Endoscope Reprocessing: 3 Reasons Your Endoscope Manual Cleaning Practices Are Failing

The complexity and advancements in flexible endoscopes designs have expanded our preventative and diagnostic care in healthcare today, but it hasn’t been without challenges and strain, especially on our sterile processing and endoscope reprocessing teams.

Ofstead & Associates consolidated and released summarized data this past quarter that showed yet another increase in MAUDE database reporting on flexible endoscope adverse events in 2024 Q3¹. Findings also suggest that flexible endoscopes are ranked as the highest risk factor for healthcare associated infections compared to other semi-critical medical devices³ (Benowitz, 2020).

As the professionals who are responsible for reprocessing flexible endoscopes, it is crucial to understand the “why”: what are the challenges and reasons failures happen in our reprocessing cycle? Understanding these challenges and identifying opportunities to address them positively supports our teams and improves preventative and diagnostic care in our healthcare facilities.

Reason #1: Obscured or Overlooked Damage

Flexible endoscopes, just like any other medical device, are subject to generalized wear and tear. Long working channels are a challenge to not only clean but also inspect for quality cleaning measures. Bends, scratches and other imperfections within the channel wall can lend to biofilm formation; undetected bioburden can often be passed over with just a traditional bristled brush.

Consequently, we learn that brush bristles or elastomer discs alone cannot effectively clean and adapt to each channel condition. One material over the other is also a contributor to effectiveness. A validation study has shown that a combination of bristles and squeegee methods provides a more comprehensive and repeatable clean in flexible endoscope channels.

Additionally, what can appear as a small “imperfection” can prove to be costly, from loose parts and cracks to damaged seals, each one has the potential to harbor bacterial, viral or fungal growth resulting in cross contamination and pathogenic transmission.

Reason #2: Biofilm

Biofilm can formulate within minutes under the right conditions. Biofilm poses a risk not only patient safety, but also the ability to effectively clean and disinfect our medical devices. Biofilms are directly linked to hospital acquired infections (HAI) and surgical site infections (SSI) with originating sources that include medical devices⁴ (Milliard et al, 2023).

It has also been long understood that despite close adherence to endoscope manufacturer instructions for use (MIFU), there are still risks of biofilm and pathogen transmission relating to outbreak⁴ (Benowitz, 2020). This lends to the fact that despite improved efforts to reduce complications, there is still gaps in the process to consider.

Reason #3: Education, Competency & Situational Awareness

Education has many arms in medical device reprocessing, some of which include:

• Standards-based reprocessing practices
• Flexible endoscopy knowledge
  • Scope anatomy
  • Scope functions & use
  • Manufacturer IFU
• Reprocessing equipment & supply knowledge
• Outbreak awareness, study results and reporting

Awareness, competency and evaluation not only justify the need for robust reprocessing, but also the empowerment of our professionals to understand the weight and impact of their role. Providing resources to extend their knowledge and awareness may improve performance, but truesustainable advancements come in a two-part form that also includes resources and tools necessary to achieve quality outcomes.

Reprocessing failures are being identified as more than a failure to comply with all steps in a process. Failures in the manual cleaning process can lend to the survival of pathogens even after the disinfection of flexible endoscopes⁵ (Kenters, 2015). There are many contributing factors including damage, drug-resistant biofilm, and inadequate instructions for use.

As we become aware of the larger picture and the full scope (pun intended) of what it takes to safely and effectively reprocess endoscopes, it is our responsibility to perform the due diligence to improve and correct practices for the safety of our teams and our patients.

Interested in digging further into endoscope manual cleaning? Check out:  Endoscope Manual Cleaning: The Challenges that Impact Our Effectiveness

References:

1. https://www.linkedin.com/company/ofstead-&-associates-inc.?trk=public_post_embed_feed-actor-image
2. Ofstead CL, Buro BL, Hopkins KM, Eiland JE, Wetzler HP, Lichtenstein DR. Duodenoscope-associated infection prevention: A call for evidence-based decision making. Endosc Int Open. 2020 Dec;8(12):E1769-E1781. doi: 10.1055/a-1264-7173. Epub 2020 Nov 17. PMID: 33269310; PMCID: PMC7671768.
3. Benowitz I, Moulton-Meissner HA, Epstein L, Arduino MJ. The Centers for Disease Control and Prevention Guidance on Flexible Gastrointestinal Endoscopes: Lessons Learned from Outbreaks, Infection Control. Gastrointest Endosc Clin N Am. 2020 Oct;30(4):723-733. doi: 10.1016/j.giec.2020.06.009. Epub 2020 Aug 1. PMID: 32891228; PMCID: PMC7962740.
4. Maillard JY, Centeleghe I. How biofilm changes our understanding of cleaning and disinfection. Antimicrob Resist Infect Control. 2023 Sep 7;12(1):95. doi: 10.1186/s13756-023-01290-4. PMID: 37679831; PMCID: PMC10483709.
5. Kenters N, Huijskens EG, Meier C, Voss A. Infectious diseases linked to cross-contamination of flexible endoscopes. Endosc Int Open. 2015 Aug;3(4):E259-65. doi: 10.1055/s-0034-1392099. PMID: 26355428; PMCID: PMC4554517.
6. https://www.linkedin.com/company/ofstead-&-associates-inc.?trk=public_post_embed_feed-actor-image