Comparison of the efficacy of disinfectants in automated endoscope reprocessors for colonoscopes: tertiary amine compound (Sencron2®) versus ortho-phthalaldehyde (Cidex®OPA)

A Manufacturer and User Facility Device Experience Analysis of Upper Aerodigestive Endoscopy Contamination: Is Flexible Laryngoscopy Different?

OBJECTIVES/HYPOTHESIS

Several recent studies have observed a high incidence of duodenoscope microbial contamination and an association of contamination with healthcare-acquired infections. This study sought to quantify nasopharyngoscope microbial contamination relative to that of other endoscope categories and characterize the manufacturers, outcomes, and microbial profiles associated with these cases.

STUDY DESIGN

Retrospective, cross-sectional study.

METHODS

A total of 3,865 adverse events were collected from 2013 to 2019 using the US Food and Drug Administration Manufacturer and User Facility Device Experience database. The fraction of total device failures associated with contamination was quantified for nasopharyngoscopes, bronchoscopes, duodenoscopes, and gastroscopes. Odds ratios of nasopharyngoscope contamination compared to that of bronchoscopes, duodenoscopes, or gastroscopes were calculated, and significance was assessed by χ² analysis. The Kruskal-Wallis test was used for nonparametric testing of significance.

RESULTS

Nasopharyngoscope device failures were reported at an incidence of 0.646 per month; 34.1% involved contamination, comparable to the frequency observed for bronchoscopes (23.4%, P = .118), duodenoscopes (29.2%, P = .493), and gastroscopes (45.3%, P = .178). The frequency of device contamination was observed to be significantly higher for a particular endoscope manufacturer regardless of endoscope category (Kruskal-Wallis P = .021). In instances of contamination, nasopharyngoscopes were significantly less associated with patient harm or death than bronchoscope (odds ratio [OR] = 10.2) and duodenoscope (OR = 4.81) cases.

CONCLUSIONS

Although the rates of contamination were comparable across all endoscope categories, nasopharyngoscope contamination was less commonly associated with patient harm or death. In an era of rising healthcare costs, determining adequate disinfection standards for nasopharyngoscopes and their impact on patient safety is crucial.

LEVEL OF EVIDENCE

NA Laryngoscope, 131:598-605, 2021.

Planarity of substituted pyrrole and furan rings in (3R*, 1′S*, 3′R*)-3-(1′-tert-butylamino-1′H, 3′ H-benzo[c]furan-3′-yl)-2-tert-butyl-2,3-dihydro-1H-benzo[c]pyrrol-1-one

The title structure, (3R*, 1′S*, 3′R*)-3-(1′-tert-butylamino-1′H,3′H-benzo[c]furan-3′-yl)-2-tert-butyl-2,3-dihydro-1H-benzo[c]pyrrol-1-one has been determined at 290 and 150 K by single-crystal X-ray diffraction. The structure comprises two symmetry independent molecules with very similar conformations which differ mostly by orientations of the tert-butyl groups, situated at the periphery of these molecules. The molecules are composed of two parts, the cores of which are isoindolinone and isobenzofuran rings being bound by C–C bonds. The planarities of the pyrrolone and furan rings are compared with the known structures retrieved from the Cambridge Crystal Structure Database. It transpires in the title molecules, the planarity of the carbonyl-substituted pyrrole rings is exceptionally distorted in contrast to the furan rings. This fact is just the opposite of the tendency inferred from the Cambridge Crystal Structure Database. The reason may be the influence of the voluminous tert-butyl group which is attached to the nitrogen of the pyrrole group, as well as short centroid–centroid distances between the carbonyl-substituted pyrrole and furan rings. Cohesion forces between the molecules and their parts are provided by weak interactions only: The packing suggests C–H···O, π–π-electron ring interactions, N–H···π-electron ring as well as C–H···π-electron ring interactions. The structure determination of the title compound, the product of the reaction of o-phthalaldehyde with tert-butylamine, has provided indication about the mechanism of a chemical reaction which resulted in the formation of the title molecule.