Bronchoscope Reprocessing and the Value of Visualization
Main Article Content
Abstract
Purpose of Review: Bronchoscopy related infection is recognized as a leading cause of healthcare hazard and this review delves into its incidence, causes and prevention. Summary: The risk of infection and contamination of endoscopes is well known. Current guidelines recommend that experts perform regular audits to ensure sufficient reprocessing practices. Borescopes have a role to play in endoscope reprocessing by allowing thorough visual inspection, ensuring effective cleaning, and reducing the risk of cross- contamination. However, a greater understanding of what types of defects can be tolerated without raising infection risk and which require the endoscope to be repaired before use.
Article Details
How to Cite
YUROSKO, Christopher; AMLANI, Karan; MEHTA, Atul.
Bronchoscope Reprocessing and the Value of Visualization.
Medical Research Archives, [S.l.], v. 12, n. 8, aug. 2024.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/5487>. Date accessed: 06 sep. 2024.
doi: https://doi.org/10.18103/mra.v12i8.5487.
Section
Review Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
1. Bardossy A, Novosad S, Perkins K, Moulton-Meissner HA, Arduino M, Benowitz I. Bronchoscope-Related Outbreaks and Pseudo-Outbreaks: CDC Consultations—United States, 2014–2019. Infect Control Hosp Epidemiol. 2020;41(S1):s144-s144. doi:10.1017/ice.2020.660
2. Ofstead CL, Quick MR, Wetzler HP, et al. Effectiveness of Reprocessing for Flexible Bronchoscopes and Endobronchial Ultrasound Bronchoscopes. Chest. 2018;154(5):1024-1034. doi:10.1016/j.chest.2018.04.045
3. Wendt C, Kampf B. Evidence-based spectrum of antimicrobial activity for disinfection of bronchoscopes. J Hosp Infect. 2008;70 Suppl 1:60-68. doi:10.1016/S0195-6701(08)60014-6
4. Machado AP, Pimenta ATM, Contijo PP, Geocze S, Fischman O. Microbiologic profile of flexible endoscope disinfection in two Brazilian hospitals. Arq Gastroenterol. 2006;43(4):255-258. doi:10.1590/s0004-28032006000400002
5. Gillespie EE, Kotsanas D, Stuart RL. Microbiological monitoring of endoscopes: 5-year review. J Gastroenterol Hepatol. 2008;23(7 Pt 1):1069-1074. doi:10.1111/j.1440-1746.2007.05264.x
6. Gavaldà L, Olmo AR, Hernández R, et al. Microbiological monitoring of flexible bronchoscopes after high-level disinfection and flushing channels with alcohol: Results and costs. Respir Med. 2015;109(8):1079-1085. doi:10.1016/j.rmed.2015.04.015
7. Mughal MM, Minai OA, Culver DA, Mehta AC. Reprocessing the bronchoscope: the challenges. Semin Respir Crit Care Med. 2004;25(4):443-449. doi:10.1055/s-2004-832717
8. A Brief Look at ECRI Institute’s 2019 Top 10 Health Technology Hazards. J Radiol Nurs. 2019;38(1):2-4. doi:10.1016/j.jradnu.2019.01.001
9. Infections Associated with Reprocessed Flexible Bronchoscopes: FDA Safety Communication. Published September 17, 2015. Accessed April 22, 2024. https://www.fda.gov/medical-devices/medical-devices-news-and-events/fda-issues-two-warning-letters-leading-manufacturer-endoscopes
10. Andersen CØ, Travis H, Dehlholm-Lambertsen E, Russell R, Jørgensen EP. The Cost of Flexible Bronchoscopes: A Systematic Review and Meta-analysis. PharmacoEconomics - Open. 2022;6(6):787-797. doi:10.1007/s41669-022-00356-0
11. Mehta AC, Prakash UBS, Garland R, et al. American College of Chest Physicians and American Association for Bronchology [corrected] consensus statement: prevention of flexible bronchoscopy-associated infection. Chest. 2005;128(3):1742-1755. doi:10.1378/chest.128.3.1742
12. Rutala W, Weber D, Healthcare Infection Control Practices Advisory Committee (HICPAC). Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008; Miscellaneous Inactivating Agents. Published online May 2019. Accessed April 22, 2024. https://www.cdc.gov/infectioncontrol/guidelines/disinfection/index.html
13. Rutala WA, Kanamori H, Sickbert-Bennett EE, Weber DJ. What’s new in reprocessing endoscopes: Are we going to ensure “the needs of the patient come first” by shifting from disinfection to sterilization? Am J Infect Control. 2019;47S:A62-A66. doi:10.1016/j.ajic.2019.01.017
14. Rowan NJ, Kremer T, McDonnell G. A review of Spaulding’s classification system for effective cleaning, disinfection and sterilization of reusable medical devices: Viewed through a modern-day lens that will inform and enable future sustainability. Sci Total Environ. 2023;878:162976. doi:10.1016/j.scitotenv.2023.162976
15. Zweigner J, Gastmeier P, Kola A, Klefisch FR, Schweizer C, Hummel M. A carbapenem-resistant Klebsiella pneumoniae outbreak following bronchoscopy. Am J Infect Control. 2014;42(8):936-937. doi:10.1016/j.ajic.2014.04.022
16. Mehta AC, Muscarella LF. Bronchoscope-Related “Superbug” Infections. Chest. 2020;157(2):454-469. doi:10.1016/j.chest.2019.08.003
17. Culver DA, Gordon SM, Mehta AC. Infection control in the bronchoscopy suite: a review of outbreaks and guidelines for prevention. Am J Respir Crit Care Med. 2003;167(8):1050-1056. doi:10.1164/rccm.200208-797CC
18. Shellnutt C. Advances in Endoscope Reprocessing Technology and Its Impact on Pathogen Transmission. Gastroenterol Nurs Off J Soc Gastroenterol Nurses Assoc. 2016;39(6):457-465. doi:10.1097/SGA.0000000000000267
19. Yassin MH, Hariri R, Hamad Y, Ferrelli J, McKibben L, Doi Y. Disposable Bronchoscope Model for Simulating Endoscopic Reprocessing and Surveillance Cultures. Infect Control Hosp Epidemiol. 2017;38(2):136-142. doi:10.1017/ice.2016.264
20. Chhabria MS, Maldonado F, Mehta AC. Infection control in the bronchoscopy suite: effective reprocessing and disinfection of reusable bronchoscopes. Curr Opin Pulm Med. 2023;29(1):21-28. doi:10.1097/MCP.0000000000000925
21. Rojo C. The Importance of Leak Testing Flexible Endoscopes: 1.6 www.aornjournal.org/content/cme. AORN J. 2018;108(6):622-632. doi:10.1002/aorn.12425
22. Avasarala SK, Muscarella LF, Mehta AC. Sans Standardization: Effective Endoscope Reprocessing. Respiration. 2021;100(12):1208-1217. doi:10.1159/000517335
23. Barakat MT, Girotra M, Banerjee S. Initial application of deep learning to borescope detection of endoscope working channel damage and residue. Endosc Int Open. 2022;10(01):E112-E118. doi:10.1055/a-1591-0258
24. FDA-Cleared Sterilants and High Level Disinfectants with General Claims for Processing Reusable Medical and Dental Devices. Published online November 30, 2023.
25. Klacik SG. Transitioning from High-Level Disinfection to Sterilization for Semicritical Devices. Biomed Instrum Technol. 2019;53(s2):23-31. doi:10.2345/0899-8205-53.s2.23
26. Behm T, Robinson N. Sterilization Central: Drying and Storage of Flexible Endoscopes: An Area of Growing Concern. Biomed Instrum Technol. 2020;54(3):223-227. doi:10.2345/0899-8205-54.3.223
27. VerifEye 2.0 Video Borescope | STERIS. https://www.steris.com/healthcare/products/sterile-processing-department-accessories/verifeye-2-video-borescope
28. Barakat MT, Girotra M, Huang RJ, Banerjee S. Scoping the scope: endoscopic evaluation of endoscope working channels with a new high-resolution inspection endoscope (with video). Gastrointestinal Endoscopy. 2018;88(4):601-611.e1. doi:10.1016/j.gie.2018.01.018
29. Ofstead CL, Heymann OL, Quick MR, Eiland JE, Wetzler HP. Residual moisture and waterborne pathogens inside flexible endoscopes: Evidence from a multisite study of endoscope drying effectiveness. American Journal of Infection Control. 2018;46(6):689-696. doi:10.1016/j.ajic.2018.03.002
30. Visrodia K, Petersen BT. Borescope examination: Is there value in visual assessment of endoscope channels? Gastrointest Endosc. 2018;88(4):620-623. doi:10.1016/j.gie.2018.07.005
2. Ofstead CL, Quick MR, Wetzler HP, et al. Effectiveness of Reprocessing for Flexible Bronchoscopes and Endobronchial Ultrasound Bronchoscopes. Chest. 2018;154(5):1024-1034. doi:10.1016/j.chest.2018.04.045
3. Wendt C, Kampf B. Evidence-based spectrum of antimicrobial activity for disinfection of bronchoscopes. J Hosp Infect. 2008;70 Suppl 1:60-68. doi:10.1016/S0195-6701(08)60014-6
4. Machado AP, Pimenta ATM, Contijo PP, Geocze S, Fischman O. Microbiologic profile of flexible endoscope disinfection in two Brazilian hospitals. Arq Gastroenterol. 2006;43(4):255-258. doi:10.1590/s0004-28032006000400002
5. Gillespie EE, Kotsanas D, Stuart RL. Microbiological monitoring of endoscopes: 5-year review. J Gastroenterol Hepatol. 2008;23(7 Pt 1):1069-1074. doi:10.1111/j.1440-1746.2007.05264.x
6. Gavaldà L, Olmo AR, Hernández R, et al. Microbiological monitoring of flexible bronchoscopes after high-level disinfection and flushing channels with alcohol: Results and costs. Respir Med. 2015;109(8):1079-1085. doi:10.1016/j.rmed.2015.04.015
7. Mughal MM, Minai OA, Culver DA, Mehta AC. Reprocessing the bronchoscope: the challenges. Semin Respir Crit Care Med. 2004;25(4):443-449. doi:10.1055/s-2004-832717
8. A Brief Look at ECRI Institute’s 2019 Top 10 Health Technology Hazards. J Radiol Nurs. 2019;38(1):2-4. doi:10.1016/j.jradnu.2019.01.001
9. Infections Associated with Reprocessed Flexible Bronchoscopes: FDA Safety Communication. Published September 17, 2015. Accessed April 22, 2024. https://www.fda.gov/medical-devices/medical-devices-news-and-events/fda-issues-two-warning-letters-leading-manufacturer-endoscopes
10. Andersen CØ, Travis H, Dehlholm-Lambertsen E, Russell R, Jørgensen EP. The Cost of Flexible Bronchoscopes: A Systematic Review and Meta-analysis. PharmacoEconomics - Open. 2022;6(6):787-797. doi:10.1007/s41669-022-00356-0
11. Mehta AC, Prakash UBS, Garland R, et al. American College of Chest Physicians and American Association for Bronchology [corrected] consensus statement: prevention of flexible bronchoscopy-associated infection. Chest. 2005;128(3):1742-1755. doi:10.1378/chest.128.3.1742
12. Rutala W, Weber D, Healthcare Infection Control Practices Advisory Committee (HICPAC). Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008; Miscellaneous Inactivating Agents. Published online May 2019. Accessed April 22, 2024. https://www.cdc.gov/infectioncontrol/guidelines/disinfection/index.html
13. Rutala WA, Kanamori H, Sickbert-Bennett EE, Weber DJ. What’s new in reprocessing endoscopes: Are we going to ensure “the needs of the patient come first” by shifting from disinfection to sterilization? Am J Infect Control. 2019;47S:A62-A66. doi:10.1016/j.ajic.2019.01.017
14. Rowan NJ, Kremer T, McDonnell G. A review of Spaulding’s classification system for effective cleaning, disinfection and sterilization of reusable medical devices: Viewed through a modern-day lens that will inform and enable future sustainability. Sci Total Environ. 2023;878:162976. doi:10.1016/j.scitotenv.2023.162976
15. Zweigner J, Gastmeier P, Kola A, Klefisch FR, Schweizer C, Hummel M. A carbapenem-resistant Klebsiella pneumoniae outbreak following bronchoscopy. Am J Infect Control. 2014;42(8):936-937. doi:10.1016/j.ajic.2014.04.022
16. Mehta AC, Muscarella LF. Bronchoscope-Related “Superbug” Infections. Chest. 2020;157(2):454-469. doi:10.1016/j.chest.2019.08.003
17. Culver DA, Gordon SM, Mehta AC. Infection control in the bronchoscopy suite: a review of outbreaks and guidelines for prevention. Am J Respir Crit Care Med. 2003;167(8):1050-1056. doi:10.1164/rccm.200208-797CC
18. Shellnutt C. Advances in Endoscope Reprocessing Technology and Its Impact on Pathogen Transmission. Gastroenterol Nurs Off J Soc Gastroenterol Nurses Assoc. 2016;39(6):457-465. doi:10.1097/SGA.0000000000000267
19. Yassin MH, Hariri R, Hamad Y, Ferrelli J, McKibben L, Doi Y. Disposable Bronchoscope Model for Simulating Endoscopic Reprocessing and Surveillance Cultures. Infect Control Hosp Epidemiol. 2017;38(2):136-142. doi:10.1017/ice.2016.264
20. Chhabria MS, Maldonado F, Mehta AC. Infection control in the bronchoscopy suite: effective reprocessing and disinfection of reusable bronchoscopes. Curr Opin Pulm Med. 2023;29(1):21-28. doi:10.1097/MCP.0000000000000925
21. Rojo C. The Importance of Leak Testing Flexible Endoscopes: 1.6 www.aornjournal.org/content/cme. AORN J. 2018;108(6):622-632. doi:10.1002/aorn.12425
22. Avasarala SK, Muscarella LF, Mehta AC. Sans Standardization: Effective Endoscope Reprocessing. Respiration. 2021;100(12):1208-1217. doi:10.1159/000517335
23. Barakat MT, Girotra M, Banerjee S. Initial application of deep learning to borescope detection of endoscope working channel damage and residue. Endosc Int Open. 2022;10(01):E112-E118. doi:10.1055/a-1591-0258
24. FDA-Cleared Sterilants and High Level Disinfectants with General Claims for Processing Reusable Medical and Dental Devices. Published online November 30, 2023.
25. Klacik SG. Transitioning from High-Level Disinfection to Sterilization for Semicritical Devices. Biomed Instrum Technol. 2019;53(s2):23-31. doi:10.2345/0899-8205-53.s2.23
26. Behm T, Robinson N. Sterilization Central: Drying and Storage of Flexible Endoscopes: An Area of Growing Concern. Biomed Instrum Technol. 2020;54(3):223-227. doi:10.2345/0899-8205-54.3.223
27. VerifEye 2.0 Video Borescope | STERIS. https://www.steris.com/healthcare/products/sterile-processing-department-accessories/verifeye-2-video-borescope
28. Barakat MT, Girotra M, Huang RJ, Banerjee S. Scoping the scope: endoscopic evaluation of endoscope working channels with a new high-resolution inspection endoscope (with video). Gastrointestinal Endoscopy. 2018;88(4):601-611.e1. doi:10.1016/j.gie.2018.01.018
29. Ofstead CL, Heymann OL, Quick MR, Eiland JE, Wetzler HP. Residual moisture and waterborne pathogens inside flexible endoscopes: Evidence from a multisite study of endoscope drying effectiveness. American Journal of Infection Control. 2018;46(6):689-696. doi:10.1016/j.ajic.2018.03.002
30. Visrodia K, Petersen BT. Borescope examination: Is there value in visual assessment of endoscope channels? Gastrointest Endosc. 2018;88(4):620-623. doi:10.1016/j.gie.2018.07.005