The objective of this descriptive study was to identify the physical, chemical and biological controls of the sterilization process by saturated steam in Pasteur autoclaves at Material and Sterilization Centers (MSC). The data was obtained by interviewing the worker responsible for the MSC of the largest hospital in every city in the interior of Goiás that had population of at least 20,000, in the period from August 2005 to June 2006. A total 44 municipalities participated. The analysis was performed using SPSS software. In 31 (94.0%) hospitals there were no nurses exclusive to the MSC, the workers responsible for the center were nursing aides and technicians. Most did not perform any physical, chemical and biological control of the sterilization process, and, in one case only these controls were performed simultaneously. Failing to monitor the sterilization cycles, and thus not ensuring the quality of the processes, is a risk to the population being assisted.

Objective: Assess the accumulation of protein and biofilm on the inner surfaces of new flexible gastroscope (FG) channels after 30 and 60 days of patient use and full reprocessing. Design: Clinical use study of biofilm accumulation in FG channels. Setting: Endoscopy service of a public hospital. Methods: First, we tested an FG in clinical use before the implementation of a revised reprocessing protocol (phase 1 baseline; n = 1). After replacement of the channels by new ones and the implementation of the protocol, 3 FGs were tested after 30 days of clinical use (phase 2; n = 3) and 3 FGs were tested after 60 days of clinical use (phase 3; n = 3), and the same FGs were tested in phase 2 and 3. Their biopsy, air, water, and air/water junction channels were removed and subjected to protein testing (n = 21), bacteriological culture (n = 21), and scanning electron microscopy (SEM) (n = 28). Air–water junction channels fragments were subjected to SEM only. Results: For the FGs, the average number of uses and reprocessing cycles was 60 times. Extensive biofilm was detected in air, water, and air–water junction channels (n = 18 of 28). All channels (28 of 28) showed residual matter, and structural damage was identified in most of them (20 of 28). Residual protein was detected in the air and water channels of all FG evaluated (phases 1–3), except for 1 air channel from phase 2. Bacteria were recovered from 8 of 21 channels, most air or water channels. Conclusions: The short time before damage and biofilm accumulation in the channels was evident and suggests that improving the endoscope design is necessary. Better reprocessing methods and channel maintenance are needed.

Avaliação arquitetônica dos centros de material e esterilização de hospitais do interior do estado de GoiásEvaluation architectural of the central supply of hospitals from towns in the state of Goiás Evaluación arquitectónica de los centros de material y esterilización de hospitales del interior del estado de Goiás

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Objetivo: Descrever a experiência da utilização de metodologia problematizadora para qualificação da equipe de enfermagem na implementação de um protocolo de processamento de endoscópios. Método: Protocolo com base em evidências e avaliado por especialistas. Na implementação, utilizou-se a metodologia problematizadora, com enfoque nas etapas do Arco de Maguerez, em três semanas, no serviço de endoscopia de um hospital de ensino. Conclusão: O método permitiu a troca de experiência entre a equipe, construção de novos conhecimentos, motivação para a padronização dos processos de trabalho e melhoria da qualidade do serviço, além de maior autonomia na busca de soluções para os próprios problemas.

Background and AimForced‐air drying (FAD) cabinets are recommended for storage of reprocessed endoscopes, but financial constraints prevent their universal application. The study aimed to determine bacterial contamination in flexible gastroscopes (FG) channels after storage, in a cabinet with filtered air and UV lights, but without FAD.MethodsEight FG in clinical use in an endoscopy service of a large Brazilian hospital were sampled: immediately “Time zero” (N = 50), 12 h “Time 1” (N = 25), and 60 h “Time 2” (N = 25) after reprocessing. Following a flush‐brush‐flush of channels, 40‐mL sterile water and 3 cm of the brush were collected. Each sample was divided, filtered onto two 0.22‐μm membranes, and incubated in media without or with disinfectant neutralizer. Automated method was used for identification and antibiotic resistance test of isolated bacteria.ResultsBacterial contamination in times “1” and “2” was 5.9 and 16.1 times greater than that of “Time zero,” respectively. Number of positive cultures in media with and without neutralizer was similar at times “1” and “2,” while media with neutralizer produced more positive cultures at “Time zero.” Most bacteria isolated at “Time 2” were Gram‐negative rods (52.3%) and showed resistance to one or more antibiotics (65%).ConclusionBacterial contamination was detected on reprocessed FG stored in non‐FAD cabinets overnight (12 h) and increased with longer storage time (60 h). The contamination source is likely to be bacteria in biofilm which multiply in the absence of FAD. Evidence‐based criteria should be available for storage time according to the cabinet available.

Background Flexible endoscopes are complex-design reusable devices, with long and narrow channels, making reprocessing difficult. Biofilm formation is a key factor for persistent contamination, as it protects microorganism against cleaning and disinfection agents. The aim of this study was to assess the accumulation of biofilm on the inner surfaces of new flexible gastroscope channels after 30 days of patient-use and full reprocessing. Methods Three flexible gastroscopes (FG) (GIF–Q150, OlympusTM) with new internal channels (TeflonTM) were subjected to 30 days of clinical use and reprocessing by trained nursing personnel, using a revised reprocessing protocol, at the endoscopy service of a Brazilian teaching hospital (235 beds). The reprocessing protocol included: pre-cleaning; manual cleaning; automated cleaning and disinfection - 2% Glutaraldehyde; manual drying (forced-air drying) and alcohol rinsing, and storage in vertical position in exclusive cabinets. Then, internal channels were removed from the three patient-ready FG (three biopsy, three air, three water and three air/water junction channels), and the inner surface subjected to bacteriological culture (~30 cm) (n=9) and Scanning Electron Microscopy (SEM) (~1 cm) (n=12). Air/water junctions (~1 cm) were subjected to SEM only. Results The average of use/reprocessing of the FG was 60 times. Bacterial growth was detected in 6/9 channels (three from FG#1 showed residual moisture) and seven bacterial isolates were recovered, most from air or water channels (Fig 1). Inner surface structural damage was identified in 11/12 channels by SEM. Extensive biofilm was detected in air, water and air/water junction channels (7/12) (Fig 2). Residuals matter were detected in all channels (12/12). Fig 1. Distribution of bacterial growth and genera/species identified in new flexible gastroscope channels after 30 days of patient-use and reprocessing at the endoscopy service of a large Brazilian teaching hospital. *FG1: flexible gastroscope nº1 **FG2: flexible gastroscope nº2 ***FG3: flexible gastroscope nº3 ¥Moisture was visually detected inside the channels during longitudinal cutting for SEM. Fig 2. Scanning Electron Micrographs showing extensive biofilm, containing bacilli/rods and/or cocci shape bacteria, on the inner surface of new flexible gastroscope channels after 30 days of patient-use and reprocessing at the endoscopy service of a large Brazilian teaching hospital. *FG1: flexible gastroscope nº1 **FG2: flexible gastroscope nº2 ***FG3: flexible gastroscope nº3 Conclusion The short timeframe before damage and biofilm accumulation in the channels were evident and suggests that improving endoscope design is necessary, while better reprocessing methods and channel maintenance needs to be investigated in detail. Improving design, maintenance and reprocessing of endoscopes will ensure safe use of these devices. Disclosures Michelle J. Alfa, B.Sc., M.Sc., Ph.D, Healthmark (Consultant, Other Financial or Material Support, Royalty monies from University of Manitoba that are provided through a License agreement with Healthmark)Kikkoman (Consultant)Olympus (Consultant, Advisor or Review Panel member, Speaker’s Bureau)STERIS (Consultant, Speaker’s Bureau)