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Current limitations about the cleaning of luminal endoscopes
1Environmental Healthcare Unit, Centre of Biological Sciences, University of Southampton, Southampton, UK. R.Herve@soton.ac.uk
Background:
The presence and potential build-up of patient material such as proteins in endoscope lumens can have significant implications, including toxic reactions, device damage, inadequate disinfection/sterilization, increased risk of biofilm development and potential transmission of pathogens.
Aim:
To evaluate potential protein deposition and removal in the channels of flexible luminal endoscopes during a simple contamination/cleaning cycle.
Methods:
The level of contamination present on disposable endoscopy forceps which come into contact with the lumen of biopsy channels was evaluated. Following observations in endoscopy units, factors influencing protein adsorption inside luminal endoscope channels and the action of current initial cleaning techniques were evaluated using a proteinaceous test soil and very sensitive fluorescence epimicroscopy.
Findings:
Disposable endoscope accessories appear to be likely to contribute to the contamination of lumens, and were useful indicators of the amount of proteinaceous soil transiting through the channels of luminal endoscopes. Enzymatic cleaning according to the manufacturer's recommendations and brushing of the channels were ineffective at removing all proteinaceous residues from new endoscope channels after a single contamination. Rinsing immediately after contamination only led to a slight improvement in decontamination outcome.
Conclusion:
Limited action of current decontamination procedures and the lack of applicable quality control methods to assess the cleanliness of channels between patients contribute to increasing the risk of cross-infection of potentially harmful micro-organisms and molecules during endoscopy procedures.
Insights
Protein contamination in endoscope channels is a risk. Current cleaning methods, including enzymatic cleaning and brushing, are insufficient to remove all protein residues, increasing infection risks.
Area of Science:
- Gastroenterology
- Infectious Disease Prevention
- Medical Device Reprocessing
Background:
- Patient material, such as proteins, can accumulate in endoscope lumens, leading to toxic reactions, device damage, and pathogen transmission.
- Biofilm development and inadequate disinfection are significant risks associated with protein build-up in endoscopes.
Purpose of the Study:
- To assess protein deposition and removal within flexible endoscope channels after a single contamination and cleaning cycle.
- To evaluate the effectiveness of current initial cleaning techniques on proteinaceous residues in endoscope lumens.
Main Methods:
- Protein contamination levels were assessed on disposable endoscopy forceps used in biopsy channels.
- Protein adsorption factors and the efficacy of initial cleaning methods were studied using a proteinaceous test soil and fluorescence epimicroscopy.
- The impact of immediate post-contamination rinsing was also evaluated.
Main Results:
- Disposable endoscopy accessories contribute to lumen contamination and indicate the amount of proteinaceous soil.
- Enzymatic cleaning and channel brushing were ineffective in completely removing protein residues from new endoscope channels after one contamination cycle.
- Immediate rinsing provided only a marginal improvement in decontamination.
Conclusions:
- Current decontamination procedures have limited effectiveness in removing proteinaceous residues from endoscope channels.
- The absence of quality control methods to verify channel cleanliness between patients heightens the risk of cross-infection.
- Endoscopic procedures carry an increased risk of transmitting harmful microorganisms and molecules due to inadequate cleaning.
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