Automated washing with the Reliance Endoscope Processing System and its equivalence to optimal manual cleaning

Manual cleaning of flexible endoscopes is prone to error. To date, attempts to automate this process have been unsuccessful. The aim of this project was to compare the efficacy of the washing phase in the new Reliance EPS (STERIS Corp, Mentor, OH) with that of optimal manual cleaning.

Using simulated-use testing, all channels in 3 different flexible endoscopes, including a bronchoscope (Pentax, Pentax Medical Company, Miami, FL), a side-viewing duodenoscope (Olympus, Olympus Corporation), and a colonoscope (Fujinon, Fujinon Corporation, Wayne, NJ) were evaluated. All of the channels in the flexible endoscope were soiled with artificial test soil (ATS) (test soil that mimics the worst case levels of hemoglobin, protein, carbohydrate, and endotoxin from patient-used flexible endoscopes) containing 10(8) cfu/mL of Enterococcus faecalis and Pseudomonas aeruginosa The soiled scopes were allowed to dry for 1 hour prior to processing. Hemoglobin, protein, and viable organism counts for the flexible endoscopes were determined before and after cleaning.

Both the Reliance EPS washing phase and optimal manual cleaning achieved >90% reduction of hemoglobin and protein, resulting in <6.4 microg/cm2 after the cleaning cycle. The reduction factor for viable organisms was not significantly different between the 2 methods, which ranged from 2.06 to 6.21 for manual cleaning and from 2.1 to 5.93 for the Reliance EPS washing phase. The mean reduction factor (all tests) was 4.32 +/- 1.03 for manual cleaning compared with 4.24 +/- 1.11 for Reliance EPS washing phase.

The efficacy of the Reliance EPS washing phase for flexible endoscopes was equivalent to optimal manual cleaning for all the makes and models of flexible endoscopes tested.