Sterilization of endoscopic instruments

Sabnis, Ravindra; Bhattu, Amit Satish; Vijaykumar, Mohankumar

doi:10.1097/mou.0000000000000034

Cited by 31 publications

(18 citation statements)

References 3 publications

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“…In the era of high prevalence of HIV and hepatitis B virus,[56] as the miniprobe enters sterile tissues, it must be sterilized according to the regulatory requirements for disinfection. [78910] However, the nCLE miniprobe is sensitive to hot temperatures, acidity, alkalinity, and oxidates, limiting the options for sterilization. The immersion of instruments in microbicidal fluids, such as glutaraldehyde, takes 10 h and can be detrimental to fine instruments.…”

Section: Discussionmentioning

confidence: 99%

Is the Stella™ 5L system an effective cold sterilization technique for needle-based confocal miniprobes?

et al. 2017

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Background and Objective:Needle-based confocal laser endomicroscopy (nCLE) under endoscopic ultrasound guidance is a newly developed imaging technique for pancreatic lesions and lymph nodes, enabling a subcellular level of resolution. The confocal miniprobe is an invasive instrument designed to be reused up to 10 times. Therefore, a method that ensures the complete elimination of microbial contaminants on the device is necessary. We studied the bactericidal efficacy of the Stella™ system, which purports to achieve this objective.Materials and Methods:The surfaces of three nCLE miniprobes were contaminated with suspensions of Bacillus atrophaeus (ATCC9372). One probe was randomly selected to count the bacterial load on the surface. The other two probes were manually cleaned and rinsed. One probe was randomly selected to count bacteria on the surface, and the other probe was sterilized using the Stella™ 5L endoscopic sterilization system before obtaining the bacterial count. The process was repeated for 20 cycles to evaluate the microbicidal efficacy of the Stella™ 5L endoscopic sterilization system. These miniprobes were immersed in the Stella Fuse disinfectant for 72 h. After the 72 h of immersion, the weight loss of probes was determined using a high precision electronic scale to examine corrosion following disinfection. The change in image quality was evaluated by an endoscopist.Results:From an initial contamination level of 4.48 × 106 ± 1.57 × 106 cfu/mL on the surface of the probes, the bacterial count was reduced to 4.25 × 102 ± 1.95 × 102 cfu/mL after manual cleaning (including enzyme washing), and no microorganisms were recovered after 20 cycles with the Stella™ 5L system. The probe weights before and after 72 h of immersion were 45.769 (45.768–45.771) g and 45.762 (45.752–45.768) g, respectively. No change in image quality was observed.Conclusion:This study shows that the Stella™ 5L system is capable of the complete elimination of microorganism contamination in a short period and avoids the toxicity of typical disinfectants. It is a safe, cheap, and efficient sterilization approach that provides a new option for nCLE miniprobe sterilization.

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Section: Discussionmentioning

confidence: 99%

Is the Stella™ 5L system an effective cold sterilization technique for needle-based confocal miniprobes?

et al. 2017

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“…Furthermore, existing endoscopes using chip cameras can be sterilized by autoclave, ethylene oxide (EtO), or STERRAD. 72 …”

Section: Discussionmentioning

confidence: 99%

A multiport MR-compatible neuroendoscope: spanning the gap between rigid and flexible scopes

Manjila

Mencattelli

Rosa

et al. 2016

FOC

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OBJECTIVE Rigid endoscopes enable minimally invasive access to the ventricular system; however, the operative field is limited to the instrument tip, necessitating rotation of the entire instrument and causing consequent tissue compression while reaching around corners. Although flexible endoscopes offer tip steerability to address this limitation, they are more difficult to control and provide fewer and smaller working channels. A middle ground between these instruments—a rigid endoscope that possesses multiple instrument ports (for example, one at the tip and one on the side)—is proposed in this article, and a prototype device is evaluated in the context of a third ventricular colloid cyst resection combined with septostomy. METHODS A prototype neuroendoscope was designed and fabricated to include 2 optical ports, one located at the instrument tip and one located laterally. Each optical port includes its own complementary metal-oxide semiconductor (CMOS) chip camera, light-emitting diode (LED) illumination, and working channels. The tip port incorporates a clear silicone optical window that provides 2 additional features. First, for enhanced safety during tool insertion, instruments can be initially seen inside the window before they extend from the scope tip. Second, the compliant tip can be pressed against tissue to enable visualization even in a blood-filled field. These capabilities were tested in fresh porcine brains. The image quality of the multiport endoscope was evaluated using test targets positioned at clinically relevant distances from each imaging port, comparing it with those of clinical rigid and flexible neuroendoscopes. Human cadaver testing was used to demonstrate third ventricular colloid cyst phantom resection through the tip port and a septostomy performed through the lateral port. To extend its utility in the treatment of periventricular tumors using MR-guided laser therapy, the device was designed to be MR compatible. Its functionality and compatibility inside a 3-T clinical scanner were also tested in a brain from a freshly euthanized female pig. RESULTS Testing in porcine brains confirmed the multiport endoscope's ability to visualize tissue in a blood-filled field and to operate inside a 3-T MRI scanner. Cadaver testing confirmed the device's utility in operating through both of its ports and performing combined third ventricular colloid cyst resection and septostomy with an endoscope rotation of less than 5°. CONCLUSIONS The proposed design provides freedom in selecting both the number and orientation of imaging and instrument ports, which can be customized for each ventricular pathological entity. The lightweight, easily manipulated device can provide added steerability while reducing the potential for the serious brain distortion that happens with rigid endoscope navigation. This capability would be particularly valuable in treating hydrocephalus, both primary and secondary (due to tumors, cysts, and so forth). Magnetic resonance compatibility can aid in endoscope-assisted ventricular aqueductal plasty and stenting, the management of multiloculated complex hydrocephalus, and postinflammatory hydrocephalus in which scarring obscures the ventricular anatomy.

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“…Ethylene oxide gas sterilization is a toxic and carcinogenic process, requiring additional time for a post-sterilization aeration period. 8 Hydrogen peroxide gas plasma sterilization also has a long processing time, is expensive, and can be corrosive to certain materials. Neither of these methods protects against prions.…”

Section: Featurementioning

confidence: 99%

“…Neither of these methods protects against prions. 8 The advent of antibiotic resistant bacteria such as CRE and deadly viruses requires that cleaning standards be continuously improved. Just about every invasive instrument we use is sterilized better than the endoscope.…”

Section: Featurementioning

confidence: 99%

“…5 The disinfectant must be potent enough to remove contaminants, yet gentle enough to preserve the integrity of the instrument, since a disinfectant that is too concentrated may decrease the life span of the instrument. 8 The scope is then rinsed, dried, and stored. 5 The SGNA also offers several guidelines for maintaining the cleaning reprocessing environment to help make reprocessing as effective as possible.…”

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confidence: 99%

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A 21st century nosocomial issue with endoscopes

Noronha¹,

Brozak²

2014

BMJ

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On 3 January 2014 the results of a year long investigation by the US Centers for Disease Control (CDC) into an outbreak of New Delhi metallo-β-lactamase (NDM)-producing carbapenem resistant Enterobacteriaceae (CRE) were released. Of 69 patients with confirmed CRE infections, 29 went to Advocate Lutheran General Hospital (ALGH) for the same procedure-an endoscopy. 1 The endoscopy itself is not dangerous, but the current cleaning process used between procedures leaves patients susceptible to infection and troubles many healthcare practitioners.With more than 18.6 million gastrointestinal endoscopies and at least a half million bronchoscopies every year in the US alone, 2 medical practitioners must take the utmost care during the cleaning process between patients, especially with the emergence of superbugs such as CRE. But the safety profiles of the cleaning protocols are less than acceptable in preventing life threatening outbreaks. The endoscopes are frequently the means for facilitating pathogenic cross contamination between patients-making the case at ALGH far from unique.The threat of cross contamination may not be visible to a clinician from personal experience alone, but broader and more comprehensive studies show that the cleanliness of endoscopes varies greatly. A mid 2013 study reported that about 15% of endoscopes in US hospitals failed to achieve an accepted standard of cleanliness after liquid reprocessing (the prevailing disinfection process used between patient procedures). 3 In this study, duodenoscopes were the dirtiest at a 30% contamination rate, and colonoscopes were the cleanest at a 3% contamination rate. 3

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Sterilization of endoscopic instruments

Abstract: If appropriate sterilization methods are adopted, then it not only will protect patients from procedure-related infections but prevent hypersensitive allergic reactions. It will also protect instruments from damage and increase its longevity.

Cited by 31 publications

References 3 publications

Is the Stella™ 5L system an effective cold sterilization technique for needle-based confocal miniprobes?

Is the Stella™ 5L system an effective cold sterilization technique for needle-based confocal miniprobes?

A multiport MR-compatible neuroendoscope: spanning the gap between rigid and flexible scopes

A 21st century nosocomial issue with endoscopes

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