title: The use of rapid indicators for the detection of organic residues on clinically used gastrointestinal endoscopes with and without visually apparent debris.
abstract: BACKGROUND
  Outbreaks of multidrug-resistant organisms have been linked to endoscope reprocessing lapses. Meticulous manual cleaning before high-level disinfection (HLD) is essential in reducing residual contamination that can interfere with HLD. Current reprocessing guidelines state that visual inspection is sufficient to confirm adequate cleaning.
  
  
  OBJECTIVE
  Our aim was to evaluate contamination of clinically used endoscopes, using visual inspection and rapid indicator tests before and after manual cleaning. A second objective was to determine which rapid indicator instruments and methods could be used for quality improvement initiatives in endoscope reprocessing.
  
  
  METHODS
  Clinical use study of endoscope reprocessing effectiveness.
  
  
  METHODS
  Tertiary care teaching hospital with an inpatient endoscopy center.
  
  
  METHODS
  Researchers sampled endoscopes used for gastrointestinal procedures before and after manual cleaning. The external surfaces and 1 channel of each endoscope were visually inspected and tested with rapid indicators to measure protein, blood, and adenosine triphosphate (ATP) contamination levels.
  
  
  RESULTS
  Multiple components were sampled during 37 encounters with 12 unique endoscopes. All bedside-cleaned endoscopes had high levels of ATP and detectable blood or protein, whether or not any residue was visible. Although there was no visible residue on any endoscopes after manual cleaning, 82% had at least 1 positive rapid indicator test.
  
  
  CONCLUSIONS
  Relying solely on visual inspection of endoscopes prior to HLD is insufficient to ensure reprocessing effectiveness. For quality assurance initiatives, tests of different endoscope components using more than 1 indicator may be necessary. Additional research is needed to validate specific monitoring protocols.
authors.affiliation: Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota.
authors.forename: Kavel H
authors.initials: KH
authors.lastname: Visrodia
authors.forename: Cori L
authors.initials: CL
authors.lastname: Ofstead
authors.forename: Hannah L
authors.initials: HL
authors.lastname: Yellin
authors.forename: Harry P
authors.initials: HP
authors.lastname: Wetzler
authors.forename: Pritish K
authors.initials: PK
authors.lastname: Tosh
authors.forename: Todd H
authors.initials: TH
authors.lastname: Baron
mesh_terms: D000255:Adenosine Triphosphate / Q000032:analysis; D001769:Blood; D003428:Cross Infection / Q000517:prevention & control; D004203:Disinfection / Q000379:methods; D020776:Endoscopes, Gastrointestinal / Q000382:microbiology / Q000592:standards*; D004866:Equipment Contamination / Q000517:prevention & control; D006801:Humans; D011506:Proteins / Q000032:analysis; D011785:Quality Assurance, Health Care; D062606:Tertiary Care Centers
chemical_list: D011506:Proteins; D000255:Adenosine Triphosphate