title: Manual methods are suboptimal compared with automated methods for cleaning of single-use biopsy forceps.
abstract: OBJECTIVE
  Most reusable biopsy forceps and all of the currently available single-use biopsy forceps do not have a port that allows fluid flow down the inner tubular shaft of the device. Reusable biopsy forceps are widely used and reprocessed in healthcare facilities, and single-use biopsy forceps are reprocessed either in-house (eg, in Canada and Japan) or by third-party reprocessors (eg, in the United States). The objective of this study was to determine the cleaning efficacy of automated narrow-lumen sonic irrigation cleaning, sonication-only cleaning, and manual cleaning for biopsy forceps.
  
  
  METHODS
  A simulated-use study was performed by inoculating the inner channel of single-use biopsy forceps with artificial test soil containing both Enterococcus faecalis and Geobacillus stearothermophilus at concentrations of 10(6) colony-forming units per milliliter. The cleaning methods evaluated were manual cleaning, sonication-only cleaning, and "retroflush" cleaning by an automated narrow-lumen irrigator. Bioburden and organic soil reduction after washing was evaluated. Forceps used in biopsies of patients were also tested to determine the worst-case soiling levels.
  
  
  RESULTS
  Only retroflush irrigation cleaning could effectively remove material from within the shaft portion of the biopsy forceps: it achieved an average reduction of more than 95% in levels of protein, hemoglobin, carbohydrate, and endotoxin. However, even this method of cleaning was not totally effective, as only a 2 log10 reduction in bioburden could be achieved, and there were low residual levels of hemoglobin and carbohydrate.
  
  
  CONCLUSIONS
  The data from this evaluation indicate that manual and sonication-only cleaning methods for biopsy forceps were totally ineffective in removing material from within the biopsy forceps. Even the use of retroflush cleaning was not totally effective. These findings suggest that in-hospital reprocessing of biopsy forceps with currently available equipment and cleaning methods is suboptimal.
authors.affiliation: Department of Medical Microbiology and Infectious Diseases, St. Boniface Research Centre, St. Boniface General Hospital, 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
authors.forename: N
authors.initials: N
authors.lastname: Olson
authors.forename: A
authors.initials: A
authors.lastname: Mulaire
mesh_terms: D001331:Automation; D001706:Biopsy; D003428:Cross Infection / Q000517:prevention & control; D003666:Decontamination / Q000379:methods* / Q000592:standards; D004209:Disposable Equipment; D004866:Equipment Contamination / Q000517:prevention & control*; D017743:Equipment Reuse; D006801:Humans; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation*; D013242:Sterilization / Q000295:instrumentation / Q000379:methods*; D013525:Surgical Instruments / Q000706:statistics & numerical data