopes were found to be non-compliant, of which 7 showed results for high-concern organisms (HCOs), such as KPC-K. pneumoniae, P. aeruginosa and E. coli. After implementing corrective actions, 12 out of 17 endoscopes were found to be non-compliant (70.5%), of which 8 showed results for HCOs, such as KPC-K. oxytoca and P. aeruginosa. During the last year of regular microbiological surveillance, only 23% of endoscopes (35/152) were found to be non-compliant, of which 7 showed results for HCOs, such as NDM-K. pneumoniae, P. aeruginosa and A. baumannii. The crucial issues were related to samples collected from the internal channels of duodenoscopes. Conclusion: Managing the risk associated with the reprocessing of digestive endoscopes, through risk assessment at every stage of the process, is important for the prevention of infections associated with the use of these device.
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Affiliation(s)
- Beatrice Casini
- Department of Translational Research, New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (B.T.); (A.L.C.); (G.A.); (M.T.); (A.B.); (G.P.)
- Correspondence: ; Tel.: +39-050-2213590; Fax: +39-050-2213588
| | - Benedetta Tuvo
- Department of Translational Research, New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (B.T.); (A.L.C.); (G.A.); (M.T.); (A.B.); (G.P.)
| | - Emanuele Marciano
- Endoscopy Service Division, University Hospital of Pisa, 56126 Pisa, Italy; (E.M.); (G.D.M.)
| | - Giuliana Del Magro
- Endoscopy Service Division, University Hospital of Pisa, 56126 Pisa, Italy; (E.M.); (G.D.M.)
| | - Giulia Gemignani
- Medical Direction, University Hospital of Pisa, 56126 Pisa, Italy; (G.G.); (G.L.)
| | - Grazia Luchini
- Medical Direction, University Hospital of Pisa, 56126 Pisa, Italy; (G.G.); (G.L.)
| | | | - Anna Laura Costa
- Department of Translational Research, New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (B.T.); (A.L.C.); (G.A.); (M.T.); (A.B.); (G.P.)
| | - Guglielmo Arzilli
- Department of Translational Research, New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (B.T.); (A.L.C.); (G.A.); (M.T.); (A.B.); (G.P.)
| | - Michele Totaro
- Department of Translational Research, New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (B.T.); (A.L.C.); (G.A.); (M.T.); (A.B.); (G.P.)
| | - Angelo Baggiani
- Department of Translational Research, New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (B.T.); (A.L.C.); (G.A.); (M.T.); (A.B.); (G.P.)
| | - Gaetano Privitera
- Department of Translational Research, New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (B.T.); (A.L.C.); (G.A.); (M.T.); (A.B.); (G.P.)
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Oya M, Taniguchi Y, Fujimura N, Miyamoto K, Oya M. Kinetic analysis of hemoglobin detergency by probability density functional method. PLoS One 2020; 15:e0237255. [PMID: 32764804 PMCID: PMC7413519 DOI: 10.1371/journal.pone.0237255] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 07/22/2020] [Indexed: 11/25/2022] Open
Abstract
In this study, washing tests were performed using samples prepared by contaminating fabrics with hemoglobin, and a kinetic analysis was conducted based the probability density functional method, which expresses the cleaning power using two parameters σrl (related to the cleaning mechanism) and μrl (related to the level of cleaning power). This method allows for the processing of uncertainties specific to protein washing under the assumption that the soil adhesion and detergency are in accordance with a normal distribution. A certain amount of hemoglobin solution was soaked in a cloth, dried, and steam-treated, and then used as a sample for a cleaning test. Two parameters σrl and μrl were calculated based on the detergency (%) after 5 min, 10 min, 15 min, and 20 min of washing with respect to different pH and temperature levels, and different sodium dodecyl sulfate (SDS) concentration and temperature levels. Based on the results, the value of σrl indicated that the hemoglobin was removed by the dissolving action. In addition, μrl increased in accordance with an increase in the pH, SDS concentration, and temperature. With respect to μrl, the relationship of ΔX + ΔY = Δ(X+Y) was observed in several cases, where ΔX represents the effect of the pH or SDS concentration, ΔY is the temperature effect, and Δ(X+Y) is the combined effect. Therefore, there may be an additive relationship between the pH and temperature effects, and the SDS concentration and temperature effects.
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Affiliation(s)
- Miyako Oya
- Surgical Department, Kimitsu Chuo Hospital, Kisarazu-shi, Chiba, Japan
| | - Yosuke Taniguchi
- Graduate School of Environment and Information Sciences, Yokohama National University, Yokohama, Kanagawa, Japan
| | - Naoaki Fujimura
- Graduate School of Environment and Information Sciences, Yokohama National University, Yokohama, Kanagawa, Japan
| | - Karen Miyamoto
- Graduate School of Environment and Information Sciences, Yokohama National University, Yokohama, Kanagawa, Japan
| | - Masaru Oya
- Graduate School of Environment and Information Sciences, Yokohama National University, Yokohama, Kanagawa, Japan
- * E-mail:
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Aarabi A, Mosleh S, Fazeli H, Farahmand H. Effect of cleaning guidelines implementation on microbial colony count of laparoscopic instruments: A study in a public hospital in Iran. Asian J Endosc Surg 2020; 13:272-278. [PMID: 31430059 DOI: 10.1111/ases.12750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 06/13/2019] [Accepted: 07/30/2019] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Some countries have implemented reuse of laparoscopic instruments for cost-effective purposes. An accurate cleaning as the first step of reprocessing would lead to the effective sterilization. The purpose was to evaluate the effect of cleaning guidelines implementation on microbial load of laparoscopic instruments which were used in laparoscopic cholecystectomy surgery. METHODS This experimental study was done in an educational hospital, in 2017 and included a total of 128 laparoscopic instruments randomly selected from cholecystectomy surgeries and divided into two cleaning groups. The instruments were checked out in terms of number (colony-forming units [CFU]/mL) and type of microorganisms in two groups of routine cleaning and according to guideline cleaning. This guideline was indigenous and taken from successful instruction in this context that was presented by the Association for the Advancement of Medical Instrumentation (AAMI). The appropriate statistical analysis was conducted by SPSS version 19. RESULTS The average microbial load was 2.4 × 106 CFU/100 mL after clinical use. It was reduced to 7.2 × 105 CFU/100 mL in the control group and 3.4 × 104 CFU/100 mL in the intervention group, after the cleaning process. The most common microorganisms that were isolated immediately after clinical use were Escherichia coli 81.2%, Pseudomonas 68.8%, Klebsiella 57.8%, and spp., and so on. CONCLUSION The AAMI cleaning method is recommended to be utilized by operating room nurses for laparoscopic instruments.
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Affiliation(s)
- Akram Aarabi
- Nursing and Midwifery Care Research Center, Operating Room Department, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sorour Mosleh
- Master Science in Perioperative Care, Operating Room Department, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hossein Fazeli
- Department of Microbiology, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hassan Farahmand
- Faculty Member of the Operating Room Department, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
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Washburn RE, Pietsch JJ. Assessment of test methods for evaluating effectiveness of cleaning flexible endoscopes. Am J Infect Control 2018; 46:685-688. [PMID: 29329921 DOI: 10.1016/j.ajic.2017.11.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 11/17/2017] [Accepted: 11/17/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Strict adherence to each step of reprocessing is imperative to removing potentially infectious agents. Multiple methods for verifying proper reprocessing exist; however, each presents challenges and limitations, and best practice within the industry has not been established. Our goal was to evaluate endoscope cleaning verification tests with particular interest in the evaluation of the manual cleaning step. The results of the cleaning verification tests were compared with microbial culturing to see if a positive cleaning verification test would be predictive of microbial growth. METHODS This study was conducted at 2 high-volume endoscopy units within a multisite health care system. Each of the 90 endoscopes were tested for adenosine triphosphate, protein, microbial growth via agar plate, and rapid gram-negative culture via assay. The endoscopes were tested in 3 locations: the instrument channel, control knob, and elevator mechanism. RESULTS This analysis showed substantial level of agreement between protein detection postmanual cleaning and protein detection post-high-level disinfection at the control head for scopes sampled sequentially. CONCLUSIONS This study suggests that if protein is detected postmanual cleaning, there is a significant likelihood that protein will also be detected post-high-level disinfection. It also infers that a cleaning verification test is not predictive of microbial growth.
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