title: High-level endoscope disinfection processes in emerging economies: financial impact of manual process versus automated endoscope reprocessing.
abstract: BACKGROUND
  The use of flexible endoscopes is growing rapidly around the world. Dominant approaches to high-level disinfection among resource-constrained countries include fully manual cleaning and disinfection and the use of automated endoscope reprocessors (AERs). Suboptimal reprocessing at any step can potentially lead to contamination, with consequences to patients and healthcare systems.
  
  
  OBJECTIVE
  To compare the potential results of guideline-recommended AERs to manual disinfection along three dimensions - productivity, need for endoscope repair, and infection transmission risk in India, China, and Russia.
  
  
  METHODS
  Financial modelling using data from peer-reviewed published literature and country-specific market research.
  
  
  RESULTS
  In countries where revenue can be gained through productivity improvements, conversion to automated reprocessing has a positive direct impact on financial performance, paying back the capital investment within 14 months in China and seven months in Russia. In India, AER-generated savings and revenue offset nearly all of the additional operating costs needed to support automated reprocessing.
  
  
  CONCLUSIONS
  Among endoscopy facilities in India and China, current survey-reported practices in endoscope reprocessing using manual soaking may place patients at risk of exposure to pathogens leading to infections. Conversion from manual soak to use of AERs, as recommended by the World Gastroenterology Organization, may generate cost and revenue offsets that could produce direct financial gains for some endoscopy units in Russia and China.
authors.affiliation: Strategic Health Resources, La Canada, CA, USA.
authors.forename: S E
authors.initials: SE
authors.lastname: Funk
authors.affiliation: Strategic Health Resources, La Canada, CA, USA. Electronic address: nancy.reaven@strathealth.com.
authors.forename: N L
authors.initials: NL
authors.lastname: Reaven
mesh_terms: D001331:Automation / Q000191:economics / Q000379:methods; D002681:China; D003666:Decontamination / Q000191:economics* / Q000379:methods*; D003906:Developing Countries; D004203:Disinfection / Q000191:economics* / Q000379:methods*; D019723:Endoscopes; D017048:Health Care Costs; D006801:Humans; D007194:India; D012426:Russia
keywords: Automatic endoscope reprocessor; Decontamination; Disinfection; Endoscopes; Infection control