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Jahrreiss V, Sarrot P, Davis NF, Somani B. Environmental Impact of Flexible Cystoscopy: A Comparative Analysis Between Carbon Footprint of Isiris ® Single-Use Cystoscope and Reusable Flexible Cystoscope and a Systematic Review of Literature. J Endourol 2024; 38:386-394. [PMID: 38185843 DOI: 10.1089/end.2023.0274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024] Open
Abstract
Introduction: There is an absence of data on the environmental impact of single-use flexible cystoscopes. We wanted to review the existing literature about carbon footprint of flexible cystoscopy and analyze the environmental impact of the Isiris® (Coloplast©) single-use flexible cystoscope compared to reusable flexible cystoscopes. Methods: First, a systematic review on single-use and reusable cystoscope carbon footprint was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Second, carbon footprints of Isiris single-use flexible cystoscope and reusable cystoscope were analyzed and compared. Life cycle of the single-use flexible cystoscope was divided in three steps: manufacturing, sterilization, and disposal. For the reusable cystoscope, several steps were considered to estimate the carbon footprint over the life cycle: manufacturing, washing/sterilization, repackaging, repair, and disposal. For each step, the carbon footprint values were collected and adapted from previous comparable published data on flexible ureteroscope. Results: The systematic literature review evidenced total carbon emissions within a range of 2.06 to 2.41 kg carbon dioxide (CO2) per each use of single-use flexible cystoscope compared to a wide range of 0.53 to 4.23 kg CO2 per each case of reusable flexible cystoscope. The carbon footprint comparative analysis between Isiris single-use flexible cystoscope and reusable cystoscope concluded in favor of the single-use cystoscope. Based on our calculation, the total carbon emissions for a reusable flexible cystoscope could be refined to an estimated range of 2.40 to 3.99 kg CO2 per case, depending on the endoscopic activity of the unit, and to 1.76 kg CO2 per case for Isiris single-use cystoscope. Conclusion: The results and our systematic literature review demonstrated disparate results depending on the calculation method used for carbon footprint analysis. However, the results tend rather toward a lower environmental impact of single-use devices. In comparison to a reusable flexible cystoscope, Isiris compared favorably in terms of carbon footprint.
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Affiliation(s)
- Victoria Jahrreiss
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, United Kingdom
- EAU Section on Urolithiasis (EULIS)
| | - Pierre Sarrot
- Medical Affairs Department, Coloplast, Le Plessis-Robinson, France
| | - Niall F Davis
- Department of Urology, Beaumont Hospital and Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
| | - Bhaskar Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, United Kingdom
- EAU Section on Urolithiasis (EULIS)
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Cheng SH, Lin YT, Lu HT, Tsuei YC, Chu W, Chu WC. The Evolution of Spinal Endoscopy: Design and Image Analysis of a Single-Use Digital Endoscope Versus Traditional Optic Endoscope. Bioengineering (Basel) 2024; 11:99. [PMID: 38275579 PMCID: PMC10813680 DOI: 10.3390/bioengineering11010099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/11/2024] [Accepted: 01/17/2024] [Indexed: 01/27/2024] Open
Abstract
Spinal endoscopy has evolved significantly since its inception, offering minimally invasive solutions for various spinal pathologies. This study introduces a promising innovation in spinal endoscopy-a single-use digital endoscope designed to overcome the drawbacks of traditional optic endoscopes. Traditional endoscopes, despite their utility, present challenges such as fragility, complex disinfection processes, weight issues, and susceptibility to mechanical malfunctions. The digital endoscope, with its disposable nature, lighter weight, and improved image quality, aims to enhance surgical procedures and patient safety. The digital endoscope system comprises a 30-degree 1000 × 1000 pixel resolution camera sensor with a 4.3 mm working channel, and LED light sources replacing optical fibers. The all-in-one touch screen tablet serves as the host computer, providing portability and simplified operation. Image comparisons between the digital and optic endoscopes revealed advantages in the form of increased field of view, lesser distortion, greater close-range resolution, and enhanced luminance. The single-use digital endoscope demonstrates great potential for revolutionizing spine endoscopic surgeries, offering convenience, safety, and superior imaging capabilities compared to traditional optic endoscopes.
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Affiliation(s)
- Shih-Hao Cheng
- Institute of Biomedical Engineering, National Yang-Ming Chiao-Tung University, Taipei 11221, Taiwan; (S.-H.C.); (Y.-T.L.); (Y.-C.T.)
- Department of Orthopedics, Cheng Hsin General Hospital, Taipei 11221, Taiwan
| | - Yen-Tsung Lin
- Institute of Biomedical Engineering, National Yang-Ming Chiao-Tung University, Taipei 11221, Taiwan; (S.-H.C.); (Y.-T.L.); (Y.-C.T.)
| | - Hsin-Tzu Lu
- Institute of Biomedical Engineering, National Yang-Ming Chiao-Tung University, Taipei 11221, Taiwan; (S.-H.C.); (Y.-T.L.); (Y.-C.T.)
| | - Yu-Chuan Tsuei
- Institute of Biomedical Engineering, National Yang-Ming Chiao-Tung University, Taipei 11221, Taiwan; (S.-H.C.); (Y.-T.L.); (Y.-C.T.)
- Department of Orthopedics, Cheng Hsin General Hospital, Taipei 11221, Taiwan
| | - William Chu
- Institute of Biomedical Engineering, National Yang-Ming Chiao-Tung University, Taipei 11221, Taiwan; (S.-H.C.); (Y.-T.L.); (Y.-C.T.)
- Department of Orthopedics, Cheng Hsin General Hospital, Taipei 11221, Taiwan
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei 11221, Taiwan
| | - Woei-Chyn Chu
- Institute of Biomedical Engineering, National Yang-Ming Chiao-Tung University, Taipei 11221, Taiwan; (S.-H.C.); (Y.-T.L.); (Y.-C.T.)
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Halmans Y, Wellenstein DJ, Romijn M, Cremers S, Smit JJ, Hopman J, Takes RP, van den Broek GB. Is ultraviolet light disinfection fit to be the future standard for the disinfection of flexible endoscopes without a working channel? Clin Otolaryngol 2024; 49:130-135. [PMID: 37882501 DOI: 10.1111/coa.14119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 08/10/2023] [Accepted: 09/21/2023] [Indexed: 10/27/2023]
Abstract
OBJECTIVE To investigate colony-forming unit (CFU) reduction on contaminated flexible endoscopes (FEs) without a working channel after UV-C light disinfection, compared to the current disinfection method with the endoscope washer disinfector (EWD). DESIGN, SETTING AND PARTICIPANTS After pharyngolaryngoscopy, a manual pre-cleaning with tap water was performed. A culture was then collected by rolling the distal 8-10 cm of the FE over an Agar plate. The FE was disinfected using the D60 (60-s disinfection process with UV-C light) or the EWD (gold standard reprocessing process with water and chemicals). Another culture was then taken. After incubation, a CFU count was performed. RESULTS A total of 200 FEs without a working channel were divided equally between the two disinfection groups. After clinical use and manual pre-cleaning, 84 of the 100 (84.0%) (UV-C light group) and 79 of the 100 (79.0%) (EWD) FEs were contaminated with at least 1 CFU. FEs that showed no contamination after use were excluded from further analysis. After disinfection with UV-C light, 72 (85.7%) FEs showed no contamination (i.e., 0 CFUs) versus 66 (83.5%) FEs after reprocessing with the EWD. CONCLUSION There is no difference in CFUs reduction on contaminated FEs without a working channel between UV-C light disinfection and the current gold standard, the EWD.
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Affiliation(s)
- Yana Halmans
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University, Medical Center Nijmegen, Nijmegen, The Netherlands
| | - David J Wellenstein
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University, Medical Center Nijmegen, Nijmegen, The Netherlands
| | - Michael Romijn
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University, Medical Center Nijmegen, Nijmegen, The Netherlands
| | - Suzan Cremers
- Department of Hygiene and Infection Prevention, Radboud University, Medical Center Nijmegen, Nijmegen, The Netherlands
| | - Jannie J Smit
- Department of Pharmacy, Radboud University, Medical Center Nijmegen, Nijmegen, The Netherlands
| | - Joost Hopman
- Department of Medical Microbiology, Radboud University, Medical Center Nijmegen, Nijmegen, The Netherlands
| | - Robert P Takes
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University, Medical Center Nijmegen, Nijmegen, The Netherlands
| | - Guido B van den Broek
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University, Medical Center Nijmegen, Nijmegen, The Netherlands
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Chen R, Baas C, Farkouh A, Shete K, Peverini DR, Hartman JC, Amasyali AS, Belle J, Baldwin EA, Baldwin DD. Time Efficiency and Performance of Single-Use vs Reusable Cystoscopes: A Randomized Benchtop and Simulated Clinical Assessment. J Endourol 2024; 38:53-59. [PMID: 37800857 DOI: 10.1089/end.2023.0372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023] Open
Abstract
Introduction: A flexible cystoscope is an indispensable tool for urologists, facilitating a variety of procedures in both the operating room and at bedside. Single-use cystoscopes offer benefits including accessibility and decreased burden for reprocessing. The aims of this study were to compare time efficiency and performance of single-use and reusable cystoscopes. Methods: Ten new Ambu® aScope™ 4 Cysto single-use and two Olympus CYF-5 reusable cystoscopes were compared in simulated bedside cystoscopy and benchtop testing. Ten urologists performed simulated cystoscopy using both cystoscopes in a randomized order. Times for supply-gathering, setup, cystoscopy, cleanup, and cumulative time were recorded, followed by a Likert feedback survey. For benchtop assessment, physical, optical, and functional specifications were assessed and compared between cystoscopes. Results: The single-use cystoscope demonstrated shorter supply-gathering, setup, cleanup, and cumulative times (824 vs 1231 seconds; p < 0.05) but a comparable cystoscopy time to the reusable cystoscope (202 vs 212 seconds; p = 0.32). The single-use cystoscope had a higher image resolution, but a narrower field of view. Upward deflection was greater for the single-use cystoscope (214.50° vs 199.45°; p < 0.01) but required greater force (2.5 × ). The working channel diameter and irrigation rate were greater in the reusable cystoscope. While the single-use cystoscope lacked tumor enhancing optical features, it had higher Likert scale scores for Time Efficiency and Overall Satisfaction. Conclusion: The single-use cystoscope demonstrates comparable benchtop performance and superior time efficiency compared to reusable cystoscopes. However, the reusable cystoscope has superior optical versatility and flow rate. Knowledge of these differences allows for optimal cystoscope selection based on procedure indication.
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Affiliation(s)
- Ricky Chen
- Department of Urology, Loma Linda University Health, Loma Linda, California, USA
| | - Catalina Baas
- Department of Urology, Loma Linda University Health, Loma Linda, California, USA
| | - Ala'a Farkouh
- Department of Urology, Loma Linda University Health, Loma Linda, California, USA
| | - Kanha Shete
- Department of Urology, Loma Linda University Health, Loma Linda, California, USA
| | - Daniel R Peverini
- Department of Urology, Loma Linda University Health, Loma Linda, California, USA
| | - John C Hartman
- Department of Urology, Loma Linda University Health, Loma Linda, California, USA
| | - Akin S Amasyali
- Department of Urology, Loma Linda University Health, Loma Linda, California, USA
| | - Joshua Belle
- Department of Urology, Loma Linda University Health, Loma Linda, California, USA
| | - Elizabeth A Baldwin
- Department of Urology, Loma Linda University Health, Loma Linda, California, USA
| | - D Duane Baldwin
- Department of Urology, Loma Linda University Health, Loma Linda, California, USA
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Ezeh UC, Achlatis E, Crosby T, Kwak PE, Phillips MS, Amin MR. The Effectiveness of Ultraviolet Smart D60 in Reducing Contamination of Flexible Fiberoptic Laryngoscopes. Laryngoscope 2023; 133:3512-3519. [PMID: 37485725 DOI: 10.1002/lary.30869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 06/12/2023] [Accepted: 06/21/2023] [Indexed: 07/25/2023]
Abstract
OBJECTIVE To compare the effectiveness of disinfection protocols utilizing a ultraviolet (UV) Smart D60 light system with Impelux™ technology with a standard Cidex ortho-phthalaldehyde (OPA) disinfection protocol for cleaning flexible fiberoptic laryngoscopes (FFLs). METHODS Two hundred FFLs were tested for bacterial contamination after routine use, and another 200 FFLs were tested after disinfection with one of four methods: enzymatic detergent plus Cidex OPA (standard), enzymatic detergent plus UV Smart D60, microfiber cloth plus UV Smart D60, and nonsterile wipe plus UV Smart D60. Pre- and post-disinfection microbial burden levels and positive culture rates were compared using Kruskal-Wallis ANOVA and Fisher's two-sided exact, respectively. RESULTS After routine use, approximately 56% (112/200) of FFLs were contaminated, with an average contamination level of 9,973.7 ± 70,136.3 CFU/mL. The standard reprocessing method showed no positive cultures. The enzymatic plus UV, microfiber plus UV, and nonsterile wipe plus UV methods yielded contamination rates of 4% (2/50), 6% (3/50), and 12% (6/50), respectively, with no significant differences among the treatment groups (p > 0.05). The pre-disinfection microbial burden levels decreased significantly after each disinfection technique (p < 0.001). The average microbial burden recovered after enzymatic plus UV, microfiber plus UV, and nonsterile wipe plus UV were 0.40 CFU/mL ± 2, 0.60 CFU/mL ± 2.4, and 12.2 CFU/mL ± 69.5, respectively, with no significant difference among the treatment groups (p > 0.05). Micrococcus species (53.8%) were most frequently isolated, and no high-concern organisms were recovered. CONCLUSION Disinfection protocols utilizing UV Smart D60 were as effective as the standard chemical disinfection protocol using Cidex OPA. LEVEL OF EVIDENCE NA Laryngoscope, 133:3512-3519, 2023.
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Affiliation(s)
- Uche C Ezeh
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, USA
| | - Efstratios Achlatis
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, USA
| | - Tyler Crosby
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, USA
| | - Paul E Kwak
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, USA
| | - Michael S Phillips
- Division of Infectious Disease, Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Milan R Amin
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, USA
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Asgari M, Magerand L, Manfredi L. A review on model-based and model-free approaches to control soft actuators and their potentials in colonoscopy. Front Robot AI 2023; 10:1236706. [PMID: 38023589 PMCID: PMC10665478 DOI: 10.3389/frobt.2023.1236706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 09/22/2023] [Indexed: 12/01/2023] Open
Abstract
Colorectal cancer (CRC) is the third most common cancer worldwide and responsible for approximately 1 million deaths annually. Early screening is essential to increase the chances of survival, and it can also reduce the cost of treatments for healthcare centres. Colonoscopy is the gold standard for CRC screening and treatment, but it has several drawbacks, including difficulty in manoeuvring the device, patient discomfort, and high cost. Soft endorobots, small and compliant devices thatcan reduce the force exerted on the colonic wall, offer a potential solution to these issues. However, controlling these soft robots is challenging due to their deformable materials and the limitations of mathematical models. In this Review, we discuss model-free and model-based approaches for controlling soft robots that can potentially be applied to endorobots for colonoscopy. We highlight the importance of selecting appropriate control methods based on various parameters, such as sensor and actuator solutions. This review aims to contribute to the development of smart control strategies for soft endorobots that can enhance the effectiveness and safety of robotics in colonoscopy. These strategies can be defined based on the available information about the robot and surrounding environment, control demands, mechanical design impact and characterization data based on calibration.
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Affiliation(s)
- Motahareh Asgari
- Division of Imaging Science and Technology, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Ludovic Magerand
- Division of Computing, School of Science and Engineering, University of Dundee, Dundee, United Kingdom
| | - Luigi Manfredi
- Division of Imaging Science and Technology, School of Medicine, University of Dundee, Dundee, United Kingdom
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Castro VDP, Thomaz DY, Vieira KDL, Lopes LG, Rossi F, Del Negro GMB, Benard G, Pires RH. In vitro activity of sanitizers against mono- and polymicrobial biofilms of C. parapsilosis and S. aureus. Antimicrob Agents Chemother 2023; 67:e0053423. [PMID: 37681981 PMCID: PMC10583669 DOI: 10.1128/aac.00534-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 07/07/2023] [Indexed: 09/09/2023] Open
Abstract
The emergence of disinfectant-resistant microorganisms poses a significant threat to public health. These resilient pathogens can survive and thrive in hospital settings despite routine disinfection practices, leading to persistent infections and the potential for outbreaks. In this study, we investigated the impact of 11 different commercial sanitizers at various concentrations and exposure times on biofilms consisting of clinical and nosocomial environmental isolates of Candida parapsilosis and Staphylococcus aureus. Among the sanitizers tested, 0.5% and 2.0% chlorhexidine (CLX), 10% polyvinyl pyrrolidone (PVP-I), a disinfectant based on quaternary ammonium compound (QAC), 2% glutaraldehyde, and 0.55% orthophthalaldehyde (OPA) demonstrated efficacy against both C. parapsilosis and S. aureus in monospecies and mixed biofilms. Analysis showed that 0.5% CLX and 10% PVP-I had fungicidal and bactericidal activity against all biofilms. However, the sanitizer based on QAC and 0.55% OPA proved to be bacteriostatic and fungicidal against both monospecies and mixed biofilms. In mixed biofilms, despite the last four sanitizers exerting fungicidal action, the reduction of fungal cells was approximately 4 log10 CFU/mL compared to monospecies biofilms, showing that the interaction provided more resistance of the yeast to the sanitizer. Formation of mixed biofilms in hospital settings can create an ecological niche that enhances the survival of pathogens against routine sanitization procedures. Therefore, effective sanitization practices, including regular cleaning with effective sanitizers, should be implemented to prevent C. parapsilosis/S. aureus biofilm formation in healthcare settings.
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Affiliation(s)
- Vitor de Paula Castro
- Laboratory of Mycology and Environmental Diagnosis, Universidade de Franca, Franca, São Paulo, Brazil
| | - Danilo Yamamoto Thomaz
- Laboratory of Medical Mycology (LIM-53), Instituto de Medicina Tropical e Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Kayro de Lima Vieira
- Laboratory of Mycology and Environmental Diagnosis, Universidade de Franca, Franca, São Paulo, Brazil
| | - Leonardo Guedes Lopes
- Laboratory of Mycology and Environmental Diagnosis, Universidade de Franca, Franca, São Paulo, Brazil
| | - Flavia Rossi
- Central Laboratory Division (LIM 03) – Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Gilda M. B. Del Negro
- Laboratory of Medical Mycology (LIM-53), Instituto de Medicina Tropical e Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Gil Benard
- Laboratory of Medical Mycology (LIM-53), Instituto de Medicina Tropical e Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Regina Helena Pires
- Laboratory of Mycology and Environmental Diagnosis, Universidade de Franca, Franca, São Paulo, Brazil
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Nylander D, Leeds J, Perry J, Narayanan M, Dipper C, Gunn M, Nayar M, Speight A, Oppong KW. Bacterial contamination of endoscopist and assistant face visors during gastrointestinal endoscopy: a pilot study. Frontline Gastroenterol 2023; 14:505-511. [PMID: 37854781 PMCID: PMC10579546 DOI: 10.1136/flgastro-2023-102427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 06/17/2023] [Indexed: 10/20/2023] Open
Abstract
Background and aim During the COVID-19 pandemic, health workers' facial exposure to pathogens has been brought into focus. In this study, we aimed to determine the occurrence and degree of facial contamination to both endoscopists and their assistants during endoscopic procedures to help inform future safety measures. Methods Non-sterile visors worn by endoscopist, assistant and room control visors from 50 procedures were swabbed post procedure for culture. Procedure type, therapy, duration and evidence of visible visor contamination were recorded. After 48-hour incubation, all bacterial colonies were identified using matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry. Organisms were classified into skin/environmental, oronasal and enteric. Results A total of 104 visors were available for assessment (93 staff; 11 control). In worn visors, skin/environmental flora were isolated from 70, oronasal flora from 8, and enteric flora from 3 with an average colony count of >9.5. Notably, bacteria of enteric origin (Escherichia coli and Enterobacter cloacae) were isolated from three worn visors. In room control, skin/environmental flora were isolated from seven and oronasal flora from one with average colony count of five. No room control visors grew enteric flora. Overall, 9.1% room control and 10.8% worn visors were contaminated with organisms that could possibly have originated from patients. However, enteric flora were only obtained from worn visors. No visors were visibly contaminated. Conclusion This pilot study demonstrates risk of contamination to faces of endoscopists and assistants. Larger studies are required to determine degree of risk and to give guidance on facial protection during gastrointestinal endoscopy.
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Affiliation(s)
- David Nylander
- Department of Gastroenterology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - John Leeds
- Department of Gastroenterology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - John Perry
- Department of Microbiology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Manjusha Narayanan
- Department of Microbiology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Chris Dipper
- Department of Gastroenterology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Mel Gunn
- Department of Gastroenterology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Manu Nayar
- Department of Gastroenterology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Ally Speight
- Department of Gastroenterology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Kofi W Oppong
- HPB Unit, Newcastle Upon Tyne Hospitals NHS Trust, Newcastle Upon Tyne, Newcastle upon Tyne, UK
- Clinical and Translational Research Institute, University of Newcastle upon Tyne, Newcastle upon Tyne, UK
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Meeusen V, McLean T. A Single-Blind Study Testing the Preparation Accuracy of Bedside Precleaning Solutions Used for Flexible Endoscopes. Gastroenterol Nurs 2023; 46:144-150. [PMID: 36779976 DOI: 10.1097/sga.0000000000000721] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/29/2022] [Indexed: 02/14/2023] Open
Abstract
Endoscopy-related pathogen transmission may occur if microorganisms are spread from patient to patient by contaminated equipment. Effective and safe endoscope reprocessing includes bedside precleaning, mechanical cleaning, high-level disinfection, storage, and drying. The aim of this research study was to observe and report on the variation in practice regarding the use of detergent for bedside precleaning of flexible gastrointestinal endoscopes. Endoscopy nurses working in the endoscopy unit at the Princess Alexandra Hospital, Australia, prepared four samples of detergent solution as per normal routine. Twenty-nine nurses participated providing in total 116 samples. There was a significant variation in detergent concentration. The detergent concentration variated between 2.00 and 288.20 ml/L ( M = 34.55, SD = 39.21). Two samples revealed lower concentrations than required. More than 25% of the samples contained at least a 10 times higher concentration than required (>40 ml/L). Current practice of bedside precleaning of gastrointestinal endoscopes was not deemed safe or cost-effective as it did not guarantee an adequate concentration of detergent. More precise methods to establish the required concentration of the bedside precleaning solution were introduced to improve practice.
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Affiliation(s)
- Vera Meeusen
- Vera Meeusen, PhD, MA, RN, FACPAN, AFACHSM, is A/Professor; Clinical Nurse Consultant, Endoscopy Unit, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia; and A/Professor in Medicine, The University of Queensland, St Lucia, Queensland, Australia
- Traci McLean, Advanced Skilled Endorsed Nurse, Endoscopy Unit, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Traci McLean
- Vera Meeusen, PhD, MA, RN, FACPAN, AFACHSM, is A/Professor; Clinical Nurse Consultant, Endoscopy Unit, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia; and A/Professor in Medicine, The University of Queensland, St Lucia, Queensland, Australia
- Traci McLean, Advanced Skilled Endorsed Nurse, Endoscopy Unit, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
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10
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Pineau L. Endoscope reprocessing: Retrospective analysis of 90,311 samples. Endosc Int Open 2023; 11:E247-E257. [PMID: 36937825 PMCID: PMC10023244 DOI: 10.1055/a-1991-1391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 11/16/2022] [Indexed: 03/19/2023] Open
Abstract
Background and study aims The contamination level of ready-to-use endoscopes published in the literature varies from 0.4 % to 49.0 %. Unfortunately, the comparison and the interpretation of these results are quite impossible, given the limited number of samples and sites included and the differences observed between sampling, culturing methods, and interpretation criteria. Methods The objective of this retrospective study was to analyze the results of 90,311 endoscope samples collected between 2004 and 2021 in 490 private or public hospitals in France. Results Through the full test period, the mean ratio of endoscopes at the action level was 12.6 % (19.5 % including alert level). Of the endoscopy units, 23.0 % had a ratio of compliant endoscopes ≤ 70.0 %. The overall microbial quality of gastroscopes, duodenoscopes, and colonoscopes is improving year by year, whereas an opposite trend is observed for ultrasound endoscopes and bronchoscopes. In 2021, following French guidelines, 13.0 % of the endoscopes should have been quarantined and 8.1 % were at the alert level, meaning that the contamination level of 21.1 % of the endoscopes exceeded what was defined as a maximum acceptable value. Conclusions This study demonstrates that additional efforts, including implementation of microbial surveillance strategies using a standardized sampling method and periodic observational audits, must be made to improve the overall microbiological quality of endoscopes and reduce the risk associated with their use.
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Affiliation(s)
- Lionel Pineau
- Eurofins Biotech Germande, Medical Device Testing, Aix-en-Provence, France
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11
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WGO Guideline-Endoscope Disinfection Update. J Clin Gastroenterol 2023; 57:1-9. [PMID: 36084165 DOI: 10.1097/mcg.0000000000001759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 06/23/2022] [Indexed: 12/14/2022]
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12
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Liu Y, Xu S, Muhetaer G, Tang H, Guo H, Li H. Evaluation of the Application Effect of a New Anti-reflux Water Injection Tube Device in the Prevention of the Contamination of Endoscopy Water Injection Bottles. Dig Dis Sci 2022; 68:1728-1734. [PMID: 36547820 PMCID: PMC9773661 DOI: 10.1007/s10620-022-07796-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Water delivery tube reflux during gastrointestinal endoscopy examination is widespread and it is the leading cause of water injection bottle pollution. AIM To evaluate the application effect of a new anti-reflux water injection tube device in preventing the contamination of endoscopy water injection bottles. METHODS A total of 520 cases received gastrointestinal endoscopy examination were included. Patients were randomly divided into the experimental and control group. The experimental group used the anti-reflux injection tube device to assist with water injection, and the control group used the ordinary delivery tube. After every five cases of gastrointestinal endoscopy, water from the injection bottles was collected. Visual inspection, crystalline violet staining, microbial culture, and microbial species analysis were performed to analyze the contamination state of the water samples. RESULTS The contamination rate in the experimental group was 5.66%, significantly lower than 76.47% in the control group. Crystalline violet staining confirmed that microorganisms existed in contaminated water samples. Microbiological culture results showed that the experimental group's undetectable rate of bacteria and fungi was 100%, significantly higher than that of the control group (19.61% for bacteria and 25.49% for fungi). The mean values of the total bacterial and fungal colonies of the control samples were 9.80 × 106 cfu/ml and 9.18 × 106 cfu/ml, respectively. The microbial species in the contaminated samples of the control group were Pseudomonas aeruginosa, Escherichia coli, and Proteus mirabilis. CONCLUSION The anti-reflux water injection tube device can effectively prevent the contamination of the endoscopy water injection bottles caused by the reflux of the ordinary water supply tube.
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Affiliation(s)
- Yingjing Liu
- Shenzhen Bao’an Traditional Chinese Medicine Hospital, Shenzhen, 518133 China
| | - Shenting Xu
- Shenzhen Bao’an Traditional Chinese Medicine Hospital, Shenzhen, 518133 China
| | - Gulizeba Muhetaer
- Shenzhen Bao’an Traditional Chinese Medicine Hospital, Shenzhen, 518133 China
| | - Hao Tang
- Shenzhen Bao’an Traditional Chinese Medicine Hospital, Shenzhen, 518133 China
| | - Hongtao Guo
- Shenzhen BAGEMEI Biotechnology Co., Ltd, Shenzhen, 518035 China
| | - Hang Li
- Shenzhen Bao’an Traditional Chinese Medicine Hospital, Shenzhen, 518133 China
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Baboudjian M, Pradere B, Martin N, Gondran-Tellier B, Angerri O, Boucheron T, Bastide C, Emiliani E, Misrai V, Breda A, Lechevallier E. Life Cycle Assessment of Reusable and Disposable Cystoscopes: A Path to Greener Urological Procedures. Eur Urol Focus 2022:S2405-4569(22)00291-7. [PMID: 36543725 DOI: 10.1016/j.euf.2022.12.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/28/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND The environmental impact of reusable and disposable devices is unclear; reuse is expected to reduce the carbon footprint, but the environmental impact of reprocessing of reusable devices is increasingly being questioned. OBJECTIVE The aim was to provide the first rigorous life cycle assessment of reusable and disposable flexible cystoscopes. DESIGN, SETTING, AND PARTICIPANTS We performed a life cycle assessment of reusable flexible cystoscopes and the aS4C single-use cystoscope (aScope; Ambu, Ballerup, Denmark). For the aScope, the complete lifespan of the scope was evaluated, including raw material extraction, material formulation, component production, product assembly, distribution, transportation after use, and final disposal. For reusable cystoscopes, we limited our analysis to their reprocessing, using a model consisting of standard high-level disinfection with peracetic acid. The environmental impact was evaluated by an independent third-party consulting company APESA (Technopole Hélioparc, Pau, France) dedicated to such risk assessments. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The environmental footprint of both cystoscopes was assessed using five environmental impact categories, namely, climate change, mineral resource depletion, ecotoxicity, acidification, and eutrophication. To perform the life cycle assessment, Simapro v9.3.3 software was used and the Ecoinvent v3.5 database was employed as the primary life cycle inventory database. A Monte Carlo analysis was used to account for the inherent uncertainty in life cycle inventory data and the variability in material and energy consumption for each type of flexible cystoscope. RESULTS AND LIMITATIONS By only comparing the disinfection reprocessing of reusable cystoscopes with the complete lifespan of the single-use cystoscope, the use of the aScope would allow a reduction of at least 33% in the climate change category, 50% in the mineral resources' depletion category, 51% in the ecotoxicity category, 71% in the acidification category, and 49% in the eutrophication category. Our results cannot be generalized to all health care facilities as we studied only one type of reprocessing method and one disposable flexible cystoscope. CONCLUSIONS Disinfection reprocessing of reusable cystoscopes was found to have a significantly larger environmental footprint and impact than the whole lifespan of the single-use cystoscope aScope. PATIENT SUMMARY Using a cradle-to-grave life cycle analysis, we showed that the environmental footprint of a flexible cystoscopy procedure can be reduced by using a disposable cystoscope instead of a reusable cystoscope.
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Boucheron T, Lechevallier E, Gondran-Tellier B, Michel F, Bastide C, Martin N, Baboudjian M. Cost and Environmental Impact of Disposable Flexible Cystoscopes Compared to Reusable Devices. J Endourol 2022; 36:1317-1321. [PMID: 35703325 DOI: 10.1089/end.2022.0201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objectives: To quantify the environmental impact and costs associated with flexible cystoscopy procedures from an institutional perspective, with particular attention for the comparison between disposable and reusable cystoscopes. Materials and Methods: This is a single-center retrospective study, including all flexible cystoscopies performed between 2020 and 2021 using reusable or single-use devices. The Ambu aS4C single-use cystoscope (Ballerup, Denmark) gradually replaced the reusable device in our center, with exclusive use from October 2021. Reprocessing costs for reusable cystoscopes were evaluated using a micro-costing approach. The environmental impact of reusable and disposable cystoscopes was assessed by the amount of waste and water consumed for each procedure. Results: A total of 1578 flexible cystoscopies using reusable cystoscopes were performed in 2020, and 550 cystoscopies were performed using the Ambu aS4C cystoscope from October 2021 to February 2022. The cost of flexible cystoscopy with a reusable and a disposable endoscope was €196 and €192, respectively. The amount of waste generated by reprocessing reusable and disposable cystoscopes was 800 and 200 g per procedure, respectively. Water consumption for sterilization of the reusable cystoscope was 60 L per procedure, whereas no water consumption was required with the Ambu aS4C cystoscope. A 100% Ambu aS4C cystoscope use would reduce waste generation and water consumption by 946.8 kg and 94.68 m3 per year. Conclusion: In this study, implementing a strategy of using 100% disposable cystoscopes was associated with similar costs and reduced waste generation and water consumption compared to reusable devices. Future studies are needed to compare the carbon footprint of these devices, through a comprehensive and rigorous life cycle assessment from manufacturing to recycling.
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Affiliation(s)
- Tiphaine Boucheron
- Pharmacy Department, La Conception Hospital, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Eric Lechevallier
- Department of Urology, La Conception Hospital, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Bastien Gondran-Tellier
- Department of Urology, La Conception Hospital, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Floriane Michel
- Department of Urology, La Conception Hospital, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Cyrille Bastide
- Department of Urology, North Hospital, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Nathalie Martin
- Pharmacy Department, La Conception Hospital, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Michael Baboudjian
- Department of Urology, La Conception Hospital, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
- Department of Urology, North Hospital, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
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15
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Geavlete B, Mareș C, Mulțescu R, Georgescu D, Geavlete P. Hybrid flexible ureteroscopy strategy in the management of renal stones - a narrative review. J Med Life 2022; 15:919-926. [PMID: 36188640 PMCID: PMC9514813 DOI: 10.25122/jml-2022-0110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 05/02/2022] [Indexed: 11/21/2022] Open
Abstract
The introduction of single-use flexible ureteroscopes (suFURSs) in daily practice tends to overcome the main limitations of reusable ureteroscopes (reFURSs), in terms of high acquisition costs, maintenance, breakages and repairing costs, reprocessing and sterilization, as retrograde intrarenal surgery (RIRS) is promoted as first-line treatment of renal stones in most cases. A hybrid strategy implies having both instruments in the armamentarium of endourology and choosing the best strategy for cost-efficiency and protecting expensive reusable instruments in selected high-risk for breakage cases such as large stones of the inferior calyx, a steep infundibulopelvic angle or narrow infundibulum, or abnormal anatomy as in horseshoe and ectopic kidney. In terms of safety and efficiency, data present suFURSs as a safe alternative considering operating time, stone-free, and complication rates. An important aspect is highlighted by several authors about reusable instrument disinfection as various pathogens are still detected after proper sterilization. This comprehensive narrative review aims to analyze available data comparing suFURSs and reFURSs, considering economic, technical, and operative aspects of the two types of instruments, as well as the strategy of adopting a hybrid approach to selecting the most appropriate flexible ureteroscope in each case.
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Affiliation(s)
- Bogdan Geavlete
- Department of Urology, Sanador Hospital, Bucharest, Romania
- Department of Urology, Emergency Clinical Hospital Sfântul Ioan, Bucharest, Romania
| | - Cristian Mareș
- Department of Urology, Emergency Clinical Hospital Sfântul Ioan, Bucharest, Romania
| | - Răzvan Mulțescu
- Department of Urology, Sanador Hospital, Bucharest, Romania
- Department of Urology, Emergency Clinical Hospital Sfântul Ioan, Bucharest, Romania
| | - Dragoș Georgescu
- Department of Urology, Sanador Hospital, Bucharest, Romania
- Department of Urology, Emergency Clinical Hospital Sfântul Ioan, Bucharest, Romania
| | - Petrișor Geavlete
- Department of Urology, Sanador Hospital, Bucharest, Romania
- Department of Urology, Emergency Clinical Hospital Sfântul Ioan, Bucharest, Romania
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16
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Güler Y, Erbin A, Gozdas T. An outbreak of postoperative rapidly developing and multidrug-resistant Klebsiella pneumoniae urosepsis due to a contaminated ureteroscope. Folia Med (Plovdiv) 2022; 64:401-407. [PMID: 35856100 DOI: 10.3897/folmed.64.e62365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 04/15/2021] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Outbreaks caused by microorganisms contaminating the inside of rigid ureteroscopes are extremely rare. Some of these outbreaks, especially those caused by multidrug-resistant (MDR) infections, can cause serious problems, even death. Among these serious infections, we have no data about Klebsiellapneumoniae outbreaks caused by rigid ureteroscopes and their management and consequences.
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Affiliation(s)
| | - Akif Erbin
- Haseki Traning and Research Hospital, Istanbul, Turkey
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17
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van Dijk HFG, Verbrugh HA, Abee T, Andriessen JW, van Dijk HFG, ter Kuile BH, Mevius DJ, Montforts MHMM, van Schaik W, Schmitt H, Smidt H, Veening JW, Voss A. Resisting disinfectants. COMMUNICATIONS MEDICINE 2022; 2:6. [PMID: 35603291 PMCID: PMC9053202 DOI: 10.1038/s43856-021-00070-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 12/16/2021] [Indexed: 12/03/2022] Open
Abstract
van Dijk et al. discuss the potential for antimicrobial resistance as a consequence of disinfectant use. The authors advocate for the prudent use of disinfectants in all sectors of society.
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18
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Keep it Clean: Novel Use of Sterile Disposable Flexible Bronchoscopes for Pleuroscopy. J Bronchology Interv Pulmonol 2022; 29:e2-e4. [PMID: 34935673 DOI: 10.1097/lbr.0000000000000761] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Smart pills for gastrointestinal diagnostics and therapy. Adv Drug Deliv Rev 2021; 177:113931. [PMID: 34416311 DOI: 10.1016/j.addr.2021.113931] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 08/03/2021] [Accepted: 08/13/2021] [Indexed: 12/13/2022]
Abstract
Ingestible smart pills have the potential to be a powerful clinical tool in the diagnosis and treatment of gastrointestinal disease. Though examples of this technology, such as capsule endoscopy, have been successfully translated from the lab into clinically used products, there are still numerous challenges that need to be overcome. This review gives an overview of the research being done in the area of ingestible smart pills and reports on the technical challenges in this field.
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20
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Avasarala SK, Muscarella LF, Mehta AC. Sans Standardization: Effective Endoscope Reprocessing. Respiration 2021; 100:1208-1217. [PMID: 34488219 DOI: 10.1159/000517335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 05/14/2021] [Indexed: 01/10/2023] Open
Abstract
Bronchoscopy is a commonly performed procedure within thoracic and critical care medicine. Modern bronchoscopes are technologically advanced tools made of fragile electronic components. Their design is catered to allow maximum maneuverability within the semi-rigid tracheobronchial tree. Effective cleaning and reprocessing of these tools can be a challenge. Although highly functional, the design poses several challenges when it comes to reprocessing. It is a very important step, and lapses in the procedure have been tied to nosocomial infections. The process lacks universal standardization; several organizations have developed their own recommendations. Data have shown that key stakeholders are not fully versed in the essentials of endoscope reprocessing. A significant knowledge gap exists between those performing bronchoscopy and those who are stewards of effective endoscope reprocessing. To service as a resource for bronchoscopists, this study summarizes the steps of effective reprocessing, details the important elements within a health-care facility that houses this process, and reviews some of the current data regarding the use of disposable endoscopes.
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Affiliation(s)
- Sameer K Avasarala
- Division of Allergy, Pulmonary, and Critical Care, Vanderbilt University Medical Center, Nashville, Tennessee, USA,
| | | | - Atul C Mehta
- Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, USA
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21
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Kong X, Zhu X, Zhang Y, Wu J. The application of plan, do, check, act (PDCA) quality management in reducing nosocomial infections in endoscopy rooms: It does work. Int J Clin Pract 2021; 75:e14351. [PMID: 33973325 DOI: 10.1111/ijcp.14351] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 05/07/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The role of plan, do, check, act (PDCA) cycle quality management in reducing nosocomial infections in endoscopy rooms remains unclear; we aimed to evaluate the effects of PDCA in the nosocomial infections control of endoscopy rooms. METHODS This present study was a before and after design. The patients treated in our endoscopy room from 1 January 2019 to 31 December 2019 were included in the control group, which were managed according to current department practice. The patients from 1 January 2020 to 31 December 2020 were included in the PDCA group, which were managed according to PDCA cycle quality management including formulation of cleaning and disinfection process, establishment of an infection control team and improvement of inspection standards. The nosocomial infections of patients, the pass rate of medical staff's knowledge on the nosocomial infection and hand hygiene, the pass rate of disinfection of endoscope cavity and surface, the incidence of sharp injury and biological pollution were compared between two groups. RESULTS A total of 1020 patients were included, with 512 patients in PDCA group and 508 patients in the control group. The incidence of nosocomial infections in PDCA group was significantly lower than that of control group (0.98% vs. 2.76%, P = .002). The pass rate of medical staff's knowledge on the nosocomial infection and hand hygiene was significantly higher than that of control group (all P < .05). The pass rate of disinfection of endoscope cavity in PDCA group was significantly higher than that of control group (P = .037). The incidence of sharp injury and biological pollution in PDCA group were significantly lower than that of control group (all P < .05). CONCLUSIONS PDCA cycle management is beneficial to reduce the risk of nosocomial infection, enhance the awareness of infection control and reduce the risk of occupational exposure of medical staff in the endoscopy room.
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Affiliation(s)
- Xiaoming Kong
- Department of Infection Management, People's Hospital of Liyang, Changzhou, China
| | - Xiaolu Zhu
- Department of Infection Management, People's Hospital of Liyang, Changzhou, China
| | - Yidan Zhang
- Department of Infection Management, People's Hospital of Liyang, Changzhou, China
| | - Jie Wu
- Department of Infection Management, People's Hospital of Liyang, Changzhou, China
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22
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Manfredi L. Endorobots for Colonoscopy: Design Challenges and Available Technologies. Front Robot AI 2021; 8:705454. [PMID: 34336938 PMCID: PMC8317132 DOI: 10.3389/frobt.2021.705454] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 06/22/2021] [Indexed: 12/12/2022] Open
Abstract
Colorectal cancer (CRC) is the second most common cause of cancer death worldwide, after lung cancer (Sung et al., 2021). Early stage detection is key to increase the survival rate. Colonoscopy remains to be the gold standard procedure due to its dual capability to optically inspect the entire colonic mucosa and to perform interventional procedures at the same time. However, this causes pain and discomfort, whereby it requires sedation or anaesthesia of the patient. It is a difficult procedure to perform that can cause damage to the colonic wall in some cases. Development of new technologies aims to overcome the current limitations on colonoscopy by using advancements in endorobotics research. The design of these advanced medical devices is challenging because of the limited space of the lumen, the contorted shape, and the long tract of the large bowel. The force applied to the colonic wall needs to be controlled to avoid collateral effects such as injuries to the colonic mucosa and pain during the procedure. This article discusses the current challenges in the colonoscopy procedure, the available locomotion technologies for endorobots used in colonoscopy at a prototype level and the commercial products available.
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Affiliation(s)
- Luigi Manfredi
- Division of Imaging Science and Technology, School of Medicine, University of Dundee, Dundee, United Kingdom
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23
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Memel ZN, Flynn DJ, Hernandez-Barco Y, Visrodia KH, Casey B, Krishnan K. Infectious Transmission from Savary Dilators is Uncommon: Retrospective Review from a Large Tertiary Academic Center. Clin Endosc 2021; 55:691-694. [PMID: 34182748 PMCID: PMC9539286 DOI: 10.5946/ce.2021.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 03/21/2021] [Indexed: 11/28/2022] Open
Affiliation(s)
- Zoe N Memel
- Harvard Medical School, MA, USA.,Department of Medicine, Massachusetts General Hospital, MA, USA
| | - Duncan J Flynn
- Harvard Medical School, MA, USA.,Department of Medicine, Massachusetts General Hospital, MA, USA
| | - Yasmin Hernandez-Barco
- Harvard Medical School, MA, USA.,Divison of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA
| | - Kavel Harish Visrodia
- Harvard Medical School, MA, USA.,Divison of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA
| | - Brenna Casey
- Harvard Medical School, MA, USA.,Divison of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA
| | - Kumar Krishnan
- Harvard Medical School, MA, USA.,Divison of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA
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Patel A, Jain N. Flexible Endoscopes: Terminal Sterilization and Impact to Patient Safety. Biomed Instrum Technol 2021; 54:80-83. [PMID: 34169975 DOI: 10.2345/0899-8205-54.s3.80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Flexible endoscopes are implicated in deaths from healthcare-associated infections (HAIs), in particular antibiotic-resistant infections. This article analyzes whether terminal sterilization should be required as part of endoscope reprocessing to reduce or eliminate HAIs and thus improve patient safety. Reusable flexible endoscopes are processed to make them ready for clinical use by the processing department of the healthcare facility. Unlike most critical and semicritical medical devices, the final step of processing an endoscope is high-level disinfection and not terminal sterilization. This is because most flexible endoscopes come in contact with mucosal membranes (versus contact with direct blood stream) and cannot withstand sterilization. However, sterilization currently is performed by a small number of U.S. healthcare facilities on reusable flexible endoscopes with the belief that they are safer for use compared to flexible endoscopes that are high-level disinfected. Based on the analysis in this article, terminal sterilization is not a required or necessary step to eliminate HAIs.
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Hughes T, Pietropaolo A, Jones P, Oderda M, Gontero P, Somani BK. Outcomes and Cost Evaluation Related to a Single-Use, Disposable Ureteric Stent Removal System: a Systematic Review of the Literature. Curr Urol Rep 2021; 22:41. [PMID: 34128107 DOI: 10.1007/s11934-021-01055-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW To present the latest evidence related to the outcomes and cost of single-use, disposable ureteric stent removal system (Isiris). RECENT FINDINGS Our review suggests that compared to a reusable flexible cystoscope (re-FC), a disposable flexible cystoscope (d-FC) with built-in grasper (Isiris) significantly reduced procedural time and provided a cost benefit when the latter was used in a ward or outpatient clinic-based setting. The use of d-FC also allowed endoscopy slots to be used for other urgent diagnostic procedures. Disposable FCs are effective and safe for ureteric stent removal. They offer greater flexibility and, in most cases, have been demonstrated to be cost-effective compared to re-FCs. They are at their most useful in remote, low-volume centres, in less well-developed countries and in centres where large demand is placed on endoscopy resources.
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Affiliation(s)
- Thomas Hughes
- Urology Department, University Hospital Southampton NHS Trust, Tremona Road, Southampton, SO16 6YD, UK.
| | - Amelia Pietropaolo
- Urology Department, University Hospital Southampton NHS Trust, Tremona Road, Southampton, SO16 6YD, UK
| | - Patrick Jones
- Urology Department, University Hospital Southampton NHS Trust, Tremona Road, Southampton, SO16 6YD, UK
| | - Marco Oderda
- Division of Urology, Department of Surgical Sciences, Città della Salute e della Scienza di Torino - Molinette Hospital, University of Torino, Torino, Italy
| | - Paolo Gontero
- Division of Urology, Department of Surgical Sciences, Città della Salute e della Scienza di Torino - Molinette Hospital, University of Torino, Torino, Italy
| | - Bhaskar K Somani
- Urology Department, University Hospital Southampton NHS Trust, Tremona Road, Southampton, SO16 6YD, UK
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Abstract
Although many aspects of infection prevention and control (IPC) mirror institutional efforts, optimization of IPC practices in the neonatal intensive care unit requires careful consideration of its unique population and environment, addressed here for key IPC domains. In addition, innovative mitigation efforts to address challenges specific to limited resource settings are discussed.
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Rindorf D, Larsen S, Ockert L, Jung H, Dahl C. Market Readiness for Single-Use Cystoscopes According to Urologists and Procurement Managers Worldwide. Res Rep Urol 2021; 13:221-226. [PMID: 33987109 PMCID: PMC8110249 DOI: 10.2147/rru.s309602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 04/19/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Single-use endoscopes have been subjected to increase awareness in recent years, and several new single-use cystoscopes (eg Ambu® aScope 4 Cysto) have entered the market. However, the market readiness for such single-use cystoscopes remains unknown. This study investigates the worldwide market readiness for single-use cystoscopes among urologists and procurement managers (PMs) from Europe, Japan, and the US. MATERIALS AND METHOD An online survey using QuestionPro® was distributed to urologists and PMs in France, Germany, Italy, Japan, Spain, the UK, and the US between March 10, 2020 and July 14, 2020. All surveys were translated into the respective local language. Statistical analyses were performed using the software package Stata/SE version 16.1, StataCorp. Fisher's exact test was used to analyze categorical variables and simple linear regression was applied to continuous variables. RESULTS A total of 415 urologists and PMs completed the survey (343 [82.7%] urologists and 72 [17.3%] PMs). Seventy (16.9%) were from Japan, 100 (24.1%) were from the US, and 245 (59.0%) were evenly distributed across the following European countries: France, Germany, Italy, Spain, and the UK. On average, respondents indicated that they would consider converting to single-use in 44.5% of their cystoscopy procedures. Respondents anticipated significantly higher conversion (p<0.05) when they (1) used single-use ureteroscopes in their department, (2) were concerned about cystoscopy-related infection as a result of contaminated cystoscopes, (3) were members of their institution's value committee, or (4) considered cost-transparency to be important when purchasing cystoscopes. CONCLUSION This study investigated the marked readiness for single-use cystoscopes according to urologists and PMs worldwide. Respondents indicated a willingness to convert to single-use cystoscopes in nearly half (44.5%) of their cystoscopy procedures. Respondents that were concerned about cystoscopy-related infections as a result of contaminated cystoscopes indicated a significantly higher anticipated conversion rate (p<0.05).
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Affiliation(s)
| | | | | | - Helene Jung
- Department of Urology, Hospital Lillebaelt, Vejle, Denmark
| | - Claus Dahl
- Department of Urology, Capio Ramsey Santé, Hellerup, Denmark
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Baboudjian M, Gondran-Tellier B, Abdallah R, Tadrist A, Sichez P, Akiki A, Gaillet S, Delaporte V, Karsenty G, Lechevallier E, Boissier R. Single use and reusable flexible ureteroscopies for the treatment of urinary stones: A comparative study of perioperative complications. Prog Urol 2021; 31:368-373. [DOI: 10.1016/j.purol.2020.11.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 09/22/2020] [Accepted: 11/26/2020] [Indexed: 10/22/2022]
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Rudhart SA, Günther F, Dapper L, Thangavelu K, Geisthoff UW, Stankovic P, Wilhelm T, Stuck BA, Hoch S. UV light-based reprocessing of flexible endoscopes without working channel in Oto-Rhino-Laryngology: an effective method? Eur Arch Otorhinolaryngol 2021; 278:4075-4080. [PMID: 33713189 PMCID: PMC8382609 DOI: 10.1007/s00405-021-06737-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 03/04/2021] [Indexed: 11/30/2022]
Abstract
Background Reprocessing of flexible endoscopes (FEs) is often expensive, time consuming, and becomes increasingly complex, due to rising demands of hygiene. After beneficial results in reprocessing of rigid endoscopes using Impelux™ UV-C light technology, we tested the same method for reprocessing of FEs without working channel. Materials and methods Testing was performed on FEs without working channel after routine clinical use (transnasal flexible endoscopy). Disinfection consisted of mechanical precleaning and 60 s exposure to Impelux™ UV-C light technology. Bacterial contamination was tested on 50 FEs before and after disinfection. Further 50 FEs regarding protein residuals. The absolute effectiveness of the D60 was tested on 50 test bodies (RAMS) with a standardized contamination of 107 colony-forming units (CFU) of Enterococcus faecium. Results The FEs were contaminated with a high average value of 916.7 CFU (± 1057 CFU) after clinical usage. After reprocessing, an average contamination of 2.8 CFU (± 1.6) on 14% (n = 7) of the FEs was detected consisting of non-pathogenic species, the remaining FE were sterile. After reprocessing, all FEs were protein-free (< 1 μg). The artificially contaminated test bodies showed no remaining bacterial contamination after disinfection, resulting in an average absolute germ reduction of about 107 CFU. Conclusion Impelux™ UV-C light technology efficiently reduces bacterial contamination of FEs and might be useful in daily practice.
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Affiliation(s)
- Stefan A Rudhart
- Department of Otolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Frank Günther
- Department of Medical Microbiology and Hygiene, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany
| | - Laura Dapper
- Department of Medical Microbiology and Hygiene, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany
| | - Kruthika Thangavelu
- Department of Otolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Urban W Geisthoff
- Department of Otolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Petar Stankovic
- Department of Otolaryngology, Head/Neck and Facial Plastic Surgery, Sana Kliniken Leipziger Land, Borna, Germany
| | - Thomas Wilhelm
- Department of Otolaryngology, Head/Neck and Facial Plastic Surgery, Sana Kliniken Leipziger Land, Borna, Germany.,Medical Faculty, Philipps-Universität Marburg, Marburg, Germany
| | - Boris A Stuck
- Department of Otolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Stephan Hoch
- Department of Otolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Baldingerstrasse, 35043, Marburg, Germany.
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Bozzini G, Filippi B, Alriyalat S, Calori A, Besana U, Mueller A, Pushkar D, Romero-Otero J, Pastore A, Sighinolfi MC, Micali S, Buizza C, Rocco B. Disposable versus Reusable Ureteroscopes: A Prospective Multicenter Randomized Comparison. Res Rep Urol 2021; 13:63-71. [PMID: 33604311 PMCID: PMC7882796 DOI: 10.2147/rru.s277049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 01/12/2021] [Indexed: 12/12/2022] Open
Abstract
Purpose To compare reusable and disposable flexible ureteroscopes in terms of efficacy and safety for patients undergoing Retrograde Intrarenal Surgery (RIRS). Patients and Methods Patients with a renal stone eligible for RIRS were enrolled in this multicenter, randomized, clinical trial study. Patients were randomized into two groups: group A (90 patients) underwent RIRS with a reusable flexible ureteroscope and group B (90 patients) were treated with a disposable one. Results The patients’ demographics, stone features and pre-operative urine cultures were comparable between the groups. The Stone Free Rates (SFRs) were not significantly different (86.6% and 90.0% for group A and group B, respectively, p=0.11) and the mean cost for each procedure was comparable (2321 € in group A vs 2543 € in group B, p=0.09). However, the days of hospitalization and of antibiotic therapy were higher in group A (p ≤ 0.05). The overall complication rate in group A was 8.8% whilst in group B it was 3.3% (p ≤ 0.05); in particular, group A exhibited a greater number of major complications (Clavien score IIIa-V). The overall postoperative infection rate was 16.6% in group A and 3.3% in group B (p ≤ 0.05). Furthermore, none of the patients in group B developed urosepsis or had a positive blood culture, while 3 patients in group A did (p<0.05). Conclusion The use of disposable ureteroscopes is characterized by significantly lower post-operative complications and infection rates, while having comparable costs and SFRs vis à vis reusable ureteroscopes. Clinical Trial Registration Number: ISRCTN92289221.
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Affiliation(s)
- Giorgio Bozzini
- Urology Department, ASST Valle Olona, Busto Arsizio, Varese, Italy
| | | | | | - Alberto Calori
- Urology Department, ASST Valle Olona, Busto Arsizio, Varese, Italy
| | - Umberto Besana
- Urology Department, ASST Valle Olona, Busto Arsizio, Varese, Italy
| | - Alexander Mueller
- Department of Urology, University Hospital Zurich, Zurich, Switzerland
| | - Dmitri Pushkar
- Urology Department First Moscow State Medical University, Moscow, Russia
| | | | | | | | | | - Carlo Buizza
- Urology Department, ASST Valle Olona, Busto Arsizio, Varese, Italy
| | - Bernardo Rocco
- Urology Department, Policlinico of Modena, Modena, Italy
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Tian H, Sun J, Guo S, Zhu X, Feng H, Zhuang Y, Wang X. The Effectiveness of Drying on Residual Droplets, Microorganisms, and Biofilms in Gastrointestinal Endoscope Reprocessing: A Systematic Review. Gastroenterol Res Pract 2021; 2021:6615357. [PMID: 33927758 PMCID: PMC8049816 DOI: 10.1155/2021/6615357] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 03/21/2021] [Accepted: 03/23/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Despite 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. METHODS A 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. RESULTS This 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. CONCLUSIONS While 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.
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Affiliation(s)
- Hefeng Tian
- 1The First Hospital of Jilin University, Changchun, China
| | - Jiao Sun
- 2School of Nursing, Jilin University, No. 965 Xinjiang Street, Changchun, Jilin Province 130021, China
| | - Shaoning Guo
- 1The First Hospital of Jilin University, Changchun, China
| | - Xuanrui Zhu
- 1The First Hospital of Jilin University, Changchun, China
| | - Han Feng
- 1The First Hospital of Jilin University, Changchun, China
| | - Yijin Zhuang
- 1The First Hospital of Jilin University, Changchun, China
| | - Xiu Wang
- 1The First Hospital of Jilin University, Changchun, China
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Satta Y, Yamashita M, Matsuo Y, Kiyokawa H, Sato Y, Takemura H, Kunishima H, Yasuda H, Itoh F. Non-tuberculous Mycobacterial Pseudo-outbreak of an Intestinal Culture Specimen Caused by a Water Tap in an Endoscopy Unit. Intern Med 2020; 59:2811-2815. [PMID: 32641662 PMCID: PMC7725637 DOI: 10.2169/internalmedicine.5188-20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Objective Gastrointestinal lesions of non-tuberculous mycobacteria (NTM) are regarded as opportunistic infections. A large number of positive specimens of NTM were identified in an intestinal fluid culture in the endoscopy unit and it was considered to be a pseudo-outbreak. Methods We reviewed the hospital, laboratory, and colonoscopy records of 263 consecutive patients whose intestinal fluids were analyzed for a mycobacterial culture by colonoscopy at St. Marianna University Hospital, between January 2009 and December 2018. The endoscopy reprocessing procedures were reviewed and samples of water used in the endoscopy unit were cultured. Results An intestinal fluid culture of 154 (58.6%) patients tested positive for NTM (M. intracellulare; 125 cases, M. gordonae; 14 cases, M. avium; 4 cases, M. abscessus; 3 cases, and 8 other cases). In 182 cases (69.2%), an intestinal mucosal culture was performed simultaneously with a fluid culture and tested positive for NTM in 2 cases. Next, we examined the endoscopy unit for any possible environmental contamination. NTM were detected in the tap water used to prepare the antifoaming solution in the endoscopy unit. The water faucets in the endoscopy unit were considered to be the source of the contamination of NTMs. Conclusion We observed that a large number of cases tested positive due to contaminated water that had been used in an endoscopy unit, thus leading to a pseudo-outbreak of NTM.
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Affiliation(s)
- Yusuke Satta
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, St. Marianna University School of Medicine, Japan
| | - Masaki Yamashita
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, St. Marianna University School of Medicine, Japan
| | - Yasumasa Matsuo
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, St. Marianna University School of Medicine, Japan
| | - Hirofumi Kiyokawa
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, St. Marianna University School of Medicine, Japan
| | - Yoshinori Sato
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, St. Marianna University School of Medicine, Japan
| | - Hiromu Takemura
- Department of Microbiology, St. Marianna University School of Medicine, Japan
| | - Hiroyuki Kunishima
- Department of Infectious Diseases, St. Marianna University School of Medicine, Japan
| | - Hiroshi Yasuda
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, St. Marianna University School of Medicine, Japan
| | - Fumio Itoh
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, St. Marianna University School of Medicine, Japan
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Wong M, Wang Y, Wang H, Marrone AK, Haugen SP, Kulkarni K, Basile R, Phillips KS. Research: Fluorescence Microscopy-Based Protocol for Detecting Residual Bacteria on Medical Devices. Biomed Instrum Technol 2020; 54:397-409. [PMID: 33339032 DOI: 10.2345/0899-8205-54.6.397] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Standard methods are needed to reliably and efficiently assess bacterial contamination of processed medical devices. This article demonstrates a standard operating procedure (SOP) for fluorescence microscopy-based detection of residual bacteria on medical devices (BAC-VIS). BAC-VIS uses a 4',6-diamidino-2-phenylindole (DAPI) stain with fluorescent microscopy to quickly and cost-effectively detect bacterial contamination of processed medical device parts. The BAC-VIS protocol was optimized and achieved greater than 80% staining efficiency and a signal-to-noise ratio of more than 20 using four representative organisms. The SOP was first validated for use on a buildup biofilm model, accessory channels of contaminated clinically used devices, and inoculated endoscope end caps and O-rings. The buildup biofilm model was used to evaluate BAC-VIS after repeated treatment of adherent bacteria with three common high-level disinfectants: glutaraldehyde, ortho-phthalaldehyde, and peracetic acid. Next, BAC-VIS was used to assess clinically used endoscope parts that cultured positive for Gram-negative bacteria. DAPI-stained cells were found on all culture-positive devices, especially in grooves and imperfections on the surface. Finally, BAC-VIS was used to detect bacteria on inoculated endoscope device components. The results showed potential for BAC-VIS to be a valuable tool for industry and academic/medical researchers for investigations of contaminated medical devices. Results obtained using BAC-VIS can increase understanding of the role of design in cleanability, wear, and prevention of contamination and may lead to improvements in materials and design that could make processed endoscope use safer for patients. Of note, this protocol is not for detecting bacteria on scopes or scope parts that will be put back into clinical use.
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Evaluation of a Single-Use Flexible Cystoscope: A Multi-Institutional International Study. J Endourol 2020; 34:981-986. [DOI: 10.1089/end.2020.0002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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Pietropaolo A, Hughes T, Tear L, Somani BK. Comparison of ureteric stent removal procedures using reusable and single-use flexible cystoscopes following ureteroscopy and lasertripsy: a micro cost analysis. Cent European J Urol 2020; 73:342-348. [PMID: 33133663 PMCID: PMC7587477 DOI: 10.5173/ceju.2020.0159] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 06/10/2020] [Accepted: 06/14/2020] [Indexed: 01/04/2023] Open
Abstract
Introduction Diagnostic pressure on endoscopy suite can lead to delay in flexible cystoscopic stent removal. We compare the cost and organizational impact of reusable flexible cystoscope versus single-use, flexible cystoscope with a built-in stent grasper (Isiris®). Material and methods Data for the reusable cystoscopic stent removal performed in endoscopy room, group A (period 1) were compared to Isiris disposable stent removal performed in outpatient clinic, group B (period 2). We chose the same calendar months in successive years for these two different groups (9 months each). A micro cost analysis was performed evaluating the impact on costs, complications and organizational benefit. Results A total of 72 patients (37, group A; 35, group B) were included with no significant differences in age and gender ratio. The mean procedure time was 14.4 and 2.2 minutes, and the mean stent dwell time was 26.8 and 15.4 days in groups A and B respectively (p <0.001). In group A, 5 patients (14%) developed stent encrustation, of which 3 needed a ureteroscopic removal subsequently. No complication occurred in group B. More staff on average were needed for procedures done in group A, than group B (p <0.001). The number of patients who had cancer diagnostic wait of >2 weeks for flexible cystoscopy and the mean number of days they waited, reduced from 16 to 3, and 21 days to 3 days respectively between period 1 to period 2. The cost per procedure between group A and group B was £267.2 and £252.62 (p <0.05) if the cost of managing complications was not considered, and £365.40 and £252.62 (p <0.001) if the cost of managing complications was also considered. Conclusions Isiris significantly reduced stent dwell time, procedural time and staff needed to carry out the stent removals. It also allowed the procedures to be done in the outpatient setting thereby reducing the organizational pressure on endoscopy related diagnostic procedures.
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Affiliation(s)
- Amelia Pietropaolo
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, United Kingdom
| | - Thomas Hughes
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, United Kingdom
| | - Loretta Tear
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, United Kingdom
| | - Bhaskar K Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, United Kingdom
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Becker S, Thum K, Philipp J, Hagemann J, Eckrich J, Ernst B. [Cost minimization analysis of flexible ENT-endoscopes]. Laryngorhinootologie 2020; 100:382-392. [PMID: 32698200 DOI: 10.1055/a-1200-1859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Reprocessing of complex instruments like flexible ENT-endoscopes with and without working channel are challanging for clinics and private practices. Aim of the study was to analyse the costs of an examination with a reusable endoscope-system and to compare it with two single-use endoscope-systems. MATERIAL AND METHODS A cost minimization analysis was performed at the Department of Otorhinolaryngology, Head and Neck Surgery of the University Medical Center in Mainz, Germany. The local reusable endoscopy-system was compared with two single-use endoscopy-systems of Ambu and Karl Storz. RESULTS Overall costs per examination with a reusable-scope were 23.03 € (11.60 € investment costs + 5.09 € repair costs + 6.34 € reprocessing costs). The single-use Endoscopy-system of Ambu resulted in 120.43 € per examination (120.00 € acquisition costs + 0.43 € storage costs). Overall costs for the single-use endoscopy-system of Karl Storz were 223.44 € per examination (investment costs for monitors 3.01 € + 220.00 € acquisition costs + 0.43 € storage costs). DISCUSSION Flexible single-use ENT-endoscopy-systems generate higher costs in comparison to conventional reusable ones. But there are also advantages from the medical and economical side. CONCLUSION A smart mix of reusable and single-use endoscopy systems seems therefore usefull.
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Affiliation(s)
- Sven Becker
- Universitätsklinik für Hals-, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie, Eberhard-Karls-Universität Tübingen, Tübingen, Germany
| | - Katharina Thum
- Universitätsklinik für Hals-, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie, Eberhard-Karls-Universität Tübingen, Tübingen, Germany
| | - Julia Philipp
- Universitätsklinik für Hals-, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie, Eberhard-Karls-Universität Tübingen, Tübingen, Germany
| | - Jan Hagemann
- Hals-, Nasen-, Ohrenklinik und Poliklinik, Johannes-Gutenberg-Universität Mainz, Germany
| | - Jonas Eckrich
- Hals-, Nasen-, Ohrenklinik und Poliklinik, Johannes-Gutenberg-Universität Mainz, Germany
| | - Benjamin Ernst
- Hals-, Nasen-, Ohrenklinik und Poliklinik, Johannes-Gutenberg-Universität Mainz, Germany
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UV light-based decontamination: an effective and fast way for disinfection of endoscopes in otorhinolaryngology? Eur Arch Otorhinolaryngol 2020; 277:2363-2369. [PMID: 32358650 PMCID: PMC7335372 DOI: 10.1007/s00405-020-05978-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 04/10/2020] [Indexed: 12/28/2022]
Abstract
Background Reprocessing of endoscopes becomes increasingly complex, due to rising demands of hygiene. Established methods are often expensive/time-consuming. Recent studies suggest beneficial aspects of disinfection by UV light. In this study we analyzed the efficiency of UV light disinfection of rigid otorhinolaryngological endoscopes. Materials and methods After mechanical pre-cleaning, the endoscopes were decontaminated for 25 s in the D25 using Impelux™ UV C light technology (UV Smart B.V., Delft, The Netherlands). First, the surface contact samples were taken from 50 used endoscopes to evaluate the bacterial load. Additionally, surface contact samples were taken from further 50 used endoscopes after reprocessing with the D25. Another 50 endoscopes were tested on protein residuals. Furthermore, the absolute effectiveness of the D25 was tested on 50 test bodies (RAMS) with a standardized contamination of 107 colony-forming units (CFU) of Enterococcus faecium. Results The used endoscopes showed a high bacterial contamination with an average value of 66.908 (± 239.215) CFU. After reprocessing, only a minimal contamination on 10% (n = 5) of the endoscopes with a mean value of 0.12 CFU (± 0.39) was found, resulting in a log-5 reduction in a clinical environment. The documented bacteria were components of the normal skin flora. All tested endoscopes were practically protein-free (< 1 μg). Furthermore, the average absolute germ reduction of the D25 was about 106 CFU on the tested RAMS. Conclusion The D25 UV light system seems to be an effective device for the reprocessing of rigid ORL endoscopes, and therefore, might be suitable for the usage in clinical practice on site.
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Wiktorczyk N, Kwiecińska‐Piróg J, Skowron K, Michalska A, Zalas‐Więcek P, Białucha A, Budzyńska A, Grudlewska‐Buda K, Prażyńska M, Gospodarek‐Komkowska E. Assessment of endoscope cleaning and disinfection efficacy, and the impact of endoscope storage on the microbiological safety level. J Appl Microbiol 2020; 128:1503-1513. [DOI: 10.1111/jam.14558] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 12/06/2019] [Accepted: 12/16/2019] [Indexed: 01/11/2023]
Affiliation(s)
- N. Wiktorczyk
- Department of Microbiology Nicolaus Copernicus University in Toruń Collegium Medicum of L. Rydygier Bydgoszcz Poland
| | - J. Kwiecińska‐Piróg
- Department of Microbiology Nicolaus Copernicus University in Toruń Collegium Medicum of L. Rydygier Bydgoszcz Poland
| | - K. Skowron
- Department of Microbiology Nicolaus Copernicus University in Toruń Collegium Medicum of L. Rydygier Bydgoszcz Poland
| | - A. Michalska
- Department of Microbiology Nicolaus Copernicus University in Toruń Collegium Medicum of L. Rydygier Bydgoszcz Poland
| | - P. Zalas‐Więcek
- Department of Microbiology Nicolaus Copernicus University in Toruń Collegium Medicum of L. Rydygier Bydgoszcz Poland
| | - A. Białucha
- Department of Microbiology Nicolaus Copernicus University in Toruń Collegium Medicum of L. Rydygier Bydgoszcz Poland
| | - A. Budzyńska
- Department of Microbiology Nicolaus Copernicus University in Toruń Collegium Medicum of L. Rydygier Bydgoszcz Poland
| | - K. Grudlewska‐Buda
- Department of Microbiology Nicolaus Copernicus University in Toruń Collegium Medicum of L. Rydygier Bydgoszcz Poland
| | - M. Prażyńska
- Department of Microbiology Nicolaus Copernicus University in Toruń Collegium Medicum of L. Rydygier Bydgoszcz Poland
| | - E. Gospodarek‐Komkowska
- Department of Microbiology Nicolaus Copernicus University in Toruń Collegium Medicum of L. Rydygier Bydgoszcz Poland
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Santos LCS, Parvin F, Huizer-Pajkos A, Wang J, Inglis DW, Andrade D, Hu H, Vickery K. Contribution of usage to endoscope working channel damage and bacterial contamination. J Hosp Infect 2020; 105:176-182. [PMID: 32169614 DOI: 10.1016/j.jhin.2020.03.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 03/04/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Biofilm formation has been shown to be associated with damaged areas of endoscope channels. It was hypothesized that the passage of instruments and brushes through endoscope channels during procedures and cleaning contributes to channel damage, bacterial attachment and biofilm formation. AIM To compare surface roughness and bacterial attachment in used and new endoscope channels in vivo and in vitro. METHODS Surface roughness of 10 clinically used (retired) and seven new colonoscope biopsy channels was analysed by a surface profiler. For the in-vitro study, a flexible endoscope biopsy forceps was passed repeatedly through a curved 3.0-mm-diameter Teflon tube 100, 200 and 500 times. Atomic force microscopy was used to determine the degree of inner surface damage. The number of Escherichia coli or Enterococcus faecium attached to the inner surface of the new Teflon tube and the tube with 500 forceps passes in 1 h at 37oC was determined by culture. RESULTS The average surface roughness of the used biopsy channels was found to be 1.5 times greater than that of the new biopsy channels (P=0.03). Surface roughness of Teflon tubes with 100, 200 and 500 forceps passes was 1.05-, 1.12- and 3.2-fold (P=0.025) greater than the roughness of the new Teflon tubes, respectively. The number of E. coli and E. faecium attached to Teflon tubes with 500 forceps passes was 2.9-fold (P=0.021) and 4.3-fold (P=0.004) higher compared with the number of E. coli and E. faecium attached to the new Teflon tubes, respectively. CONCLUSION An association was found between endoscope usage with damage to the biopsy channel and increased bacterial attachment.
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Affiliation(s)
- L C S Santos
- Surgical Infection Research Group, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia; Ribeirao Preto Nursing School, Sao Paulo University, Ribeirao Preto, Sao Paulo, Brazil
| | - F Parvin
- Surgical Infection Research Group, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - A Huizer-Pajkos
- Surgical Infection Research Group, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - J Wang
- Surgical Infection Research Group, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - D W Inglis
- School of Engineering, Macquarie University, Sydney, Australia
| | - D Andrade
- Ribeirao Preto Nursing School, Sao Paulo University, Ribeirao Preto, Sao Paulo, Brazil
| | - H Hu
- Surgical Infection Research Group, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - K Vickery
- Surgical Infection Research Group, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia.
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Mati MLDM, Guimarães NR, Magalhães PP, Farias LDM, de Oliveira AC. Enzymatic detergent reuse in gastroscope processing: a potential source of microorganism transmission. Rev Lat Am Enfermagem 2019; 27:e3211. [PMID: 31826156 PMCID: PMC6896813 DOI: 10.1590/1518-8345.3101.3211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Accepted: 08/01/2019] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE to evaluate the potential contamination of enzymatic detergent from its reuse and to identify the microbiological profile in the solution used to clean gastrointestinal endoscopic devices. METHOD cross-sectional study based on microbiological analysis of 76 aliquots of 19 different enzymatic detergent solutions used to clean endoscopic devices. The aliquots were homogenized, subjected to Millipore® 0.45 µm membrane filtration and the presumptive identification of microorganisms was performed by biochemical-physiological methods according to previously established specific bacterial groups that are of clinical and epidemiological relevance. RESULTS the mean values, as well as the standard deviation and the median, of the enzymatic detergent microbial load increased as the solution was reused. There was a significant difference between the means of after first use and after fifth reuse. A total of 97 microorganisms were identified, with predominance of the coagulase-negative Staphylococcus, Pseudomonas spp., Klebsiella spp., Enterobacter spp. genus, and Escherichia coli species. CONCLUSION the reuse of the enzymatic detergent solution is a risk to the safe processing of endoscopic devices, evidenced by its contamination with pathogenic potential microorganisms, since the enzymatic detergent has no bactericidal property and can contribute as an important source for outbreaks in patients under such procedures.
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Affiliation(s)
| | - Natália Rocha Guimarães
- Universidade Federal de Minas Gerais, Instituto de Ciências Biológicas, Belo Horizonte, MG, Brazil
- Scholarship holder at the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brazil
| | - Paula Prazeres Magalhães
- Universidade Federal de Minas Gerais, Instituto de Ciências Biológicas, Belo Horizonte, MG, Brazil
| | - Luiz de Macêdo Farias
- Universidade Federal de Minas Gerais, Instituto de Ciências Biológicas, Belo Horizonte, MG, Brazil
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Iwakiri R, Tanaka K, Gotoda T, Oka S, Ohtsuka T, Sakata Y, Chiba T, Higuchi K, Masuyama H, Nozaki R, Matsuda K, Shimono N, Fujimoto K, Tajiri H. Guidelines for standardizing cleansing and disinfection of gastrointestinal endoscopes. Dig Endosc 2019; 31:477-497. [PMID: 31241788 DOI: 10.1111/den.13474] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 06/23/2019] [Indexed: 02/05/2023]
Abstract
As part of the activities toward standardizing endoscopy procedures, the Japan Gastroenterological Endoscopy Society has prepared guidelines for cleansing and disinfection of gastrointestinal endoscopes. The environment of gastrointestinal endoscopy differs between Japan and advanced Western countries. In advanced Western countries, gastrointestinal endoscopy is performed almost exclusively at specialized facilities, where strict provisions are observed for cleansing and disinfecting endoscopes. In Japan, however, gastrointestinal endoscopy is performed even in small clinics, and the annual number of gastrointestinal endoscopy cases is enormous. In addition, the method for cleansing and disinfecting endoscopes differs among hospitals. Although there is a distinct lack of evidence for how gastrointestinal endoscopes are cleaned and disinfected, it is necessary to standardize the method for doing so to advance the field of endoscopic medicine.
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Affiliation(s)
| | | | - Takuji Gotoda
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Shiro Oka
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Takao Ohtsuka
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | | | - Toshimi Chiba
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | | | | | - Ryoichi Nozaki
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Koji Matsuda
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | | | | | - Hisao Tajiri
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
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Johnston ER, Habib-Bein N, Dueker JM, Quiroz B, Corsaro E, Ambrogio M, Kingsley M, Papachristou GI, Kreiss C, Khalid A. Risk of bacterial exposure to the endoscopist's face during endoscopy. Gastrointest Endosc 2019; 89:818-824. [PMID: 30391253 DOI: 10.1016/j.gie.2018.10.034] [Citation(s) in RCA: 100] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 10/24/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Nonuniversal use of facial protection during endoscopy may place endoscopists at risk of exposure to blood and body fluids; however, the frequency of exposure is unknown. METHODS A prospective 6-month study of 4 gastroenterologists using a face shield during endoscopy was undertaken. The face shield was swabbed in a standardized fashion before and at the end of the session. Controls included pre- and post-swabs of face shields placed on the (1) endoscopy suite wall, (2) remote patient intake bay wall, and (3) after deliberate contamination with a colonoscope immediately after colonoscopy. The swabs were cultured for 48 hours, and growth was reported as no growth or by number of colony-forming units (CFUs). The groups were compared for +CFU rate and CFU number. RESULTS A total of 1100 procedures were performed in 239 endoscopy sessions. The +CFU rate in the pre-endoscopy groups (2%-4.8%, not significant) was significantly lower than the postendoscopist face shield (45.8%, P < .001) and endoscopy suite wall groups (21.4%, P < .001), respectively. Using a cut-off of >15 CFUs as an indicator of definite exposure, the occurrence rate was 5.6 per 100 half days of endoscopy to the endoscopist's face and 3.4 per 100 half days of endoscopy 6 feet away. CONCLUSIONS This is the first study to quantify the rate of unrecognized exposure to the endoscopist's face to potentially infectious biologic samples during endoscopy (5.6/100 days of endoscopy). This exposure may result in transmission of infectious diseases. As such, we recommend the use of universal facial protection during GI endoscopy.
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Affiliation(s)
- Elyse R Johnston
- Veterans Affairs Pittsburgh HealthCare System, Pittsburgh, Pennsylvania, USA; The University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Nadia Habib-Bein
- Veterans Affairs Pittsburgh HealthCare System, Pittsburgh, Pennsylvania, USA
| | - Jeffrey M Dueker
- Veterans Affairs Pittsburgh HealthCare System, Pittsburgh, Pennsylvania, USA; The University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Barbara Quiroz
- Veterans Affairs Pittsburgh HealthCare System, Pittsburgh, Pennsylvania, USA
| | - Enrico Corsaro
- Veterans Affairs Pittsburgh HealthCare System, Pittsburgh, Pennsylvania, USA
| | - Megan Ambrogio
- Veterans Affairs Pittsburgh HealthCare System, Pittsburgh, Pennsylvania, USA
| | - Michael Kingsley
- Veterans Affairs Pittsburgh HealthCare System, Pittsburgh, Pennsylvania, USA; The University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Georgios I Papachristou
- Veterans Affairs Pittsburgh HealthCare System, Pittsburgh, Pennsylvania, USA; The University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Christianna Kreiss
- Veterans Affairs Pittsburgh HealthCare System, Pittsburgh, Pennsylvania, USA
| | - Asif Khalid
- Veterans Affairs Pittsburgh HealthCare System, Pittsburgh, Pennsylvania, USA; The University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Molloy-Simard V, Lemyre JL, Martel K, Catalone BJ. Elevating the standard of endoscope processing: Terminal sterilization of duodenoscopes using a hydrogen peroxide-ozone sterilizer. Am J Infect Control 2019; 47:243-250. [PMID: 30442443 DOI: 10.1016/j.ajic.2018.09.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 09/07/2018] [Accepted: 09/08/2018] [Indexed: 01/21/2023]
Abstract
BACKGROUND The health care community is increasingly aware of the processing challenges and infection risks associated with duodenoscopes owing to published reports of outbreaks and regulatory recalls. Studies have demonstrated that the current practices are inadequate for consistently producing patient-ready endoscopes. Alternatively, terminal sterilization would offer a greater margin of safety and potentially reduce the risk of patient infection. The purpose of this study was to evaluate the efficacy of a hydrogen peroxide-ozone sterilizer with regulatory clearance for terminal sterilization of duodenoscopes. METHODS AND RESULTS Validation studies were performed under laboratory simulated-use and clinical in-use conditions. The overkill method study demonstrated a reduction of at least 6-log of Geobacillus stearothermophilus spores at half-cycle, providing a sterility assurance level of 10-6. In addition, the sterilizer achieved a 6-log reduction of G stearothermophilus in the presence of inorganic and organic soils in a simulated-use study. The clinical in-use study confirmed that the sterilizer achieved sterilization of patient-soiled duodenoscopes under actual use conditions. CONCLUSIONS Simulated-use and clinical in-use studies demonstrated the efficacy of a hydrogen peroxide-ozone sterilizer for terminal sterilization of duodenoscopes. This offers health care facilities a viable alternative for duodenoscope processing to enhance patient safety as part of a comprehensive infection control strategy.
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Kenters N, Tartari E, Hopman J, El-Sokkary RH, Nagao M, Marimuthu K, Vos MC, Huijskens EGW, Voss A. Worldwide practices on flexible endoscope reprocessing. Antimicrob Resist Infect Control 2018; 7:153. [PMID: 30564309 PMCID: PMC6296091 DOI: 10.1186/s13756-018-0446-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 12/04/2018] [Indexed: 12/21/2022] Open
Abstract
Background Endoscopy related infections represent an important threat for healthcare systems worldwide. Recent outbreaks of infections with multidrug resistant micro-organisms have highlighted the problems of contaminated endoscopes. Endoscopes at highest risk for contamination have intricate mechanisms, multiple internal channels and narrow lumens that are especially problematic to clean. In light of raised awareness about the necessity for meticulous reprocessing of all types of endoscopes, a call for international collaboration is needed. An overview is presented on current practices for endoscope reprocessing in facilities worldwide. Method An electronic survey was developed and disseminated by the International Society for Antimicrobials and Chemotherapy. The survey consisted of 50 questions aimed at assessing the reprocessing of flexible endoscopes internationally. It covered three core elements: stakeholder involvement, assessment of perceived risks, and reprocessing process. Results The survey received a total of 165 completed responses from 39 countries. It is evident that most facilities, 82% (n = 136), have a standard operating procedure. There is, however a lot of variation within the flexible endoscope reprocessing practices observed. The need for regular training and education of reprocessing practitioners were identified by 50% (n = 83) of the respondents as main concerns that need to be addressed in order to increase patient safety in endoscope reprocessing procedures. Conclusion This international survey on current flexible endoscope reprocessing identified a large variation for reprocessing practices among different health care facilities/countries. A standardised education and training programme with a competency assessment is essential to prevent reprocessing lapses and improve patient safety. Electronic supplementary material The online version of this article (10.1186/s13756-018-0446-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- N Kenters
- 1Department of Medical Microbiology, Radboud University Medical Centre, Radboudumc, Nijmegen, the Netherlands
| | - E Tartari
- 2Infection Control Programme & WHO collaborating Centre of Patient, Safety, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.,3Faculty of Health Sciences, University of Malta, Msida, Malta
| | - J Hopman
- 1Department of Medical Microbiology, Radboud University Medical Centre, Radboudumc, Nijmegen, the Netherlands
| | - Rehab H El-Sokkary
- 4Department of Medical Microbiology and Immunology, Faculty of Medicine, Zagazig University, Zagazig, Arab Republic of Egypt
| | - M Nagao
- 5Department of Infection and Prevention, Kyoto University Hospital, Kyoto, Japan
| | - K Marimuthu
- 6Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Republic of Singapore.,National Centre for Infectious Diseases, Singapore, Republic of Singapore
| | - M C Vos
- 8Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, the Netherlands
| | | | - E G W Huijskens
- 10Department of Medical Microbiology, Albert Schweitzer hospital, Dordrecht, the Netherlands
| | - Andreas Voss
- 1Department of Medical Microbiology, Radboud University Medical Centre, Radboudumc, Nijmegen, the Netherlands.,11Department of Medical Microbiology, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands
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Decristoforo P, Kaltseis J, Fritz A, Edlinger M, Posch W, Wilflingseder D, Lass-Flörl C, Orth-Höller D. High-quality endoscope reprocessing decreases endoscope contamination. Clin Microbiol Infect 2018; 24:1101.e1-1101.e6. [DOI: 10.1016/j.cmi.2018.01.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 01/13/2018] [Accepted: 01/18/2018] [Indexed: 01/10/2023]
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Voor In 't Holt AF, Severin JA, Hagenaars MBH, de Goeij I, Gommers D, Vos MC. VIM-positive Pseudomonas aeruginosa in a large tertiary care hospital: matched case-control studies and a network analysis. Antimicrob Resist Infect Control 2018; 7:32. [PMID: 29492262 PMCID: PMC5828133 DOI: 10.1186/s13756-018-0325-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 02/20/2018] [Indexed: 11/29/2022] Open
Abstract
Background Emergence of multidrug-resistant Pseudomonas aeruginosa is of global concern. We aimed to identify epidemiological relationships, the most common way of transmission, and risk factors for presence of Verona Integron-encoded Metallo-β-lactamase (VIM)-positive P. aeruginosa (VIM-PA). Methods We conducted a network analysis and matched case-control studies (1:2:2). Controls were hospital-based and matched with cases for ward, day of admission (control group 1 and 2) and time between admission and the identification of VIM-PA (control group 1). The network was visualized using Cytoscape, and risk factors were determined using conditional logistic regression. Results Between August 2003 and April 2015, 144 case patients and 576 control patients were recruited. We identified 307 relationships in 114 out of these 144 patients, with most relationships (84.7%) identified at the same department < 3 months after a previous case patient was discharged. In the multivariable model, having undergone ≥1 gastroscopy (odds ratio [OR] = 4.40, 95% confidence interval [CI] = 2.00 to 9.65 and OR = 2.47; 95% CI = 1.12 to 5.49), > 10 day use of selective digestive tract decontamination (SDD) (OR = 2.97; 95% CI = 1.02 to 8.68 and OR = 4.61; 95% CI = 1.22 to 17.37), and use of quinolones (OR = 3.29; 95% CI = 1.34 to 8.10 and OR = 3.95; 95% CI = 1.13 to 13.83 and OR = 4.47; 95% CI = 1.75 to 11.43) were identified as risk factors when using both control groups. Conclusions The network analysis indicated that the majority of transmissions occurred on the wards, but through unidentified and presumably persistent sources, which are most likely in the innate hospital environment. Previous use of certain antibiotic regimens made patients prone to VIM-PA carriage. Additionally, gastroscopy could be considered as a high-risk procedure in patients with risk factors. Our results add to the growing body of evidence that infection control measures targeting VIM-PA should be focused on reducing antibiotics and eliminating sources in the environment. Electronic supplementary material The online version of this article (10.1186/s13756-018-0325-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anne F Voor In 't Holt
- 1Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Juliëtte A Severin
- 1Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Margot B H Hagenaars
- 1Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Inge de Goeij
- 1Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Diederik Gommers
- 2Department of Adult Intensive Care, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Margreet C Vos
- 1Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
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Oh TH, Han ST, Hong KI, Jeong EH, Lee H, Yun JW, Park KH, Lee JW, Kim YJ, Chang W, Park CY. Guidelines of cleaning and disinfection in gastrointestinal endoscope for clinicians. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2018. [DOI: 10.5124/jkma.2018.61.2.130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Tae Hoon Oh
- Korean Society of Digestive Endoscopy Practice Committee, Seoul, Korea
| | - Sang Taek Han
- Korean Society of Digestive Endoscopy Practice Committee, Seoul, Korea
| | - Kwang Il Hong
- Korean Society of Digestive Endoscopy Practice Committee, Seoul, Korea
| | - Eun Haeng Jeong
- Korean Society of Digestive Endoscopy Practice Committee, Seoul, Korea
| | - Hyug Lee
- Korean Society of Digestive Endoscopy Practice Committee, Seoul, Korea
| | - Jung Won Yun
- Korean Society of Digestive Endoscopy Practice Committee, Seoul, Korea
| | - Kwang Hyuk Park
- Korean Society of Digestive Endoscopy Practice Committee, Seoul, Korea
| | - Joon Woo Lee
- Korean Society of Digestive Endoscopy Practice Committee, Seoul, Korea
| | - Young Joon Kim
- Korean Society of Digestive Endoscopy Practice Committee, Seoul, Korea
| | - Woonki Chang
- Korean Society of Digestive Endoscopy Practice Committee, Seoul, Korea
| | - Chang Young Park
- Korean Society of Digestive Endoscopy Practice Committee, Seoul, Korea
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Blázquez-Garrido RM, Cuchí-Burgos E, Martín-Salas C, Ruiz-Garbajosa P. Microbiological monitoring of medical devices after cleaning, disinfection and sterilisation. Enferm Infecc Microbiol Clin 2017; 36:657-661. [PMID: 29146038 DOI: 10.1016/j.eimc.2017.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 09/18/2017] [Indexed: 10/18/2022]
Abstract
The use of reusable semi-critical devices has been extended in current medical practice for both diagnostic and therapeutic purposes. However, reuse of these instruments carries the risk of cross-transmission of microorganisms from one patient to another. The process of cleaning and disinfecting these devices is complex, long, expensive and very error-prone. This paper analyses the epidemiological aspects of infections associated with the reuse of semi-critical devices and the role of the Microbiology laboratory in monitoring the cleaning and disinfecting process through microbiological controls. The recommendations of different scientific societies on the relevance of such controls are reviewed and specific recommendations are proposed for the taking and processing of the samples, interpretation of the results and measures to be taken depending on the results obtained.
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Affiliation(s)
| | | | - Carmen Martín-Salas
- Servicio de Microbiología, Complejo Hospitalario de Navarra, Pamplona, Navarra, España
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Bashaw MA. Guideline Implementation: Processing Flexible Endoscopes. AORN J 2017; 104:225-36. [PMID: 27568535 DOI: 10.1016/j.aorn.2016.06.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 06/29/2016] [Indexed: 01/10/2023]
Abstract
The updated AORN "Guideline for processing flexible endoscopes" provides guidance to perioperative, endoscopy, and sterile processing personnel for processing all types of reusable flexible endoscopes and accessories in all procedural settings. This article focuses on key points of the guideline to help perioperative personnel safely and effectively process flexible endoscopes to prevent infection transmission. The key points address verification of manual cleaning, mechanical cleaning and processing, storage in a drying cabinet, determination of maximum storage time before reprocessing is needed, and considerations for implementing a microbiologic surveillance program. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures.
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