A Race Against Time: Unraveling the Importance of Timely Endoscope Reprocessing

In the healthcare industry, preventing the spread of infection and ensuring patient safety is of paramount importance. Infections can severely affect patient health, prolonging hospital stays and increasing the financial burden on patients and healthcare systems.

When considering reusable medical devices such as endoscopes, efficient and correct reprocessing of these is critical to minimise the risk of contamination and the spread of infection, safeguarding patient safety and the integrity of healthcare procedures.

Endoscope reprocessing is a complex, multi-step process that demands meticulous attention to detail. Achieving successful reprocessing relies on excellent time management, yet this aspect needs to be addressed or considered, potentially posing risks to patient safety.

Why is time such a critical factor in endoscope reprocessing, and how can this be effectively managed? This blog post delves into the importance of time management and why it should be given the attention it deserves.  

Reusable Endoscopes: The Risks and Why Successful Reprocessing Is So Important

Endoscopes are vital tools for diagnosing and treating patients without requiring more invasive complex surgery. Reusable scopes are widespread, as they are more cost-efficient and have a lower environmental impact (due to less waste generation) than single-use disposable devices. However, their use is not without risks. Endoscopy is an invasive procedure, so contact of the instrument with bodily fluids and biological materials occurs. This creates a potential breeding ground for microorganisms and presents significant risks concerning infection transmission. Therefore, the safe use of such devices hinges on the success of reprocessing between uses.

Endoscope reprocessing begins immediately after use on a patient and involves multiple cleaning processes, disinfection (and sometimes sterilisation), drying and storage. The various reprocessing steps aim to remove any biological material, debris or contamination from the endoscope, ensuring all microorganisms that pose a risk of infection are removed or killed before use on the next patient.

Failure to achieve this threatens patient safety and compliance with manufacturers’ reprocessing guidelines, which is key in the fight against infection transmission. Each step in the procedure must require precision and accuracy, and any lapses in the reprocessing risk compromising the safety of the device and, in turn, impacting the safety of the patients undergoing endoscopic procedures.

However, it is not just the processes themselves that are important. Key time constraints must also be adhered to for reprocessing to be effective. Any delay in the journey from patient use to reprocessing and subsequent storage compromises the effectiveness of the decontamination process.

Biofilm Formation – Every Second Counts

During use, endoscopes pick up an array of biological materials and debris, which, if left to dry, can develop into a biofilm - complex matrices of bacterial, fungal or protozoan cells that form on the device. The moist conditions inside the endoscope offer a perfect environment for biofilm formation. The longer the debris has to dry before cleaning starts, the greater the chance of significant biofilm formation.

Why are biofilms such an issue? To understand this, we need to consider the multi-stage process by which they form. During the initial stages of biofilm formation, a layer of organic material resides on the surface of the device, and microorganisms begin to form. 

This attachment is dynamic and reversible by cleaning the endoscope.  At this early stage, the risks the biofilm poses are low, and if cleaned quickly after the endoscopy is complete, the biofilm should be able to be removed entirely. 

However, suppose the device is not cleaned quickly, and the biofilm is not disrupted at the initial formation stage; the microorganisms begin to attach irreversibly to the device surface and eventually form a mature biofilm.

An extracellular barrier layer of polysaccharides, nucleic acids and proteins is secreted as a shield to protect the microorganisms below from physical and chemical damage. In this mature state, a biofilm becomes resistant to cleaning, disinfection and sterilisation, rendering reprocessing of the device ineffective.

The risk with biofilm lies in what can happen next – the biofilm can detach from the device whilst in use on a patient, posing serious infection control risks. 

Early Intervention is Key

The more mature a biofilm is, the harder it is to clean, and eventually, it will become resistant to clearance. So, how do we reduce the risks? The time between device use and cleaning and reprocessing is critical. We need to limit the opportunity for bacterial growth and mature biofilm formation, and the first step in achieving this is ensuring the device is cleaned as soon as possible after use. 

The time required for a mature biofilm to develop will depend on various factors; however, it is widely accepted that commencing cleaning within 1 hour of a procedure being complete should prevent mature biofilm formation.¹  If this 1-hour window is exceeded, manufacturers, such as Olympus, insist on an extended soaking procedure.²

Once cleaning is complete, the next time critical parameter is drying of the scope. Wet surfaces can become a breeding ground for microorganisms and increase the risk of biofilm formation. Therefore, drying should be carried out as soon as possible following the cleaning steps.

Significant links exist between delays in endoscope reprocessing and infection transmissions in patients. ^3,4,5 Ensuring that the used device moves through the reprocessing steps promptly helps prevent the bioburden and debris from hardening, reducing the risk of biofilm formation and the risk of infection transmission.

Regulatory bodies such as the FDA and CDC have established strict guidelines for endoscope reprocessing, including time-based requirements for various steps throughout the process. Failing to meet these timeframes leads to non-compliance with the official guidance and can have legal repercussions for healthcare facilities.

Time is Money

In the healthcare sector, time is a valuable resource. As well as the potential threat to patient safety resulting from inadequate time management endoscope reprocessing, there are other ways in which it can impact healthcare facilities.

Infections lead to increased medical interventions and prolonged hospitalisation, all of which come at an added cost. Consequently, mitigating the risk of infection helps reduce these related costs.

Compliance with critical cleaning and drying times can minimise the unnecessary expense linked to inefficient endoscope reprocessing. Failure to clean scopes within the recommended 1-hour post procedure window results in a more time and resource-intensive cleaning process being required. Naturally, this increases the reprocessing costs, ultimately impacting a healthcare facility’s bottom line.

Efficient endoscope reprocessing ensures that instruments are swiftly cleaned and prepared for use, minimising the likelihood of procedure delays and any associated financial implications.  

The Takeaway

Time management in endoscopy reprocessing is far from a minor detail – it is vital to ensuring patient safety and reducing the risk of infection transmission. Poor time management during the reprocessing can also have financial implications for healthcare facilities.

With this in mind, healthcare facilities should recognise the significance of time in reprocessing and understand the extra steps that must be taken if reprocessing is delayed or disrupted. Patient safety is paramount, and efficient reprocessing is key in helping prevent hospital-acquired infections. 

Facilities must implement a robust system to ensure compliance with the guidelines; failure to do so threatens patient safety, impacts efficiency and increases cost.

In an industry where every second counts, it's essential to prioritise time management in endoscope reprocessing.

 

 

 

1. CG Roberts, “The role of biofilms in the reprocessing of medical devices”, American Journal of Infection Control, 2013

2. Benedict M, “Delays in Endoscope Reprocessing…and the Biofilms Within”, Olympus

3. Naas T et al. “Endoscopy-associated transmission of carbapenem-resistant Klebsiella pneumoniae producing KPC-2 b-lactamase”, Journal of Antimicrobial Chemotherapy, 2010]

4. Shimono N et al., “An outbreak of Pseudomonas aeruginosa infections following thoracic surgeries occurring via the contamination of bronchoscopes and an automatic endoscope reprocessor”, Journal of Infection and Chemotherapy, 2008

5. Carbonne A et al., “Control of a multi-hospital outbreak of KPC-producing Klebsiella pneumoniae type 2 in France, September to October”, American Journal of Infection Control, 2013, Eurosurveillance, 2010