FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W2106050473> ?p ?o ?g. }

• W2106050473 endingPage "854" @default.
• W2106050473 startingPage "853" @default.
• W2106050473 abstract "We are writing this to bring to attention the important but often overlooked problem of delayed reprocessing of endoscopes. Guidelines by different gastroenterology associations recommend that trained staff reprocess endoscopes immediately after use.1American Society for Gastrointestinal EndoscopyMulti-society guideline for reprocessing flexible gastrointestinal endoscopes.Gastrointest Endosc. 2003; 58: 1-8Abstract Full Text Full Text PDF PubMed Scopus (41) Google Scholar, 2Nelson D. Jarvis W. Rutala W. et al.Society for Healthcare Epidemiology of AmericaMulti-society guideline for reprocessing flexible gastrointestinal endoscopes.Infect Control Hosp Epidemiol. 2003; 24: 532-537Crossref PubMed Scopus (87) Google Scholar, 3Society of Gastroenterology Nurses and AssociatesStandards of infection control in reprocessing of flexible gastrointestinal endoscopes.Gastroenterol Nurs. 2000; 23: 172-187Crossref PubMed Scopus (34) Google Scholar Allowing the endoscope to sit idle and soiled for hours before being reprocessed would, therefore, appear to be inconsistent with guidelines and could pose an increased risk of disease transmission and result in endoscope damage. Although there are no prospective published studies, the presence of biofilms in the internal channels of the endoscopes may pose an increased risk of infection transmission.4Alfa M.J. Howie R. Modeling microbial survival in buildup biofilm for complex medical devices.BMC Infect Dis. 2009; 9: 56Crossref PubMed Scopus (38) Google Scholar, 5Pajkos A. Vickery K. Cossart Y. Is biofilm accumulation on endoscope tubing a contributor to the failure of cleaning and decontamination?.J Hosp Infect. 2004; 58: 224-229Abstract Full Text Full Text PDF PubMed Scopus (143) Google Scholar, 6Muscarella L.F. Evaluation of the risk of transmission of bacterial biofilms and Clostridium difficile during gastrointestinal endoscopy.Gastroenterol Nurs. 2010; 33: 28-35Crossref PubMed Scopus (11) Google ScholarDelays in reprocessing usually occur when endoscopies are performed at night or over a weekend, and the endoscopes are left for proper reprocessing by regular staff the next business day. In these situations, the initial cleaning of the endoscopes is usually performed by gastroenterology fellows who are usually inadequately trained to thoroughly perform all of the steps in endoscope reprocessing, ie, precleaning, leak testing, mechanical cleaning, sterilization and/or disinfection, and storage. An unpublished personal survey of gastroenterology fellows who had performed endoscope reprocessing revealed a wide range of practices and poor understanding of the importance of different steps. Although most of them performed precleaning and mechanical cleaning, there were differences in subsequent handling of endoscopes. Some left the endoscopes soaked in water, detergent, or disinfectant, some left the endoscopes in the sink without water, and some left the endoscope hanging to dry. Furthermore, proper leak testing and cleaning of channels of endoscopes were infrequent. Few loaded the automated reprocessors and left the endoscopes there. Depending on when the procedure was performed, the time to repeated reprocessing could be a few hours to more than a day.The relevant question then is: “What is the preferred strategy in delayed reprocessing?” The only recommendation available for gastroenterology endoscopes is: “If precleaning is not initiated within an hour, the endoscope should be soaked in an appropriate enzymatic detergent according to the manufacturer's recommendations before continuing with mechanical cleaning and then terminal reprocessing.”7Catalone B. Koos G. Avoiding reprocessing errors critical for infection prevention and control.http://www.olympusamerica.com/msg_section/files/mic0605p74.pdfDate: 2005Google Scholar However, this recommendation is not clear and has practical limitations. For example, the duration of the soak period is not mentioned, and the importance of flushing of the channels with the detergent is not clearly stated. Review of the data and personal communication with the companies suggest that the extended soak period should be 2 to 5 hours but ≤10 hours. The extended soak period adds a few extra hours to the processing time—an unpleasant task when being performed after-hours or on weekends. So either this step is skipped altogether, often allowing debris to harden on the endoscope's external surfaces and inside its channels, raising the chance of disinfection failure, or the endoscopes are left soaked until they are reprocessed the next day. Soaks longer than the recommended time may result in increased bioburden, potential biofilm formation, and moisture damage of the endoscope (especially if the endoscope was not first leak tested).4Alfa M.J. Howie R. Modeling microbial survival in buildup biofilm for complex medical devices.BMC Infect Dis. 2009; 9: 56Crossref PubMed Scopus (38) Google Scholar, 8Muscarella L.F. Inconsistencies in endoscope-reprocessing and infection-control guidelines: the importance of endoscope drying.Am J Gastroenterol. 2006; 101: 2147-2154Crossref PubMed Scopus (87) Google Scholar A similar problem may be encountered if the endoscopes are left coiled in the sink, which interferes with the drying of the endoscope channels.It is understandable that there are no guidelines on delayed endoscope reprocessing, because it is not an optimal method and no organizations to date have endorsed it. But this is also a real-world scenario, and some recommendations should be made. Every effort should be made to get trained staff to completely reprocess the endoscopes immediately after the procedure. If the gastroenterology fellows are required to reprocess the endoscopes, rigorous training (including watching the training videos and reprocessing under supervision every few weeks) should be established and documented as part of a complete quality assurance program. We propose that immediately after every procedure, precleaning of the endoscope be performed in the procedure room (in accordance with the endoscope manufacturer's instructions) followed by prompt leak testing and mechanical cleaning (detergent use, channel brushings, channel reprocessing, cleaning accessories, water rinsing) in the reprocessing area. Studies indicate that mechanical cleaning alone can reduce the bioburden by an average of 3 to 4 logs (−99.999%).9Martiny H. Floss H. Zuhlsdorf B. The importance of cleaning for the overall results of processing endoscopes.J Hosp Infect. 2004; 56: S16-S22Abstract Full Text Full Text PDF PubMed Scopus (36) Google ScholarThe importance of leak testing before soaking should be emphasized to prevent more severe damage to the endoscope. Only detergents specifically recommended and formulated for soaking gastroenterology endoscopes should be used. Aldehyde-containing solutions are recommended only for high-level disinfection and not for soaking. If used for soaking, they may cause cross-linking of proteins, with biofilm formation, making subsequent cleaning of endoscopes even more difficult.4 The practice of soaking the used endoscopes in an appropriate detergent longer than the recommended time (eg, overnight) also can increase rather than reduce the microbial load and hinder the subsequent disinfection process.4 Therefore, endoscopy units should be careful about prolonged soaking of endoscopes and should specifically first check with the endoscope manufacturer.In conclusion, delayed reprocessing is a reality in need of evidence-based guidelines. We recommend and await a consensus statement by gastroenterology societies regarding the practice of delayed reprocessing. We are writing this to bring to attention the important but often overlooked problem of delayed reprocessing of endoscopes. Guidelines by different gastroenterology associations recommend that trained staff reprocess endoscopes immediately after use.1American Society for Gastrointestinal EndoscopyMulti-society guideline for reprocessing flexible gastrointestinal endoscopes.Gastrointest Endosc. 2003; 58: 1-8Abstract Full Text Full Text PDF PubMed Scopus (41) Google Scholar, 2Nelson D. Jarvis W. Rutala W. et al.Society for Healthcare Epidemiology of AmericaMulti-society guideline for reprocessing flexible gastrointestinal endoscopes.Infect Control Hosp Epidemiol. 2003; 24: 532-537Crossref PubMed Scopus (87) Google Scholar, 3Society of Gastroenterology Nurses and AssociatesStandards of infection control in reprocessing of flexible gastrointestinal endoscopes.Gastroenterol Nurs. 2000; 23: 172-187Crossref PubMed Scopus (34) Google Scholar Allowing the endoscope to sit idle and soiled for hours before being reprocessed would, therefore, appear to be inconsistent with guidelines and could pose an increased risk of disease transmission and result in endoscope damage. Although there are no prospective published studies, the presence of biofilms in the internal channels of the endoscopes may pose an increased risk of infection transmission.4Alfa M.J. Howie R. Modeling microbial survival in buildup biofilm for complex medical devices.BMC Infect Dis. 2009; 9: 56Crossref PubMed Scopus (38) Google Scholar, 5Pajkos A. Vickery K. Cossart Y. Is biofilm accumulation on endoscope tubing a contributor to the failure of cleaning and decontamination?.J Hosp Infect. 2004; 58: 224-229Abstract Full Text Full Text PDF PubMed Scopus (143) Google Scholar, 6Muscarella L.F. Evaluation of the risk of transmission of bacterial biofilms and Clostridium difficile during gastrointestinal endoscopy.Gastroenterol Nurs. 2010; 33: 28-35Crossref PubMed Scopus (11) Google Scholar Delays in reprocessing usually occur when endoscopies are performed at night or over a weekend, and the endoscopes are left for proper reprocessing by regular staff the next business day. In these situations, the initial cleaning of the endoscopes is usually performed by gastroenterology fellows who are usually inadequately trained to thoroughly perform all of the steps in endoscope reprocessing, ie, precleaning, leak testing, mechanical cleaning, sterilization and/or disinfection, and storage. An unpublished personal survey of gastroenterology fellows who had performed endoscope reprocessing revealed a wide range of practices and poor understanding of the importance of different steps. Although most of them performed precleaning and mechanical cleaning, there were differences in subsequent handling of endoscopes. Some left the endoscopes soaked in water, detergent, or disinfectant, some left the endoscopes in the sink without water, and some left the endoscope hanging to dry. Furthermore, proper leak testing and cleaning of channels of endoscopes were infrequent. Few loaded the automated reprocessors and left the endoscopes there. Depending on when the procedure was performed, the time to repeated reprocessing could be a few hours to more than a day. The relevant question then is: “What is the preferred strategy in delayed reprocessing?” The only recommendation available for gastroenterology endoscopes is: “If precleaning is not initiated within an hour, the endoscope should be soaked in an appropriate enzymatic detergent according to the manufacturer's recommendations before continuing with mechanical cleaning and then terminal reprocessing.”7Catalone B. Koos G. Avoiding reprocessing errors critical for infection prevention and control.http://www.olympusamerica.com/msg_section/files/mic0605p74.pdfDate: 2005Google Scholar However, this recommendation is not clear and has practical limitations. For example, the duration of the soak period is not mentioned, and the importance of flushing of the channels with the detergent is not clearly stated. Review of the data and personal communication with the companies suggest that the extended soak period should be 2 to 5 hours but ≤10 hours. The extended soak period adds a few extra hours to the processing time—an unpleasant task when being performed after-hours or on weekends. So either this step is skipped altogether, often allowing debris to harden on the endoscope's external surfaces and inside its channels, raising the chance of disinfection failure, or the endoscopes are left soaked until they are reprocessed the next day. Soaks longer than the recommended time may result in increased bioburden, potential biofilm formation, and moisture damage of the endoscope (especially if the endoscope was not first leak tested).4Alfa M.J. Howie R. Modeling microbial survival in buildup biofilm for complex medical devices.BMC Infect Dis. 2009; 9: 56Crossref PubMed Scopus (38) Google Scholar, 8Muscarella L.F. Inconsistencies in endoscope-reprocessing and infection-control guidelines: the importance of endoscope drying.Am J Gastroenterol. 2006; 101: 2147-2154Crossref PubMed Scopus (87) Google Scholar A similar problem may be encountered if the endoscopes are left coiled in the sink, which interferes with the drying of the endoscope channels. It is understandable that there are no guidelines on delayed endoscope reprocessing, because it is not an optimal method and no organizations to date have endorsed it. But this is also a real-world scenario, and some recommendations should be made. Every effort should be made to get trained staff to completely reprocess the endoscopes immediately after the procedure. If the gastroenterology fellows are required to reprocess the endoscopes, rigorous training (including watching the training videos and reprocessing under supervision every few weeks) should be established and documented as part of a complete quality assurance program. We propose that immediately after every procedure, precleaning of the endoscope be performed in the procedure room (in accordance with the endoscope manufacturer's instructions) followed by prompt leak testing and mechanical cleaning (detergent use, channel brushings, channel reprocessing, cleaning accessories, water rinsing) in the reprocessing area. Studies indicate that mechanical cleaning alone can reduce the bioburden by an average of 3 to 4 logs (−99.999%).9Martiny H. Floss H. Zuhlsdorf B. The importance of cleaning for the overall results of processing endoscopes.J Hosp Infect. 2004; 56: S16-S22Abstract Full Text Full Text PDF PubMed Scopus (36) Google Scholar The importance of leak testing before soaking should be emphasized to prevent more severe damage to the endoscope. Only detergents specifically recommended and formulated for soaking gastroenterology endoscopes should be used. Aldehyde-containing solutions are recommended only for high-level disinfection and not for soaking. If used for soaking, they may cause cross-linking of proteins, with biofilm formation, making subsequent cleaning of endoscopes even more difficult.4 The practice of soaking the used endoscopes in an appropriate detergent longer than the recommended time (eg, overnight) also can increase rather than reduce the microbial load and hinder the subsequent disinfection process.4 Therefore, endoscopy units should be careful about prolonged soaking of endoscopes and should specifically first check with the endoscope manufacturer. In conclusion, delayed reprocessing is a reality in need of evidence-based guidelines. We recommend and await a consensus statement by gastroenterology societies regarding the practice of delayed reprocessing." @default.
• W2106050473 created "2016-06-24" @default.
• W2106050473 creator A5004142982 @default.
• W2106050473 creator A5084313199 @default.
• W2106050473 date "2011-04-01" @default.
• W2106050473 modified "2023-10-01" @default.
• W2106050473 title "Delayed reprocessing of endoscopes" @default.
• W2106050473 cites W1982446798 @default.
• W2106050473 cites W2013323596 @default.
• W2106050473 cites W2042317685 @default.
• W2106050473 cites W2049478836 @default.
• W2106050473 cites W2079068297 @default.
• W2106050473 cites W2084235320 @default.
• W2106050473 cites W4244839861 @default.
• W2106050473 doi "https://doi.org/10.1016/j.gie.2010.09.028" @default.
• W2106050473 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/21457830" @default.
• W2106050473 hasPublicationYear "2011" @default.
• W2106050473 type Work @default.
• W2106050473 sameAs 2106050473 @default.
• W2106050473 citedByCount "9" @default.
• W2106050473 countsByYear W21060504732012 @default.
• W2106050473 countsByYear W21060504732013 @default.
• W2106050473 countsByYear W21060504732014 @default.
• W2106050473 countsByYear W21060504732015 @default.
• W2106050473 countsByYear W21060504732016 @default.
• W2106050473 countsByYear W21060504732019 @default.
• W2106050473 countsByYear W21060504732023 @default.
• W2106050473 crossrefType "journal-article" @default.
• W2106050473 hasAuthorship W2106050473A5004142982 @default.
• W2106050473 hasAuthorship W2106050473A5084313199 @default.
• W2106050473 hasBestOaLocation W21060504731 @default.
• W2106050473 hasConcept C19527891 @default.
• W2106050473 hasConcept C61434518 @default.
• W2106050473 hasConcept C71924100 @default.
• W2106050473 hasConceptScore W2106050473C19527891 @default.
• W2106050473 hasConceptScore W2106050473C61434518 @default.
• W2106050473 hasConceptScore W2106050473C71924100 @default.
• W2106050473 hasIssue "4" @default.
• W2106050473 hasLocation W21060504731 @default.
• W2106050473 hasLocation W21060504732 @default.
• W2106050473 hasOpenAccess W2106050473 @default.
• W2106050473 hasPrimaryLocation W21060504731 @default.
• W2106050473 hasRelatedWork W1946354434 @default.
• W2106050473 hasRelatedWork W2019250753 @default.
• W2106050473 hasRelatedWork W2102644969 @default.
• W2106050473 hasRelatedWork W2109699640 @default.
• W2106050473 hasRelatedWork W2370073206 @default.
• W2106050473 hasRelatedWork W2922159997 @default.
• W2106050473 hasRelatedWork W2967287585 @default.
• W2106050473 hasRelatedWork W3208701539 @default.
• W2106050473 hasRelatedWork W4313346385 @default.
• W2106050473 hasRelatedWork W4317816533 @default.
• W2106050473 hasVolume "73" @default.
• W2106050473 isParatext "false" @default.
• W2106050473 isRetracted "false" @default.
• W2106050473 magId "2106050473" @default.
• W2106050473 workType "article" @default.