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Ensure proper use of reprocessing machines
Infection control professionals should watch for outbreaks linked to inadequately reprocessed bronchoscopes or other flexible endoscopes, public health authorities warn. A public health advisory on the potential hazard recently was issued jointly by the Centers for Disease Control and Prevention and the Food and Drug Administration (FDA).
The alert follows recent reports of patient-to-patient pathogen transmission after procedures using bronchoscopes that were designed to be reprocessed. However, they were inadequately reprocessed in an automated endoscope reprocessor (AER).1 Investigation of the incidents revealed inconsistencies between reprocessing instructions provided by the manufacturer of the bronchoscope and the manufacturer of the AER. Also, some bronchoscopes were reprocessed inadequately when inappropriate channel connectors were used with the AER.
"Be sure that all staff who handle soiled endoscopes comply with the endoscope manufacturer’s instructions for cleaning of the endoscope," the agencies advise. "It is imperative that your staff flush all endoscopes immediately following the procedure. In addition, they should meticulously remove any debris or residuals collected in or on the endoscope, perform leak tests, and visually inspect the endoscope to ensure that it is in proper working order in accordance with the endoscope manufacturer’s recommendations. These steps are critical regardless of whether your facility manually reprocesses endoscopes or uses an AER."
Other recommendations include checking with endoscope manufacturers to determine whether the devices can be reprocessed in an AER and whether specific steps need to be taken to do so. For example, the elevator-wire-channel of most duodenoscopes cannot be accessed by the AER and requires manual reprocessing. Regardless of whether you manually reprocess your endoscope or use an AER, consider incorporating a final drying step in the reprocessing protocol. Studies indicate that flushing all channels with alcohol followed by purging the channels with air (to remove the alcohol) greatly reduces the possibility of recontamination of the endoscope by waterborne microorganisms, the advisory states.
Be sure your facility’s instructions for preparing endoscopes for patient contact are appropriate and your staff are adhering to these instructions. That includes confirming that you have the correct version of the instructions applicable to your AER for the specific endoscope models used at your facility. Copies of written, device-specific instructions for every endoscope model and reprocessing system you use should be distributed to reprocessing staff.
The advisory can be found on the Internet at www.fda.gov/cdrh/safety.html.
1. Centers for Disease Control and Prevention. Bronchoscopy-related infections and pseudoinfections — New York, 1996 and 1998. MMWR 1999; 48:557-560.