Novel Algorithms for Reprocessing, Drying and Storing Endoscopes

Costs of purchase, maintenance, microbiological control, and reprocessing of a reusable duodenoscope

Background and study aims The costs of reusable endoscope reprocessing have been evaluated, yet external validity of the findings remains challenging. The aim of this study was to assess the costs of purchase, maintenance, microbiological control, and reprocessing of a reusable duodenoscope per endoscopic retrograde cholangiopancreatography (ERCP) in France. Study findings exclude the costs of infection, downtime due to breakdown, reprocessing single-use material disposal, and device disposal, all of which should also be considered. Materials and methods The study encompassed both observational and theoretical approaches. Observational data were collected in four hospitals, from December 2019 to December 2020, with an ad hoc survey, based on 2016 and 2018 national guidelines for duodenoscope reprocessing. Costs were modeled, using the same guidelines, assuming a mean workload of 223 ERCP/duodenoscope/year. Results The mean observed cost of purchase, maintenance, microbiological control, reprocessing (human resources and consumables), and overhead (additional 35%) with a reusable duodenoscope was €80.23 (standard deviation €3.77) per ERCP. The corresponding mean theoretical cost was €182.71 for manual reprocessing without endoscope drying cabinet (EDC), €191.36 for manual reprocessing with EDC, €235.25 for automated endoscope reprocessing (AER) without EDC, and €253.62 for AER with EDC. Conclusions Because procedures, equipment, volume activity, number of duodenoscopes, human resources, and internal work organizations are hospital-dependent, observed costs varied between hospitals. Theoretical costs were higher than observed costs, showing that the theoretical approach is not sufficient. Hypotheses to explain the difference between the two approaches include failing to measure some costs in the survey and challenges in guideline implementation.

A Single-Blind Study Testing the Preparation Accuracy of Bedside Precleaning Solutions Used for Flexible Endoscopes

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.

A narrative review on current duodenoscope reprocessing techniques and novel developments

Duodenoscopy-associated infections occur worldwide despite strict adherence to reprocessing standards. The exact scope of the problem remains unknown because a standardized sampling protocol and uniform sampling techniques are lacking. The currently available multi-society protocol for microbial culturing by the Centers for Disease Control and Prevention, the United States Food and Drug Administration (FDA) and the American Society for Microbiology, published in 2018 is too laborious for broad clinical implementation. A more practical sampling protocol would result in increased accessibility and widespread implementation. This will aid to reduce the prevalence of duodenoscope contamination. To reduce the risk of duodenoscopy-associated pathogen transmission the FDA advised four supplemental reprocessing measures. These measures include double high-level disinfection, microbiological culturing and quarantine, ethylene oxide gas sterilization and liquid chemical sterilization. When the supplemental measures were advised in 2015 data evaluating their efficacy were sparse. Over the past five years data regarding the supplemental measures have become available that place the efficacy of the supplemental measures into context. As expected the advised supplemental measures have resulted in increased costs and reprocessing time. Unfortunately, it has also become clear that the efficacy of the supplemental measures falls short and that duodenoscope contamination remains a problem. There is a lot of research into new reprocessing methods and technical applications trying to solve the problem of duodenoscope contamination. Several promising developments such as single-use duodenoscopes, electrolyzed acidic water, and vaporized hydrogen peroxide plasma are already applied in a clinical setting.