Decontamination methods for flexible nasal endoscopes

Cost minimization analysis of nasopharyngoscope reprocessing in community practice

BACKGROUND

Reprocessing of nasopharyngoscopes represents a large financial burden to community physicians. The aim of this study was to perform a cost analysis of nasopharyngoscope reprocessing methods at the community level.

METHODS

Electronic surveys were distributed by email to community otolaryngologists. Surveys were comprised of 14 questions assessing clinic size, nasopharyngoscope volume, scope reprocessing method and maintenance. Four manual techniques were evaluated: (1) soak with ortho-phthalaldehyde solution (Cidex-OPA; Advanced Sterilization Products, Johnson and Johnson Inc., Markham, Canada), (2) soak with accelerated hydrogen peroxide solution (Revital-Ox; Steris Canada Inc., Mississauga, Canada), (3) disinfection with chlorine dioxide wipe (Tristel Trio Wipes System; Tristel plc., Cambridgeshire, UK), (4) UV-C light system (UV Smart, Delft, The Netherlands). All costs are reported in CAD, and consumable and capital costs for reprocessing methods were obtained from reported vendor prices. Time costs were derived from manufacturer recommendations, the Ontario Medical Association Physician's Guide to Uninsured Services, and the Ontario Nurses Association Collective Agreement. Cost analyses determined the most cost-effective reprocessing method in the community setting. Sensitivity analyses assessed the impact of reprocessing volume and labour costs.

RESULTS

Thirty-six (86%) otolaryngologists responded and answered the survey. The cost per reprocessing event for Cidex-OPA, Revital-Ox, Tristel and UV system were $38.59, $26.47, $30.53, and $22.74 respectively when physicians reprocessed their endoscopes themselves. Sensitivity analyses demonstrated that Revital-Ox was the least costly option in a low volume, however, the UV system remained the most cost effective in higher volumes. The cost per reprocessing event when done by clinic staff was $5.51, $4.42, $11.23 and $6.21 for Cidex-OPA, Revital-Ox, Tristel and the UV system.

CONCLUSIONS

The UV light system appears to be the most cost-effective method in high volumes of reprocessing, and Revital-Ox is cheaper in lower volumes and when performed by clinic staff rather than physicians. It is important to consider the anticipated work volume, shared clinic space and number of co-workers prior to choosing a reprocessing method.

Disposable chlorine dioxide wipes for high-level disinfection in the ENT department: A systematic review

BACKGROUND

Nasopharyngoscope reprocessing methods should be effective, rapid and reproducible with moderate cost. Tristel Trio Wipes system (TTWS) is a manual reprocessing method based on chlorine dioxide that has lately emerged in ENT department. This review aims to collect evidence on this system.

METHODS

The PubMed, Web of Science and Cochrane Library databases were searched for all the studies on TTWS or one of its components. Data were grouped according to the study type.

RESULTS

Ten articles were included in the review. TTWS ensured high-level disinfection in laboratory and clinical setting. Although the limitations of the manual systems, TTWS proved to be faster than automated endoscope reprocessing (AER) and safe for patients and health-care workers. TTWS represented cheaper system than AER or sheaths in low- and medium-volume centers.

CONCLUSION

TTWS could be a valid, safe and fast HLD method for nasopharyngoscopes, with reasonable costs for medium-low reprocessing volumes.

Clinical Issues- March 2017

Using one flexible endoscope for an upper and lower gastrointestinal (GI) endoscopy procedure Key words: flexible endoscope, esophagogastroduodenoscopy, colonoscopy, enteroscope, risk assessment. Enhanced methods for processing flexible duodenoscopes Key words: flexible duodenoscopes, liquid chemical sterilization, ethylene oxide sterilization, low-temperature sterilization, risk assessment. Modification of the Spaulding classification Key words: Spaulding classification, critical items, semicritical items, mucous membranes, risk assessment. Flushing flexible endoscope lumens with alcohol Key words: flexible endoscopes, isopropyl alcohol, ethyl alcohol, fixative, risk assessment. Using chlorine dioxide wipes for nonchanneled flexible endoscopes Key words: nonchanneled flexible endoscopes, high-level disinfectant, chlorine dioxide, risk assessment.