Longitudinal assessment of reprocessing effectiveness for colonoscopes and gastroscopes: Results of visual inspections, biochemical markers, and microbial cultures.
BACKGROUND
Flexible endoscopes are currently reused following cleaning and high-level disinfection. Contamination has been found on endoscopes, and infections have been linked to gastrointestinal, respiratory, and urologic endoscopes.


METHODS
This longitudinal study involved visual inspections with a borescope, microbial cultures, and biochemical tests for protein and adenosine triphosphate to identify endoscopes in need of further cleaning or maintenance. Three assessments were conducted over a 7-month period. Control group endoscopes reprocessed using customary practices were compared with intervention group endoscopes subjected to more rigorous reprocessing.


RESULTS
At final assessment, all endoscopes (N = 20) had visible irregularities. Researchers observed fluid (95%), discoloration, and debris in channels. Of 12 (60%) endoscopes with microbial growth, 4 had no growth until after 48 hours. There were no significant differences in culture results by study group, assessment period, or endoscope type. Similar proportions of control and intervention endoscopes (~20%) exceeded postcleaning biochemical test benchmarks. Adenosine triphosphate levels were higher for gastroscopes than colonoscopes (P = .014). Eighty-five percent of endoscopes required repair due to findings.


CONCLUSIONS
More rigorous reprocessing was not consistently effective. Seven-day incubation allowed identification of slow-growing microbes. These findings bolster the need for routine visual inspection and cleaning verification tests recommended in new reprocessing guidelines.
Ofstead & Associates, Inc, Saint Paul, MN. Electronic address: cori@ofsteadinsights.com.
Cori L
CL
Ofstead
Ofstead & Associates, Inc, Saint Paul, MN.
Harry P
HP
Wetzler
Ofstead & Associates, Inc, Saint Paul, MN.
Otis L
OL
Heymann
Ofstead & Associates, Inc, Saint Paul, MN.
Ellen A
EA
Johnson
Ofstead & Associates, Inc, Saint Paul, MN.
John E
JE
Eiland
Division of Gastroenterology, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN.
Michael J
MJ
Shaw
D000255:Adenosine Triphosphate / Q000032:analysis; D015415:Biomarkers; D020685:Colonoscopes; D003666:Decontamination / Q000379:methods*; D004203:Disinfection / Q000379:methods*; D004866:Equipment Contamination; D017743:Equipment Reuse; D020699:Gastroscopes; D006801:Humans; D008137:Longitudinal Studies; D011446:Prospective Studies; D011506:Proteins / Q000032:analysis
D015415:Biomarkers; D011506:Proteins; D000255:Adenosine Triphosphate
Adenosine triphosphate; Endoscope; Epidemiology