Cleaning of in-hospital flexible endoscopes: Limitations and challenges.
Rosilaine Aparecida da Silva Madureira, Adriana Cristina de Oliveira
PMID 36287399WHAT IT FOUND
Endoscopes in eight Brazilian hospitals were frequently contaminated after cleaning.
Single-diameter brushes were used in 63.6% of devices, and 25% of stored scopes grew microorganisms, including resistant bacteria and mycobacteria.
Key findings
01Friction of channels with single-diameter brushes occurred in 63.6% of endoscopes, failing to match brush size to channel diameter.
02Microbial growth was detected in 25% of samples from stored endoscopes and 32% of samples from endoscopes after processing.
03Protein residues were found in 33.3% of sampled duodenoscope elevator channels after cleaning, specifically in devices where the elevator channel was not subjected to friction.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study was conducted during the COVID-19 pandemic, which reduced the number of participating services from eighteen identified to eight. Observation of the cleaning process may have induced a Hawthorne effect, where staff performed better than usual because they were being watched, potentially underestimating the true failure rate in routine practice. The study focused only on pre-cleaning and cleaning stages, not the full disinfection and storage cycle.
Declared interests
No specific funding source or conflicts of interest were explicitly detailed in the provided text, though ethical approval was obtained from the UFMG Ethics Committee.
The easy way to misread this
Do not assume that a negative ATP test means an endoscope is safe. This study found that ATP tests can miss non-viable cells and do not detect the physical residues that harbor biofilms, which were present in many devices despite standard monitoring.