Worst-case soiling levels for patient-used flexible endoscopes before and after cleaning☆☆☆★★★

Reply to Petersen

“…Even though cultures were not employed in this study, it should be noted that residual contamination within endoscope suction/biopsy channels after manual cleaning was assessed using previously microbiologically validated cutoffs for protein, hemoglobin, and ATP. 7,8 Alfa et al 7 established benchmarks for protein, hemoglobin, and bioburden to verify that clinically used endoscopes have been adequately manually cleaned. These benchmarks were used in a simulated-use study with artificial test soil to validate ATP levels in relative light units (RLUs).…”

“…7,13 The tests detected potentially significant contamination that otherwise would not have been identified, given the currently recommended practice of visual inspection. As ongoing studies attempt to define optimal methods for assessing cleanliness, we maintain that rapid indicator tests could be used to detect persistent contamination that should be absent prior to high-level disinfection.…”

ERCP Scopes: What Can We Do to Prevent Infections?

“…Studies have shown that the internal channel of GI endoscopes, including duodenoscopes, may contain 10 7-10 (7-10 log 10 ) enteric microorganisms. 12,13 Investigations have demonstrated that the cleaning step in endoscope reprocessing results in a 2-6 log 10 reduction of microbes and that the HLD step results in another 4-6 log 10 reduction of mycobacteria for a total 6-12 log 10 reduction of microbes. [12][13][14] Thus, the margin of safety associated with cleaning and HLD of GI endoscopes is minimal or nonexistent (level of contamination: 4 log 10 [maximum contamination, minimal cleaning/HLD] to -5 log 10 [minimum contamination, maximum cleaning/HLD]).…”

“…12,13 Investigations have demonstrated that the cleaning step in endoscope reprocessing results in a 2-6 log 10 reduction of microbes and that the HLD step results in another 4-6 log 10 reduction of mycobacteria for a total 6-12 log 10 reduction of microbes. [12][13][14] Thus, the margin of safety associated with cleaning and HLD of GI endoscopes is minimal or nonexistent (level of contamination: 4 log 10 [maximum contamination, minimal cleaning/HLD] to -5 log 10 [minimum contamination, maximum cleaning/HLD]). Therefore, any deviation from proper reprocessing (eg, in crevices associated with the elevator channel) could lead to failure to eliminate contamination with a possibility of subsequent patient-to-patient transmission.…”

O impacto da fricção, solução de limpeza e subsequente desinfecção de alto nível na remoção de biofilme buildup-5 e de biofilme tradicional-5 em canais endoscópicos gastrointestinais flexíveis

“…Após a realização dos exames de endoscopia gastrointestinal, os endoscópios tornam-se contaminados, interna e externamente, por bactérias, fungos e vírus das hepatites B e C (Chu, MCalister, Antonoplos, 1998;Alfa, DeGagne, Olson, 1999;Alfa et al, 2002;Ishino, Ido, Sugano, 2005;Obee et al, 2005;e Barbosa, 2008). A carga microbiana pode variar de 10 3 a 10 10 unidades formadoras de colônias por mililitro -UFC/ml (Chu, MCalister, Antonoplos, 1998;Chu, Favero, 2000;e Machado et al, 2006 (Rejchrt et al, 2004;Lee et al, 2004;Machado et al, 2006;Vergis et al, 2007;Barbosa, 2008;Ribeiro et al, 2013) e RNA do vírus da hepatite C (Bisset et al, 2006).…”