Persistent residual contamination in endoscope channels; a fluorescence epimicroscopy study

Hervé, R.; Keevil, C. W.

doi:10.1055/s-0042-105744

Cited by 31 publications

(25 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…(10,11) Endoscope disinfection failure may also be due to the gradual accumulation of organic soils and wear on the surfaces of endoscope channels resulting in reduced exposure of bacteria to biocide and subsequent biofilm formation on endoscope channels. (10,12,13) There are evidences that bacterial species can form biofilm in endsocope lumens. (10,14,15) Biofilm formation can also occur within an endoscope reprocessor due to faults in it, or inadequate preventative maintenance for the unit.…”

Section: Introductionmentioning

confidence: 99%

Tolerance of Pseudomonas aeruginosa in in-vitro biofilms to high-level peracetic acid disinfection

Akinbobola

Sherry

Mckay

et al. 2017

Journal of Hospital Infection

View full text Add to dashboard Cite

show abstract

Section: Introductionmentioning

confidence: 99%

Tolerance of Pseudomonas aeruginosa in in-vitro biofilms to high-level peracetic acid disinfection

Akinbobola

Sherry

Mckay

et al. 2017

Journal of Hospital Infection

View full text Add to dashboard Cite

show abstract

“…Nine studies 183,[191][192][193][194][195][196][197][198] reported this outcome after autoclaving with and without other decontamination processes (Table 18): seven studies [192][193][194][195][196][197][198] for surgical instruments and two studies for endoscopes. 183,191 All studies were conducted in the UK. Seven studies 183,[193][194][195][196][197][198] reported on protein residue on instruments acquired between one and nine NHS trusts; the number of trusts involved was not reported in two studies.…”

Section: Clinical Evidencementioning

confidence: 99%

“…Seven studies 183,[193][194][195][196][197][198] reported on protein residue on instruments acquired between one and nine NHS trusts; the number of trusts involved was not reported in two studies. 191,192 All studies reported that cleaning essentially involved conventional procedures for the equipment concerned. With the exception of two studies, 192,193 the assay appears to have involved detection of protein in situ on the instruments.…”

Section: Clinical Evidencementioning

confidence: 99%

See 1 more Smart Citation

Interventions to reduce the risk of surgically transmitted Creutzfeldt–Jakob disease: a cost-effective modelling review

Stevenson

Uttley

Oakley

et al. 2020

Health Technol Assess

View full text Add to dashboard Cite

Background Creutzfeldt–Jakob disease is a fatal neurological disease caused by abnormal infectious proteins called prions. Prions that are present on surgical instruments cannot be completely deactivated; therefore, patients who are subsequently operated on using these instruments may become infected. This can result in surgically transmitted Creutzfeldt–Jakob disease. Objective To update literature reviews, consultation with experts and economic modelling published in 2006, and to provide the cost-effectiveness of strategies to reduce the risk of surgically transmitted Creutzfeldt–Jakob disease. Methods Eight systematic reviews were undertaken for clinical parameters. One review of cost-effectiveness was undertaken. Electronic databases including MEDLINE and EMBASE were searched from 2005 to 2017. Expert elicitation sessions were undertaken. An advisory committee, convened by the National Institute for Health and Care Excellence to produce guidance, provided an additional source of information. A mathematical model was updated focusing on brain and posterior eye surgery and neuroendoscopy. The model simulated both patients and instrument sets. Assuming that there were potentially 15 cases of surgically transmitted Creutzfeldt–Jakob disease between 2005 and 2018, approximate Bayesian computation was used to obtain samples from the posterior distribution of the model parameters to generate results. Heuristics were used to improve computational efficiency. The modelling conformed to the National Institute for Health and Care Excellence reference case. The strategies evaluated included neither keeping instruments moist nor prohibiting set migration; ensuring that instruments were kept moist; prohibiting instrument migration between sets; and employing single-use instruments. Threshold analyses were undertaken to establish prices at which single-use sets or completely effective decontamination solutions would be cost-effective. Results A total of 169 papers were identified for the clinical review. The evidence from published literature was not deemed sufficiently strong to take precedence over the distributions obtained from expert elicitation. Forty-eight papers were identified in the review of cost-effectiveness. The previous modelling structure was revised to add the possibility of misclassifying surgically transmitted Creutzfeldt–Jakob disease as another neurodegenerative disease, and assuming that all patients were susceptible to infection. Keeping instruments moist was estimated to reduce the risk of surgically transmitted Creutzfeldt–Jakob disease cases and associated costs. Based on probabilistic sensitivity analyses, keeping instruments moist was estimated to on average result in 2.36 (range 0–47) surgically transmitted Creutzfeldt–Jakob disease cases (across England) caused by infection occurring between 2019 and 2023. Prohibiting set migration or employing single-use instruments reduced the estimated risk of surgically transmitted Creutzfeldt–Jakob disease cases further, but at considerable cost. The estimated costs per quality-adjusted life-year gained of these strategies in addition to keeping instruments moist were in excess of £1M. It was estimated that single-use instrument sets (currently £350–500) or completely effective cleaning solutions would need to cost approximately £12 per patient to be cost-effective using a £30,000 per quality-adjusted life-year gained value. Limitations As no direct published evidence to implicate surgery as a cause of Creutzfeldt–Jakob disease has been found since 2005, the estimations of potential cases from elicitation are still speculative. A particular source of uncertainty was in the number of potential surgically transmitted Creutzfeldt–Jakob disease cases that may have occurred between 2005 and 2018. Conclusions Keeping instruments moist is estimated to reduce the risk of surgically transmitted Creutzfeldt–Jakob disease cases and associated costs. Further surgical management strategies can reduce the risks of surgically transmitted Creutzfeldt–Jakob disease but have considerable associated costs. Study registration This study is registered as PROSPERO CRD42017071807. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 11. See the NIHR Journals Library website for further project information.

show abstract

“…The recent outbreaks of bacterial infections involving reusable medical devices resulted in increased scrutiny of reprocessing protocols for such devices . Several research and clinical studies have assessed reprocessing related issues in reusable devices such as arthroscopic shavers, needleless injectors, biopsy forceps, suction tips, laryngoscopic blades, surgical instruments, anesthetic devices, and endoscopes . Preventing cross‐infection between patients is essential for reusable devices; therefore, the reprocessing protocol must ensure sufficient decontamination of the devices before reuse.…”

Section: Introductionmentioning

confidence: 99%

A test method to assess the contribution of fluid shear stress to the cleaning of reusable device surfaces

et al. 2018

View full text Add to dashboard Cite

Adequate cleaning of reusable medical devices is critical for preventing cross-infection among patients. For reusable medical devices, cleaning using mechanical brushes and detergent may not be sufficient to completely remove the infectious contaminants from the surfaces. This study evaluates the role of fluid flow-induced shear stress in the detachment and removal of contaminants from device surfaces. A stainless-steel test coupon, acting as a surrogate for a device surface, was coated with artificial clot of varying mass. The test coupon was exposed to fluid shear stress both with and without an enzymatic detergent. The relationship between clot removal quantity and the applied shear stress was obtained for multiple clot masses. Our results showed that fluid shear increased the effectiveness of the cleaning process. In the absence of flow, soaking the clot surface in the enzymatic detergent removed 67%, 77%, and 95% of the clot for 16 mg, 6.8 mg, and 1 mg initial masses, respectively. In the presence of fluid shear (0.3 Pa for 5 min), approximately 85%, 97%, and 99% of the clot was removed from the surface. The clot mass removed followed a linear relationship (R = 0.98) versus the applied fluid shear stress. This study showed that different cleaning processes such as fluid shear and detergent action contribute to the soil removal process. This method could be used to evaluate cleaning protocols for minimizing contaminant residue after the reprocessing of medical devices.

show abstract

Persistent residual contamination in endoscope channels; a fluorescence epimicroscopy study

Cited by 31 publications

References 26 publications

Tolerance of Pseudomonas aeruginosa in in-vitro biofilms to high-level peracetic acid disinfection

Tolerance of Pseudomonas aeruginosa in in-vitro biofilms to high-level peracetic acid disinfection

Interventions to reduce the risk of surgically transmitted Creutzfeldt–Jakob disease: a cost-effective modelling review

A test method to assess the contribution of fluid shear stress to the cleaning of reusable device surfaces

Contact Info

Product

Resources

About