Droplet dispersal in decontamination areas of instrument reprocessing suites

Fluid retention in endoscopes: A real-world study on drying effectiveness

BACKGROUND

Outbreaks linked to inadequate endoscope drying have infected numerous patients, and current standards and guidelines recommend at least 10 minutes of forced air for drying channels. This study evaluated a new forced-air drying system (FADS) for endoscopes.

METHODS

Drying was assessed using droplet detection cards; visual inspection of air/water connectors, suction connectors, and distal ends; and borescope examinations of endoscope interiors. Assessments were performed after automated endoscope reprocessor (AER) alcohol flush and air purge cycles and after 10-minute FADS cycles.

RESULTS

Researchers evaluated drying during encounters with 22 gastroscopes and 20 colonoscopes. After default AER alcohol and air purge cycles, 100% (42/42) of endoscopes were still wet. Substantial fluid emerged from distal ends during the first 15 seconds of the FADS cycle, and droplets also emerged from air/water and suction connectors. Following FADS cycle completion, 100% (42/42) were dry, with no retained fluid detected by any of the assessment methods.

CONCLUSIONS

Multiple endoscope ports and channels remained wet after AER cycles intended to aid in drying but were dry after the FADS cycle. This study reinforced the need to evaluate the effectiveness of current drying practices and illustrated the use of practical tools in a real-world setting.

Decontamination of a robot used to reprocess reusable surgical instruments

BACKGROUND

Using robots to handle medical devices in the decontamination area of the Central Sterile Supply Department (CSSD) can reduce risks and address staff shortages. The gripper design must allow reliable cleaning using standard CSSD procedures to avoid build-up of biofilms and possible cross-contamination between different instrument trays and the gripper's functionality. This study explores the design of the robot's gripper regarding cleanability, aiming to determine whether successful cleaning can be achieved even after prolonged drying for a working shift of 8 h.

METHODS

We optimized a gripper for cleanability and used it to assess the spread of different test soils depending on different forms of motion. Subsequently, we analysed the cleanability using sheep's blood as test soil, reprocessing the gripper in different assembly configurations after 4 and 8 h of drying, and measuring residual protein.

FINDINGS

Based on our investigations, we documented the spread of contamination depending on the type of motion of the gripper's components. Sheep's blood exhibited the highest dispersion among the test soils, permeating through thin crevices. Importantly, all samples displayed residual protein levels below the warning threshold, irrespective of drying time and gripper disassembly or cleaning position. Cleaning in a device-specific optimized position achieved results comparable to cleaning the disassembled individual components.

CONCLUSIONS

These findings indicate that cleaning even after one working shift of 8 h and without the labour-intensive disassembly of the gripper is feasible, supporting the future use of robots to handle contaminated medical devices in the CSSD decontamination area.

Guidelines in Practice: Processing Flexible Endoscopes

Flexible endoscopes allow surgeons and proceduralists to view patients' internal organs through small incisions or natural orifices. These devices may be difficult to clean and dry adequately, and the formation of biofilm can further complicate effective cleaning. The updated AORN "Guideline for processing flexible endoscopes" provides perioperative personnel with evidence-based best practice recommendations on a variety of concepts associated with this topic. This article provides an overview of the guideline and discusses recommendations for point-of-use treatment, transport, cleaning (including verification and drying), and storage of flexible endoscopes. It also includes a scenario that illustrates the importance of adequately drying and storing flexible endoscopes. When processing flexible endoscopes, personnel should adhere to the endoscope and processing equipment manufacturers' instructions for use. Perioperative nurses should review the guideline in its entirety and implement recommendations in practice settings where flexible endoscopes are used.

Clinical Issues-November 2022

Reuse of single-use bronchoscopes Key words: single use, bronchoscope, contamination, time limit, instructions for use (IFU). Endoscope processing room workflow Key words: one-room design, decontamination sink, droplets, clean storage, transport. Simethicone use during endoscopy Key words: adenosine triphosphate (ATP) testing, defoaming agent, water bottle, borescope inspection, residue. Implementing borescope inspection of flexible endoscopes Key words: visual inspection, cleaning verification, high-risk endoscopes, competency verification, prepurchase evaluation.

Splash generation and droplet dispersal in a well-designed, centralized high-level disinfection unit

BACKGROUND

Sterile processing personnel routinely decontaminate medical devices that are heavily soiled with blood, tissue, and secretions. Contamination may spread throughout processing areas, potentially exposing personnel and patient-ready devices, especially when there is insufficient separation between the dirty and clean areas.

OBJECTIVE

This study aimed to identify activities that generate splash, determine how far droplets travel during manual cleaning, characterize the impact of practices on splash generation, and assess effectiveness of personal protective equipment (PPE) at preventing splash exposure to technicians and visitors in the decontamination unit.

METHODS

Moisture-detection paper was affixed to PPE and environmental surfaces in a new processing department designed to optimize workflow and prevent cross-contamination. Droplet generation and dispersal were assessed during manual cleaning of a colonoscope and a transvaginal ultrasound probe.

RESULTS

Splash was generated by most activities and droplets were detected up to 7.25 feet away. Transporting wet endoscopes dispersed droplets on a 15-foot path from the sink to the automated endoscope reprocessor. Extensive droplets were detected on PPE worn by technicians at the sink and observers 3-4 feet away.

CONCLUSIONS

Manual cleaning of devices generated substantial splash, drenching technicians and the environment with droplets that traveled more than 7 feet. Engineering controls and better PPE are needed to reduce personnel exposure and risks associated with the potential dispersal of contaminated fluids throughout the facility.

Adoption of Improved Reprocessing Decreased Microbiological Non-Compliance for Bronchoscopes

BACKGROUND

In the past few decades, the inadequate reprocessing of bronchoscopes has been associated with several serious outbreaks caused by multidrug-resistant microorganisms. In this study we evaluated the improvement in the quality of reprocessing in a Bronchoscopy Unit (BU), after the introduction of a new procedure.

METHODS

In 2019, observational and clinical audits were conducted in the BU. After the introduction of an improved procedure in 2020, a microbiological surveillance plan was implemented in 2021.

RESULTS

In 2019, 13 of 22 bronchoscopes (59%) resulted as non-compliant, 18% as high concern organisms (HCO) and 36.4% as high microbial count (≥100 CFU/all channels) and HCO. The most frequent microorganisms were Staphylococcus aureus (38.5%) and NDM-producing Klebsiella pneumoniae (15.4%). The bronchoscopes were stored inside their transport cases, which in some cases were found to be contaminated by the same strains isolated on the bronchoscopes (Enterobacter gergoviae and Vibrio alginolyticus). In 2021, all 31 bronchoscopes were sampled at least three times and 13/99 (13.1%) resulted as non-compliant, mostly K. pneumoniae (4.04%). Contamination level increases weakly in bronchoscopes in use for more than 14 years (R = 0.32).

CONCLUSIONS

The adoption of an improved reprocessing procedure decreased the non-compliance of bronchoscopes, increasing the quality of the process and patient safety.