Healthcare Hygiene magazine November 2019

blue lint was observed on cabinet floors, and technicians could not recall the last time they cleaned the cabinets. ATP tests were completed for at least one cabinet at each site. ATP levels in storage cabinets at all three sites indicated residual contamination (maximum levels on cabinet door handles, interior walls, and floors at A: 898, 247, 44; B: 53, 900, 85; C: 161, 286, 4219 RLU).” The researchers add, “Although it is tempting to conclude that retained moisture was responsible for fostering microbial growth, researchers identified several variables that could have affected reprocessing outcomes. At Sites A and C, researchers observed numerous quality breaches that were unexpected given their Joint Commission accreditation and affiliations with large healthcare systems. In addition to violating several reprocessing standards, Sites A and C intentionally disabled AERs’ automated cleaning cycles because of pressure to achieve faster turnaround times. Omitting this cleaning step presumably reduced the effectiveness of HLD. Given these breaches and contamination found, both sites followed researchers’ recommendations to convene multidisciplinary teams to assess risk, determine whether patient notification was warranted, and address quality issues.” During endoscopic procedures at all sites, clinicians used silicone-containing products as lubricants and de-foaming agents (e.g., infant gas relief drops with simethicone, cooking oil sprays, and silicone sprays), which are not water soluble. En- doscope manufacturers state that these products may interfere with reprocessing effectiveness. Researchers have found that simethicone is not removed during reprocessing. The Canadian Association of Gastroenterology states that simethicone products are universally used in endoscopy; however, their use should be minimized because simethicone residues may contribute to biofilm formation and microbial growth. Scope reprocessing quality is an ongoing issue. The December 2019 issue of HHM will report on an upcoming FDA meeting examining the contaminated endoscope issue, so stay tuned for updates. References and Recommended Reading: Alfa MJ, et al. Comparison of clinically relevant benchmarks and channel sampling methods used to assess manual cleaning compli- ance for flexible gastrointestinal endoscopes. Am J Infect Control, 42. Pp. e1-e5. 2014. Alfa MJ, et al. Validation of adenosine triphosphate to audit manual cleaning of flexible endoscope channels. Am J Infect Control, 41. Pp. 245-248. 2013. Alfa MJ, et al. Establishing a clinically relevant bioburden bench- mark: a quality indicator for adequate reprocessing and storage of flexible gastrointestinal endoscopes. Am J Infect Control, 40. Pp. 233- 236. 2012. ANSI/AAMI ST91: 2015, Flexible and semi-rigid endoscope process- ing in healthcare facilities. (2015), pp. 1-70. AORN. Guideline for processing flexible endoscopes. Sterilization and disinfection. (2016), pp. 675-758. Association for the Advancement of Medical Instrumentation (AAMI). A compendium of processes, materials, test methods, and acceptance criteria for cleaning reusable medical devices. 2011. AAMI and FDA. 2011 Summit on Reprocessing: Priority Issues from the AAMI/FDA Medical Device Reprocessing Summit. Coton T, et al. New flexible endoscopes: Surprising bacteri- al colonization post-disinfection. Clin Res Hepatol Gastroenterol, 41. Pp. e63-e64. 2017. FDA. Infections associated with reprocessed flexible bronchoscopes: 24 FDA safety communication. Sept. 17, 2015. Fushimi R, et al. Comparison of adenosine triphosphate, micro- biological load, and residual protein as indicators for assessing the cleanliness of flexible gastrointestinal endoscopes. Am J Infect Control, 41. Pp. 161-164. 2013. Grein JD and Murthy RK. New Developments in the Prevention of Gastrointestinal Scope-Related Infections. Infect Dis Clin North America. Vol. 32, No. 4. Pp. 899-913. December 2018. Kovaleva J. Endoscope drying and its pitfalls. J Hosp Infect, 97. Pp. 319-328. 2017. Lichtenstein D and Alfa MJ. Cleaning and Disinfecting Gastrointesti- nal Endoscopy Equipment In: Clinical Gastrointestinal Endoscopy (Third Edition). 2019 Neves MS, et al. Effectiveness of current disinfection procedures against biofilm on contaminated GI endoscopes. Gastrointest Endosc, 83. Pp. 944-953. 2016. Ofstead C. Webinar: Conducting visual examinations of flexible endoscopes: A focus on channels and ports. 2019. Ofstead CL, Heymann OL, et al. Residual moisture and waterborne pathogens inside flexible endoscopes: Evidence from a multisite study of endoscope drying effectiveness. Am J Infect Control. Vol. 46, No. 6. Pages 689-696. June 2018. Ofstead CL, Wetzler HP, Heymann OL, Johnson EA, Eiland JE and Shaw MJ. Longitudinal assessment of reprocessing effectiveness for colonoscopes and gastroscopes: Results of visual inspections, biochem- ical markers, and microbial cultures. Am J Infect Control. Vol. 45, No. 2. Pp. e26-e33. February 2017. Ofstead CL, Wetzler HP, et al. Assessing residual contamination and damage inside flexible endoscopes over time. Am J Infect Control. 1;44(12):1675-1677. 2016. Ofstead CL, Wetzler HP, et al. Simethicone residue remains inside gastrointestinal endoscopes despite reprocessing. Am J Infect Control, 44. Pp. 1237-1240. 2016. Ofstead CL, Doyle EM, et al. Practical toolkit for monitoring endo- scope reprocessing effectiveness: Identification of viable bacteria on gastroscopes, colonoscopes, and bronchoscopes. Am J Infect Control, 44. Pp. 815-819. 2016. Ofstead CL, Wetzler HP, et al. Persistent contamination on colo- noscopes and gastroscopes detected by biologic cultures and rapid indicators despite reprocessing performed in accordance with guidelines. Am J Infect Control, 43. Pp. 794-801. 2015. Ofstead CL, Wetzler HP, Doyle EM, Rocco CK, Visrodia KH and Baron TH, et al. Persistent contamination on colonoscopes and gastroscopes detected by biologic cultures and rapid indicators despite reprocessing performed in accordance with guidelines. Am J Infect Control, 43. Pp. 794-801. 2015. Ofstead C, Tosh P, et al. Persistence of Organic Residue and Viable Microbes on Gastrointestinal Endoscopes Despite Reprocessing in Accordance with Guidelines. APIC 41st annual meeting, Anaheim, Calif. June 7-9, 2014. Ofstead CL and Dirlam Lang AM. Re-evaluating endoscopy-associat- ed infection risk estimates and their implications. Am J Infect Control. 41. Pp. 734-6. 2013. Rex DK, et al. A double-reprocessing high-level disinfection protocol does not eliminate positive cultures from the elevators of duodenos- copes. Endoscopy. Dec 13, 2017. Ribeiro MM, et al. Effectiveness of flexible gastrointestinal endo- scope reprocessing. Infect Control Hosp Epidemiol, 34. Pp. 309-312. 2013. Rubin ZA and Murthy RK. Outbreaks associated with duodeno- scopes: new challenges and controversies. Curr Opin Infect Dis, 29. Pp. 407-414. 2016. Rutala WA and Weber DJ. Gastrointestinal endoscopes: a need to shift from disinfection to sterilization? JAMA, 312. Pp. 1405-1406. 2014. Saliou P, et al. Measures to improve microbial quality surveillance of gastrointestinal endoscopes. Endoscopy, 48. Pp. 704. 2016. SGNA. Standards of infection prevention in reprocessing flexible gastrointestinal endoscopes. (2015), pp. 1-31. Snyder GM, Wright SB, et al. Randomized comparison of 3 high-lev- el disinfection and sterilization procedures for duodenoscopes. Gastroen- terology, 153. Pp. 1018-1025. 2017. Visrodia K, et al. Duodenoscope reprocessing surveillance with ad- enosine triphosphate testing and terminal cultures: A clinical pilot study. Gastrointest Endosc, 86. Pp. 180-186. 2017. november 2019 • www.healthcarehygienemagazine.com

Healthcare Hygiene magazine November 2019 | Page 24