Steps of reprocessing and equipments

An Analysis of the Contaminants on Otoscopes of Otolaryngology Residents: An Observational Study

The study was conducted to learn if the otoscope, a noncritical medical device, used by ENT residents harbor pathogenic organism. This study was conducted in a medical teaching hospital in India. Total of 38 otoscopes of ENT residents were examined after taking samples using sterile cotton swabs from otoscope speculum and otoscope head and both bacterial and fungal culture were studied. The study showed that 11 otoscope heads (28.94%) and 11 otoscope speculums (28.94%) out of the 38 otoscopes studied showed bacterial growth. Most commonly isolated bacteria were skin commensals followed by Klebsiella species. Fungal growth was seen in 3 out of 38 otoscope Speculums (7.89%). All 3 fungi isolated during the study belonged to Aspergillus species. Training residents regarding hygiene of medical equipments is necessary. Residents must be periodically assessed regarding their practice in handling medical equipments.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12070-024-04695-8.

Experimental Study to Develop a Method for Improving Sample Collection to Monitor Laryngoscopes after Reprocessing

BACKGROUND/AIMS

The microbiological surveillance of endoscopes and automated flexible endoscope reprocessing have been proven to be two of the most difficult and controversial areas of infection control in endoscopy. The purpose of this study was to standardize a sampling method for assessing the effectiveness of standard reprocessing operating procedures for flexible fiberoptic laryngoscopes (FFLs).

METHODS

First, the sampling devices were directly inoculated with Bacillus atrophaeus spores; second, tissue non tissue (TNT) wipes were tested on artificially contaminated surfaces and on FFLs.

RESULTS

Comparison of the sponges, cellulose, and TNT wipes indicated that the TNT wipes were more effective in releasing spores (93%) than the sponges (49%) and cellulose wipes (52%). The developed protocol provides a high efficiency for both collection and extraction from the stainless steel surface (87% of the spores were removed and released) and from the FFL (85% of the spores were removed and released), with relatively low standard deviations for recovery efficiency, particularly for the analysis of the FFL.

CONCLUSION

TNT wipes are more efficient for sampling surface areas, thereby aiding in the accuracy and reproducibility of environmental surveillance.

Education and Training Guidelines for the Board of the Korean Society of Gastrointestinal Endoscopy

The Korean Society of Gastrointestinal Endoscopy (KSGE) developed a gastrointestinal (GI) endoscopy board in 1995 and related regulations. Although the KSGE has acquired many specialists since then, the education and training aims and guidelines were insufficient. During GI fellowship training, obtaining sufficient exposure to some types of endoscopic procedures is difficult. Fellows should acquire endoscopic skills through supervised endoscopic procedures during GI fellowship training. Thus, the KSGE requires training guidelines for fellowships that allow fellows to perform independent endoscopic procedures without supervision. This document is intended to provide principles that the Committee of Education and Training of the KSGE can use to develop practical guidelines for granting privileges to perform accurate GI endoscopy safely. The KSGE will improve the quality of GI endoscopy by providing guidelines for fellowships and supervisors.

Endoscope Reprocessing: Update on Controversial Issues

Several issues concerning endoscope reprocessing remain unresolved based on currently available data. Thus, further studies are required to confirm standard practices including safe endoscope shelf life, proper frequency of replacement of some accessories including water bottles and connecting tubes, and microbiological surveillance testing of endoscopes after reprocessing. The efficacy and cost-effectiveness of newer technology that allows automated cleaning and disinfection is one such controversial issue. In addition, there are no guidelines on whether delayed reprocessing and extended soaking may harm endoscope integrity or increase the bioburden on the external or internal device surfaces. In this review, we discuss the unresolved and controversial issues regarding endoscope reprocessing.

Role of Clinical Endoscopy in Emphasizing Endoscope Disinfection

Based on the unexpected Middle East respiratory syndrome (MERS) outbreak in Korea, it was established that the virus can spread easily, MERS exposure in hospitals carries an extreme risk for infection as well as mortality, and the sharing of information was essential for infection control. Although the incidence of exogenous infections related to contaminated endoscopes is very low, the majority of published outbreaks have been caused by various shortcomings in reprocessing procedures, including insufficient training or awareness. Ever since the inauguration of "Clinical Endoscopy" as an English-language journal of the Korean Society of Gastrointestinal Endoscopy in 2011, it has published several articles on disinfection of the endoscope and its accessories. Many Science Citation Index journals have also emphasized high-level disinfection of the gastrointestinal endoscope. Many papers have been produced specifically, since the outbreak of carbapenem-resistant Enterobacteriaceae in 2013. The recent review papers concluded that quality control is the most important issue among all the aspects of procedural care, including the efficiency of the gastrointestinal endoscopy unit and reprocessing room. Thorough reprocessing of endoscopes using high-level disinfection and sterilization methods may be essential for reducing the risk of infection.

Recent Update on Microbiological Monitoring of Gastrointestinal Endoscopes after High-Level Disinfection

Endoscopy-related infections are important contributors to nosocomial infections. Endoscope reprocessing according to standard guidelines ensures high-level disinfection and prevents endoscopy-related infections. Microbiological surveillance may help in monitoring the effectiveness of gastrointestinal endoscope disinfection. The process involves microbial cultures and non-culture methods such as bioburden assays, adenosine triphosphate (ATP) bioluminescence, and quantitative polymerase chain reactions (PCRs). Surveillance culturing to monitor endoscopes after reprocessing has been recommended by a majority of organizations. Bioburden assays, ATP bioluminescence, and quantitative PCRs provide rapid and reliable measures. Each institution will have to try to establish its own surveillance guidelines.

Introduction to Starting Upper Gastrointestinal Endoscopy: Proper Insertion, Complete Observation, and Appropriate Photographing

Diagnostic upper gastrointestinal endoscopy is the most basic of endoscopy procedures and is the technique that trainee doctors first learn. Mastering the basics of endoscopy is very important because when this process is imprecise or performed incorrectly, it can severely affect a patient's health or life. Although there are several guidelines and studies that consider these basics, there are still no standard recommendations for endoscopy in Korea. In this review, basic points, including proper endoscope insertion, precise observation without blind spots, and appropriate photographing, for upper gastrointestinal endoscopy will be discussed.

High-level disinfection of gastrointestinal endoscope reprocessing

High level disinfection (HLD) of the gastrointestinal (GI) endoscope is not simply a slogan, but rather is a form of experimental monitoring-based medicine. By definition, GI endoscopy is a semicritical medical device. Hence, such medical devices require major quality assurance for disinfection. And because many of these items are temperature sensitive, low-temperature chemical methods, such as liquid chemical germicide, must be used rather than steam sterilization. In summarizing guidelines for infection prevention and control for GI endoscopy, there are three important steps that must be highlighted: manual washing, HLD with automated endoscope reprocessor, and drying. Strict adherence to current guidelines is required because compared to any other medical device, the GI endoscope is associated with more outbreaks linked to inadequate cleaning or disinfecting during HLD. Both experimental evaluation on the surveillance bacterial cultures and in-use clinical results have shown that, the monitoring of the stringent processes to prevent and control infection is an essential component of the broader strategy to ensure the delivery of safe endoscopy services, because endoscope reprocessing is a multistep procedure involving numerous factors that can interfere with its efficacy. Based on our years of experience in the surveillance of culture monitoring of endoscopic reprocessing, we aim in this study to carefully describe what details require attention in the GI endoscopy disinfection and to share our experience so that patients can be provided with high quality and safe medical practices. Quality management encompasses all aspects of pre- and post-procedural care including the efficiency of the endoscopy unit and reprocessing area, as well as the endoscopic procedure itself.

Highlights of the 48th seminar of korean society of gastrointestinal endoscopy

This special May issue of Clinical Endoscopy discusses the tutorial contents dealing with either the diagnostic or therapeutic gastrointestinal (GI) endoscopy that contain very fundamental and essential points in this filed. The seminar of Korean Society of Gastrointestinal Endoscopy (KSGE) had positioned as one of prime educational seminars covering the very beginner to advanced experts of GI endoscopy. Besides of four rooms allocated for each lecture, two additional rooms were open for either live demonstration or hands-on course, covering totally 20 sessions including one special lecture. Among these prestigious lectures, 12 lectures were selected for the current review articles in this special issue of Clinical Endoscopy journal. Basic course for beginner to advanced tips to expert were all covered in this seminar. This introductory review prepared by four associated editors of Clinical Endoscopy contained core contents divided into four sessions-upper gut, lower gut, pancreaticobiliary, and specialized topic session part-to enhance understandings not covered by enlisted review articles in this issue.