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Nabi Z, Tang RSY, Sundaram S, Lakhtakia S, Reddy DN. Single-use accessories and endoscopes in the era of sustainability and climate change-A balancing act. J Gastroenterol Hepatol 2024; 39:7-17. [PMID: 37859502 DOI: 10.1111/jgh.16380] [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: 08/12/2023] [Revised: 09/27/2023] [Accepted: 09/28/2023] [Indexed: 10/21/2023]
Abstract
Gastrointestinal (GI) endoscopy is among the highest waste generator in healthcare facilities. The major reasons include production of large-volume non-renewable waste, use of single-use devices, and reprocessing or decontamination processes. Single-use endoscopic accessories have gradually replaced reusable devices over last two decades contributing to the rising impact of GI endoscopy on ecosystem. Several reports of infection outbreaks with reusable duodenoscopes raised concerns regarding the efficacy and adherence to standard disinfection protocols. Even the enhanced reprocessing techniques like double high-level disinfection have not been found to be the perfect ways for decontamination of duodenoscopes and therefore, paved the way for the development of single-use duodenoscopes. However, the use of single-use endoscopes is likely to amplify the net waste generated and carbon footprint of any endoscopy unit. Moreover, single-use devices challenge one of the major pillars of sustainability, that is, "reuse." In the era of climate change, a balanced approach is required taking into consideration patient safety as well as financial and environmental implications. The possible solutions to provide optimum care while addressing the impact on climate include selective use of disposable duodenoscopes and careful selection of accessories during a case. Other options include use of disposable endcaps and development of effective high-level disinfection techniques. The collaboration between the healthcare professionals and the manufacturers is paramount for the development of environmental friendly devices with low carbon footprint.
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Affiliation(s)
- Zaheer Nabi
- Asian Institute of Gastroenterology, Hyderabad, India
| | - Raymond S Y Tang
- Department of Medicine and Therapeutics, S. H. Ho Center for Digestive Health Faculty of Medicine, Chinese University of Hong Kong, Endoscopy Center, Prince of Wales Hospital, Hong Kong, China
| | - Sridhar Sundaram
- Department of Digestive Diseases and Clinical Nutrition, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, India
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Xu F, Yang Y, Ding Z. Esophagogastroduodenoscopy procedure using disposable endoscope to detect the cause of melena in a patient with COVID-19. Dig Endosc 2021; 33:e1-e2. [PMID: 33124138 DOI: 10.1111/den.13840] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 09/09/2020] [Indexed: 01/14/2023]
Affiliation(s)
- Fenghua Xu
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yunsheng Yang
- Division of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing, China
| | - Zhen Ding
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Evaluation of Clinical Use and Cost-Effectiveness of a Flexible Cystoscope System with a Disposable Sheath: A Randomized Clinical Trial. UROLOGY PRACTICE 2019. [DOI: 10.1097/upj.0000000000000019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Wang W, Short M, Tai IT, Zeng H. Disposable sheath that facilitates endoscopic Raman spectroscopy. JOURNAL OF BIOMEDICAL OPTICS 2016; 21:25001. [PMID: 26836206 DOI: 10.1117/1.jbo.21.2.025001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 12/22/2015] [Indexed: 06/05/2023]
Abstract
In vivo endoscopic Raman spectroscopy of human tissue using a fiber optic probe has been previously demonstrated. However, there remain several technical challenges, such as a robust control over the laser radiation dose and measurement repeatability during endoscopy. A decrease in the signal to noise was also observed due to aging of Raman probe after repeated cycles of harsh reprocessing procedures. To address these issues, we designed and tested a disposable, biocompatible, and sterile sheath for use with a fiber optic endoscopic Raman probe. The sheath effectively controls contamination of Raman probes between procedures, greatly reduces turnaround time, and slows down the aging of the Raman probes. A small optical window fitted at the sheath cap maintained the measurement distance between Raman probe end and tissue surface. To ensure that the sheath caused a minimal amount of fluorescence and Raman interference, the optical properties of materials for the sheath, optical window, and bonding agent were studied. The easy-to-use sheath can be manufactured at a moderate cost. The sheath strictly enforced a maximum permissible exposure standard of the tissue by the laser and reduced the spectral variability by 1.5 to 8.5 times within the spectral measurement range.
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Affiliation(s)
- Wenbo Wang
- BC Cancer Agency Research Centre, Imaging Unit-Integrative Oncology Department, 675 West 10th Avenue, Vancouver, British Columbia, V5Z 1L3, CanadabUniversity of British Columbia, Faculty of Applied Science, Department of Biomedical Engineering, KAIS 5500
| | - Michael Short
- BC Cancer Agency Research Centre, Imaging Unit-Integrative Oncology Department, 675 West 10th Avenue, Vancouver, British Columbia, V5Z 1L3, Canada
| | - Isabella T Tai
- BC Cancer Agency, Michael Smith Genome Sciences Centre, 675 West 10th Avenue, Vancouver, British Columbia, V5Z 1L3, CanadadUniversity of British Columbia, Faculty of Medicine, Division of Gastroenterology, 2775 Laurel Street, Vancouver, British Columbia
| | - Haishan Zeng
- BC Cancer Agency Research Centre, Imaging Unit-Integrative Oncology Department, 675 West 10th Avenue, Vancouver, British Columbia, V5Z 1L3, Canada
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Al-Jebur H, JungHun C. Design of Dividable Colonoscope Sheath1. J Med Device 2014. [DOI: 10.1115/1.4027123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Hussein Al-Jebur
- Department of Mechanical Engineering, Ohio University, 259 Stocker Center, Athens, OH 45701
| | - Choi JungHun
- Department of Mechanical Engineering and Biomedical Engineering Program, Ohio University, 254 Stocker Center, Athens, OH 45701 e-mail:
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Jin P, Wang X, Yu DL, Li AQ, Wang HH, Meng MM, Li SR, Liu DQ, Sheng JQ, Cai Q. Safety and efficacy of a novel disposable sheathed gastroscopic system in clinical practice. J Gastroenterol Hepatol 2014; 29:757-61. [PMID: 24325649 DOI: 10.1111/jgh.12482] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/07/2013] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIM Endoscopic examinations carry a potential risk of cross-infection, and the traditional reprocessing method is time consuming. We evaluated the safety and efficacy of a novel disposable sheathed gastroscope system in clinical practice in comparison with the conventional gastroscope. METHODS There were two phases in the study. In phase 1, 20 patients with hepatitis B were randomized into two groups: the sheathed group was examined with the novel disposable sheathed gastroscope (n = 10) and the conventional group with the conventional gastroscope (n = 10). Microbiologic tests were performed on each endoscope afterwards. In the second phase, 1120 patients were randomized again into the same two groups with 568 and 552 patients in the sheathed group and the conventional group, respectively. The time duration of the endoscopic procedure and reprocessing were measured. The pathology detection rate of endoscopic examinations, the patients' subjective feelings, and problems occurred during procedures were also recorded. RESULTS The total instrument turn-around time in the phase 2 sheathed group (9.9 ± 1.3 min) was significantly shorter than the conventional group (39.0 ± 1.4 min, P = 0.000). The mean procedural time was slightly longer in the sheathed group than in the conventional group (4.9 ± 1.4 vs 4.1 ± 1.3 min, P = 0.000). However, the duration of endoscopic reprocessing was much shorter (4.9 ± 0.2 vs 35 ± 0.2 min, P = 0.000). No significant differences were observed in patient discomfort, optical clarity, or pathology detection rate. There were no complications in either group, and no microbial contamination was detected in phase 1 of the study. CONCLUSIONS Compared with the conventional gastroscope, the novel disposable sheathed gastroendoscope is safe and more efficient in clinical practice.
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Affiliation(s)
- Peng Jin
- Department of Gastroenterology, Beijing Military General Hospital, Beijing, China; Third Military Medical University, Chongqing, China
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Elackattu A, Zoccoli M, Spiegel JH, Grundfast KM. A comparison of two methods for preventing cross-contamination when using flexible fiberoptic endoscopes in an otolaryngology clinic: Disposable sterile sheaths versus immersion in germicidal liquid. Laryngoscope 2010; 120:2410-6. [DOI: 10.1002/lary.21146] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Saidel-Odes L, Borer A, Riesenberg K, Schlaeffer F. Shewanella spp. infection following treatment for upper gastrointestinal bleeding. ACTA ACUST UNITED AC 2009; 39:360-1. [PMID: 17454904 DOI: 10.1080/00365540600978948] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Shewanella spp. are an uncommon cause of human infection, with exposure to water being the commonest source. We report a patient with a malignancy and upper gastrointestinal bleeding who underwent a gastric lavage followed by an endoscopy as part of her investigations. She subsequently developed Shewanella spp. bacteraemia without any clinical source of infection.
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Affiliation(s)
- Lisa Saidel-Odes
- Infectious Disease Unit, Soroka University Hospital, Beersheva, Israel.
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Alvarado CJ, Anderson AG, Maki DG. Microbiologic assessment of disposable sterile endoscopic sheaths to replace high-level disinfection in reprocessing: a prospective clinical trial with nasopharygoscopes. Am J Infect Control 2009; 37:408-413. [PMID: 19482219 DOI: 10.1016/j.ajic.2009.04.276] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2008] [Revised: 04/02/2009] [Accepted: 04/03/2009] [Indexed: 01/29/2023]
Abstract
BACKGROUND Conventional reprocessing of endoscopes with high-level disinfection is labor intensive, expensive, delays the turnover of instruments, and involves potential exposure of personnel to toxic chemicals. We report a prospective clinical trial with rigorous microbiologic assessment of a novel disposable, sterile, polyurethane sheath, which can be easily and snugly applied over a nasopharyngoscope before performing the endoscopic procedure, with enzymatic cleansing and disinfection of the instrument with 70% ethanol following the procedure to determine whether the use of the novel sheath can provide reliable protection against bacterial contamination and obviate the need for routine high-level disinfection in reprocessing. METHODS Baseline cultures were obtained at 3 time periods from the control heads and insertion shafts of nasopharyngoscopes used in 100 clinical examinations: before application of the protective sheath and execution of the procedure; immediately after the procedure and removal of the sheath; and after enzymatic cleaning, disinfection with 70% ethanol, and drying. All 100 used sheaths and 20 unused sheaths were subjected to high-pressure leak testing to assess barrier integrity. RESULTS Bacteria were detected on 16 control heads and 6 shafts prior to the procedure; from 13 heads and 1 shaft immediately following the nasopharyngoscopic procedure and sterile sheath removal; and none of the instruments following cleaning, ethanol disinfection, and drying. No sheath showed loss of barrier integrity on leak testing. CONCLUSION Use of a high-quality, snugly fitting, sterile, disposable polyurethane sheath on a nasopharyngoscope during a clinical examination, combined with enzymatic detergent cleaning and disinfection with 70% ethanol, can provide a reliably decontaminated, patient-ready instrument, eliminating the need for high-level disinfection of endoscopes.
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Krebs A, Borin JF, Kim IY, Jackson DJ, McDougall EM, Clayman RV. Evaluation of Practice Efficiency with a Novel Sheathed Flexible Cystoscope: A Randomized Controlled Trial. Urology 2007; 70:883-7. [PMID: 17919698 DOI: 10.1016/j.urology.2007.06.1112] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2006] [Revised: 03/06/2007] [Accepted: 06/29/2007] [Indexed: 11/30/2022]
Affiliation(s)
- Alfred Krebs
- Department of Urology, University of California, Irvine, Medical Center, Orange, California 92868, USA.
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Seoane-Vazquez E, Rodriguez-Monguio R, Visaria J, Carlson A. Exogenous endoscopy-related infections, pseudo-infections, and toxic reactions: clinical and economic burden. Curr Med Res Opin 2006; 22:2007-21. [PMID: 17022860 DOI: 10.1185/030079906x121048] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The objective of this study was to analyze the characteristics and costs of exogenous endoscopy-related infections, pseudo-infections, and toxic reactions in the US. METHODS A systematic review of the scientific literature published between 1966 and 2005 was conducted in Medline. Data collection was based on a prospective protocol developed by the authors. RESULTS The literature review included 70 outbreaks described in 64 scientific articles. Bronchoscopy accounted for half of all reported outbreaks. Inadequate decontamination practices were the leading cause of contamination; equipment malfunction became the second leading cause of contamination during the period 1990-2004. More than 91% of the infections identified could be prevented by health care providers if quality control systems are improved and implemented. The available economic information concerning exogenous endoscope related events is very limited. A model for the analysis of the economic burden of exogenous endoscopy-related events is proposed. CONCLUSIONS Proper decontamination practices, the use of protective sheaths, and the improvement of surveillance systems could reduce the clinical and economic burdens associated with exogenous endoscopy-related events.
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Lawrentschuk N, Chamberlain M. Sterile disposable sheath system for flexible cystoscopes. Urology 2005; 66:1310-3. [PMID: 16360465 DOI: 10.1016/j.urology.2005.06.118] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2005] [Revised: 05/25/2005] [Accepted: 06/23/2005] [Indexed: 11/18/2022]
Abstract
Flexible cystourethroscopy is an accepted routine procedure in urology. The sterilization of instruments is time consuming and may damage flexible instruments. However, it must be performed to prevent contamination of the endoscopes. This study is the first to document experience using a flexible cystoscope with a disposable sheath in a urologic setting.
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Affiliation(s)
- Nathan Lawrentschuk
- Division of Urology, Department of Surgery, University of Melbourne, Austin Hospital, Heidelberg, Victoria, Australia.
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Imbert G, Seccia Y, La Scola B. Methylobacterium sp. bacteraemia due to a contaminated endoscope. J Hosp Infect 2005; 61:268-70. [PMID: 15939507 DOI: 10.1016/j.jhin.2005.01.030] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2005] [Accepted: 01/28/2005] [Indexed: 11/23/2022]
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Abstract
Contaminated endoscopes are the most common cause of device-related nosocomial outbreaks in the United States. Because almost all outbreaks are related to breaches in reprocessing techniques, it is crucial that endoscope cleaning and disinfection are performed carefully. Key elements that should be emphasized are availability of and adherence to guidelines, thorough staff training, and ensuring proper equipment is used in the reprocessing. Encouraging endoscopists to notify infection control when they see unexpected postprocedure complications and document which endoscopes are used in each case are key elements in limiting the impact of outbreaks.
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Affiliation(s)
- Arjun Srinivasan
- Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop A-35, Atlanta, GA 30333, USA.
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Winter SCA, Thirwell A, Jervis P. Flexible nasendoscope with a disposable-sheath system versus standard nasendoscopy: a prospective, randomized trial. CLINICAL OTOLARYNGOLOGY AND ALLIED SCIENCES 2002; 27:81-3. [PMID: 11994110 DOI: 10.1046/j.1365-2273.2002.00534.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
There are no published guidelines for the sterilization of the flexible nasendoscope and various techniques exist. We have conducted a randomized, prospective, blinded trial of the barrier Endosheath system versus immersion in Cidex disinfectant. Using a visual analogue assessment, there were no differences at a 99% confidence interval (CI) between the two techniques from the nursing assistant and patient perspectives. Image quality was assessed blinded and no difference could be detected at a 99% CI. The Endosheath offers the advantage of increasing the productivity of each nasendoscope as the sterilization time is reduced. It also provides barrier protection against cross-contamination, including prion diseases.
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Abstract
Biocides are helpful in different healthcare settings to reduce or eradicate harmful pathogens on the skin, medical devices, and in the environment. This article reviews recent advances in hand hygiene, instrument sterilization, decolonization with mupirocin, and the challenges posed by environmental contamination, and prion disease. Do biocides induce resistance?
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Affiliation(s)
- Hugo Sax
- Infection Control Program, Department of Internal Medicine, University of Geneva Hospitals, Geneva, Switzerland
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DiMarino AJ. GI endoscopic reprocessing: maintaining public confidence in the face of decreasing reimbursements. Gastrointest Endosc 1999; 50:585-8. [PMID: 10502191 DOI: 10.1016/s0016-5107(99)70093-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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