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Manual brushing in endoscope reprocessing: how brush design impacts endoscope cleaning efficacy
Inès Beaugelin1, Lionel Pineau1
1Eurofins Biotech Germande, Aix en Provence, France.
Background:
Adequate removal of organic residues during manual pre-cleaning is essential to support subsequent endoscope disinfection, yet the effectiveness achievable with routine brushing is closely dependent on proper technique and adherence to instructions for use.
Aim:
To compare the cleaning efficacy of four commercially available endoscope brushes under recommended-use and simulated degraded-use conditions using a standardized surrogate model.
Methods:
PTFE tubes (4.2-mm inner diameter) were soiled with coagulated sheep blood in accordance with ISO 15883-5:2021 Annex A and incorporated into an endoscope surrogate device. Four brushes (Olympus, Boston Scientific, Pentax and Steris) were evaluated under the manufacturers' instructions for use (IFU; three passes) and under one-pass simulated worst-case conditions. Residual protein and total organic carbon (TOC) were quantified.
Findings:
Under IFU conditions, all brushes reduced residual protein to approximately 1 μg/cm2 and residual TOC to 2-4 μg/cm2, below the ISO 15883-5:2021 alert levels (<3 μg/cm2 for protein; <6 μg/cm2 for TOC). Differences in residual protein were not significant between brushes (analysis of variance F = 0.3844; P = 0.7647), whereas significant differences in residual TOC were found (Kruskal-Wallis H = 36.31; P < 0.000001), although all values remained below the alert level. Under worst-case conditions, between-brush differences increased for residual protein (H = 19.42; P = 0.0002) and residual TOC (H = 15.73; P = 0.0013). The Steris brush remained below the alert level for both protein (mean 1.20 μg/cm2) and TOC (mean 1.99 μg/cm2), whereas the Boston Scientific brush exceeded the action level for protein (mean 7.11 μg/cm2).
Conclusion:
Under recommended-use conditions, all tested brushes achieved residual protein and TOC levels below the predefined alert levels. Under degraded-use conditions, performance differences became more pronounced. These findings support the importance of adherence to manufacturers' IFU.
