The risk of cross-contamination related to inadequate disinfection of a reusable endoscope during cleaning, rinsing, leak testing or drying phases is well documented in the literature.(1) The design of the devices makes reconditioning complicated and expensive. In fact, following disinfection, a biofilm can still form, particularly when the device has diﬃcult-to-detect micro-cracks.
Due to the complexity of the devices and the presence of micro-cracks in the working channel related to the introduction of instruments, bacteria can become established and collect there. Then, they form a biofilm in the micro-cracks, which becomes very difficult to remove, despite very scrupulous compliance with good disinfection practices.
In this study, researchers examined 24 bronchoscopes from different sites after clinical use and manual reprocessing. Following analysis, it emerges that 100% of the devices were contaminated with residues and pathogens of different types. The study demonstrated that even when correctly followed, the procedures in place were inadequate to eliminate 100% of the pathogens present. It concludes with a recommendation to tighten up disinfection requirements.(2)
Risk of residual cross-contamination after decontamination of a bronchoscope following the guidellness
Risk of patient developing an infection following the use of a contaminateds reusable broncoscope
Additional cost of treatment per patient having contracted VAP
When the risk of developing VAP in a ventilated patient is multiplied by the risk of residual contamination of an endoscope, an infection risk of 0.007% per procedure is obtained. This risk related to the cost of treating VAP leads to an estimated cost of $178 per procedure for the treatment of cross-contamination according to this study.(3)
The main objective of reprocessing guidelines is care safety optimization in order to strive towards infection zero risk for patients and health care staff.
Attention is also paid to the characteristics of disinfectants used daily, in terms of toxicity, precautions for use, protection of personnel, measures to take in case of exposure and environmental risk.
Flow chart for endoscope reprocessing:
Single-use bronchoscopes do not require disinfection, manual cleaning or leak testing
Single-use bronchoscopes do not require scope-compatible reprocessing equipment
Single-use bronchoscopes do not house accumalation of biofilm
The new abstract from Dr Garret, presented at the CHEST 2021 annual meeting, shown that hospitals using single-use bronchoscopes can reduce potential acquisition of healthcare-associated infections.(7)
The data analysis demonstrates that on a total of 14,228 procedures identified, using reusable bronchoscopes can lead to a risk of
readmission of ~2.3 times more than a single-use device.
Single-use bronchoscopes participate to prevent readmission which may lead to financials penalties back to the hospitals.
Multiple studies concerning contamination of reusable endoscopes have been published. Pulmonology studies continue to demonstrate higher than expected contamination rates.
In addition to contamination studies, numerous performance studies comparing single-use and reusable endoscopes have been published, showing great results for single-use. Due to the Covid-19 pandemic several societies have published recommendations and guidelines.
References to read:
(1) Pajkos et al. Is biofilm accumulation on endoscope tubing a contributor to the failure of cleaning and decontamination? Journal of Hospital Infection (2004), 58, 224-229
(2) Journal of Hospital Infection (2004), 58, 224-229
(3) Terjesen, Christoffer Lilja et al. “Early Assessment of the Likely Cost Effectiveness of Single-Use Flexible Video Bronchoscopes” PharmacoEconomics – open vol. 1,2 (2017): 133-141.»
(12) Leidraad infectiepreventiemaatregelen KNO-zorg tijdens COVID-19 pandemie.pdf