Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
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Efficacy of a novel channel-cleaning ball brush for endoscope reprocessing: a randomized controlled trial

  • Kwang Hyun Chung (Division of Gastroenterology, Department of Internal Medicine, Uijeongbu Eulji Medical Center, Eulji University School of Medicine) ;
  • Jeong Don Chae (Department of Laboratory Medicine, Nowon Eulji Medical Center, Eulji University School of Medicine) ;
  • Wonho Choe (Department of Laboratory Medicine, Uijeongbu Eulji Medical Center, Eulji University School of Medicine) ;
  • Hyo Young Lee (Division of Gastroenterology, Department of Internal Medicine, Uijeongbu Eulji Medical Center, Eulji University School of Medicine) ;
  • Il Hwan Oh (Division of Gastroenterology, Department of Internal Medicine, Uijeongbu Eulji Medical Center, Eulji University School of Medicine) ;
  • Byoung Kwan Son (Division of Gastroenterology, Department of Internal Medicine, Uijeongbu Eulji Medical Center, Eulji University School of Medicine)
  • Received : 2021.07.28
  • Accepted : 2021.12.05
  • Published : 2022.09.30
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Abstract

Background/Aims: Endoscopic channels are difficult to clean and can cause infection transmission. We examined the effectiveness of a newly developed channel-cleaning ball brush (BB), which is sucked into the endoscopic channel and scrapes and cleans the lumen as it passes through. Methods: The upper and lower gastrointestinal endoscopes used for patient examinations were randomly selected as the conventional brush (CB) or BB group. After manual cleaning, the presence or absence of carbohydrates, proteins, adenosine triphosphate, and hemoglobin was assessed. Results: Fifty-six and 58 endoscopes were cleaned with the CB and BB, respectively. Carbohydrate and protein were detected in one (1.8%) and two endoscopes (3.4%) in the CB and BB groups, respectively (p=1.000). Hemoglobin was observed in one (1.8%) and three endoscopes (5.2%) in the CB and BB groups, respectively (p=0.636). The adenosine triphosphate levels were 10.6±15.9 and 12.5±14.3 relative light units in the CB and BB groups, respectively (p=0.496). Twenty-seven (48.2%) and 19 (32.8%) endoscopes were positive for microbial cultures in the CB and BB groups, respectively (p=0.136). Conclusions: The efficacy of BB was not significantly different from that of CB in the endoscopic channel-cleaning process.

Keywords

Acknowledgement

This study was funded by Silverex (Incheon, Korea).

References

  1. Epstein L, Hunter JC, Arwady MA, et al. New Delhi metallo-β-lactamase-producing carbapenem-resistant Escherichia coli associated with exposure to duodenoscopes. JAMA 2014;312:1447-1455. 
  2. Kovaleva J, Peters FT, van der Mei HC, et al. Transmission of infection by flexible gastrointestinal endoscopy and bronchoscopy. Clin Microbiol Rev 2013;26:231-254. 
  3. Spach DH, Silverstein FE, Stamm WE. Transmission of infection by gastrointestinal endoscopy and bronchoscopy. Ann Intern Med 1993;118:117-128. 
  4. McCafferty CE, Aghajani MJ, Abi-Hanna D, et al. An update on gastrointestinal endoscopy-associated infections and their contributing factors. Ann Clin Microbiol Antimicrob 2018;17:36. 
  5. Beilenhoff U, Biering H, Blum R, et al. Reprocessing of flexible endoscopes and endoscopic accessories used in gastrointestinal endoscopy: Position Statement of the European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastroenterology Nurses and Associates (ESGENA): update 2018. Endoscopy 2018;50:1205-1234. 
  6. Son BK, Kim BW, Kim WH, et al. Korean Society of Gastrointestinal Endoscopy guidelines for endoscope reprocessing. Clin Endosc 2017;50:143-147. 
  7. Reprocessing Guideline Task Force, Petersen BT, Cohen J, et al. Multisociety guideline on reprocessing flexible GI endoscopes: 2016 update. Gastrointest Endosc 2017;85:282-294.e1. 
  8. Barakat MT, Girotra M, Huang RJ, et al. Scoping the scope: endoscopic evaluation of endoscope working channels with a new high-resolution inspection endoscope (with video). Gastrointest Endosc 2018;88:601-611.e1. 
  9. Barakat MT, Huang RJ, Banerjee S. Simethicone is retained in endoscopes despite reprocessing: impact of its use on working channel fluid retention and adenosine triphosphate bioluminescence values (with video). Gastrointest Endosc 2019;89:115-123. 
  10. Otter JA, Vickery K, Walker JT, et al. Surface-attached cells, biofilms and biocide susceptibility: implications for hospital cleaning and disinfection. J Hosp Infect 2015;89:16-27. 
  11. Ren-Pei W, Hui-Jun X, Ke Q, et al. Correlation between the growth of bacterial biofilm in flexible endoscopes and endoscope reprocessing methods. Am J Infect Control 2014;42:1203-1206. 
  12. Cheung DY, Jang BI, Kim SW, et al. Multidisciplinary and multisociety practice guideline on reprocessing flexible gastrointestinal endoscopes and endoscopic accessories. Clin Endosc 2020;53:276-285.
  13. Thaker AM, Kim S, Sedarat A, et al. Inspection of endoscope instrument channels after reprocessing using a prototype borescope. Gastrointest Endosc 2018;88:612-619. 
  14. Buss AJ, Been MH, Borgers RP, et al. Endoscope disinfection and its pitfalls--requirement for retrograde surveillance cultures. Endoscopy 2008;40:327-332. 
  15. FDA/CDC/ASM Working Group on Duodenoscope Culturing. Duodenoscope surveillance sampling & culturing: reducing the risks of infection [Internet]. Atlanta (GA): Centers for Disease Control and Prevention; 2018 [cited 2021 Mar 8]. Available from: https://www.cdc.gov/hai/organisms/cre/cre-duodenoscope-surveillance-protocol.html. 
  16. ASGE Technology Committee, Komanduri S, Abu Dayyeh BK, et al. Technologies for monitoring the quality of endoscope reprocessing. Gastrointest Endosc 2014;80:369-373. 
  17. Suzuki S, Nishimoto K, Igarashi T, et al. A novel bioluminescent cycling assay for ATP and AMP using pyruvate orthophosphate dikinase. In: Stanley PE, Kricka LJ, editors. Bioluminescence and chemiluminescence. Singapore: World Scientific; 2002. p. 457-460. 
  18. Ridtitid W, Pakvisal P, Chatsuwan T, et al. Performance characteristics and optimal cut-off value of triple adenylate nucleotides test versus adenosine triphosphate test as point-of-care testing for predicting inadequacy of duodenoscope reprocessing. J Hosp Infect 2020;106:348-356. 
  19. Alrabaa SF, Nguyen P, Sanderson R, et al. Early identification and control of carbapenemase-producing Klebsiella pneumoniae, originating from contaminated endoscopic equipment. Am J Infect Control 2013;41:562-564. 
  20. Muscarella LF. Risk of transmission of carbapenem-resistant Enterobacteriaceae and related "superbugs" during gastrointestinal endoscopy. World J Gastrointest Endosc 2014;6:457-474. 
  21. Fushimi R, Takashina M, Yoshikawa H, et al. Comparison of adenosine triphosphate, microbiological load, and residual protein as indicators for assessing the cleanliness of flexible gastrointestinal endoscopes. Am J Infect Control 2013;41:161-164. 
  22. Alfa MJ, Fatima I, Olson N. Validation of adenosine triphosphate to audit manual cleaning of flexible endoscope channels. Am J Infect Control 2013;41:245-248. 
  23. Alfa MJ, Olson N. Simulated-use validation of a sponge ATP method for determining the adequacy of manual cleaning of endoscope channels. BMC Res Notes 2016;9:258. 
  24. Chu NS, McAlister D, Antonoplos PA. Natural bioburden levels detected on flexible gastrointestinal endoscopes after clinical use and manual cleaning. Gastrointest Endosc 1998;48:137-142. 
  25. Ofstead CL, Hopkins KM, Eiland JE, et al. Widespread clinical use of simethicone, insoluble lubricants, and tissue glue during endoscopy: a call to action for infection preventionists. Am J Infect Control 2019;47:666-670. 
  26. Liu TC, Peng CL, Wang HP, et al. SpyGlass application for duodenoscope working channel inspection: impact on the microbiological surveillance. World J Gastroenterol 2020;26:3767-3779. 
  27. Bhatt S, Mehta P, Chen C, et al. Efficacy of low-temperature plasma-activated gas disinfection against biofilm on contaminated GI endoscope channels. Gastrointest Endosc 2019;89:105-114.