title: Manual versus automated methods for cleaning reusable accessory devices used for minimally invasive surgical procedures.
abstract: We undertook a simulated-use study using quantitative methods to evaluate the cleaning efficacy of ported and non-ported accessory devices used in minimally invasive surgery. We chose laparoscopic scissors and forceps to represent worst-case devices which were inoculated with artificial test soil containing 10(6) cfu/mL Enterococcus faecalis and Geobacillus stearothermophilus and allowed to dry for 1 h. Cleaning was performed manually, as well as by the automated SI-Auto Narrow lumen cleaner. Manual cleaning left two- to 50-fold more soil residuals (protein, haemoglobin and carbohydrate) inside the lumen of non-ported versus ported laparoscopic accessory devices. The SI-Auto Narrow lumen cleaner was more efficient than manual cleaning and achieved >99% reduction in soil parameters in both non-ported (using retro-flushing) and ported laparoscopic devices. Only the automated cleaning of ported devices achieved 10(3)-10(4)-fold reduction in bacterial numbers. Sonication alone (no flushing of inner channel) did not effectively remove soil or organisms from the inner channel. Our findings indicate that non-ported accessory devices cannot be as reliably cleaned as ported devices regardless of the cleaning method used. If non-ported accessory devices are reprocessed, they should be cleaned using retro-flushing in an automated narrow lumen cleaner.
authors.affiliation: St Boniface General Hospital and University of Manitoba, Winnipeg, Manitoba, Canada. malfa@sbgh.mb.ca
authors.forename: M J
authors.initials: MJ
authors.lastname: Alfa
authors.forename: R
authors.initials: R
authors.lastname: Nemes
mesh_terms: D001331:Automation; D013293:Enterococcus faecalis; D004866:Equipment Contamination / Q000517:prevention & control*; D017743:Equipment Reuse; D001411:Geobacillus stearothermophilus; D006801:Humans; D010535:Laparoscopy; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation*; D012988:Soil Microbiology; D013242:Sterilization / Q000295:instrumentation / Q000379:methods*; D013525:Surgical Instruments / Q000382:microbiology*