Becker's ASC Review

57 Executive Briefing: Increasing available appointments will help manage the procedural backlog brought on by the ongoing COVID-19 pandemic and puts patients at ease regarding their safety, Dr. Bechis added. "In the time of COVID, I think patients really appreciate the idea of a disposable, single-use scope that has not been used on another person." Fears of cross-contamination, however, pre-date the COVID-19 era. While more high-profile media reports have exposed duodenoscope-associated infections and related deaths, patients have begun to question the cross-contamination risk involved in other areas of GI endoscopy, Dr. Adler said, particularly healthy colonoscopy patients in for a cancer screening. Because all reusable endoscopes need reprocessing, the complex process of cleaning, disinfecting or sterilization equipment for use, they carry a risk for patient cross- contamination and subsequent infection. Multidrug-resistant bacterial infections have been traced back to patient-ready duodenoscopes, bronchoscopes and cystoscopes. FDA post market surveillance studies point to inconsistencies in reprocessing success, the complexity of reprocessing such delicate instruments, as well as the time pressures on technicians that may cause vital steps to be skipped or performed poorly. "Before a few years ago, we never really thought about it. I mean, literally never thought about it," Dr. Adler said of device- related infection in GI endoscopy. That was before some highly-regarded institutions reported instances of duodenoscope-associated infection from multidrug-resistant bacteria. "As clinicians, you have to have a healthy respect for these organisms," Dr. Adler said. "It really can happen to you." Cost transparency in single-use News coverage of infection outbreaks can damage an institution's reputation. Negative attention might drive patients to other hospitals and providers, leading to a financial hit as well as other losses that are difficult to quantify. "Everybody who knows anything about this is very, very afraid of the possibility of this happening to their patients and in their hospital system," Dr. Adler said. "If you have an outbreak in your hospital, you will never, ever forget it." It is similarly challenging to put a dollar amount on the impact to a healthcare system should patients need readmission or further treatment for endoscope-associated infection, according to Russ Montgomery, director of health economics and market access at Ambu. That's why, when reviewing cost drivers in endoscopy, Mr. Montgomery focuses on transparency. Repair and maintenance of sterile processing equipment, the chemicals used, and the personal protective equipment worn by cleaning personnel all contribute to reprocessing expenses. Ongoing training and labor costs must also be accounted for. Mr. Montgomery said it is hard to measure the efficacy of the sterile processing unit or if institutions are getting the full value out of outside contracts associated with endoscope reprocessing and repair. "With single-use you know what you're spending, you know what you're getting," he said. "Many don't fully appreciate all that they're spending already for reusables because the costs are distributed across different budgets within the hospital." Endoscopes are delicate and can get damaged being transported to or set up for a procedure — not to mention during the examination itself. If an accident occurs mid- procedure, such as a patient biting through a scope when not fully anesthetized, valuable time is also lost as staff search for a new endoscope to complete the procedure, Dr. Tabatabai said. Instead of damaging a piece of equipment "that is relatively irreplaceable in real time" and running into the tens of thousands of dollars, damaging a single-use bronchoscope is "less of a big deal," he said. When considering the depreciating capital investment of reusable endoscopes and subsequent reprocessing and repairs, single-use endoscopy for many facilities is cost neutral or even saves money, according to Mr. Montgomery. Adding the operational benefits of single-use endoscopes and the reduced risk of exogenous patient infection makes single-use a clear, cost-effective solution. 'The ultimate disruptive technology' Single-use endoscopy ensures quality care, reduces patient infection risk, and increases potential procedural volume. Sterile equipment that provides reliable performance in an easily portable platform helps clinicians better serve their patients. And as hospitals recover from the impacts of the ongoing COVID-19 pandemic, single-use endoscopes also provide a cost-effective patient safety solution. "There is some impetus behind trying to minimize, however we can, the risk of transmitting infectious diseases between patients," he added. "A disposable product is a natural evolution of that concept." Today, Ambu's complete line of single-use endoscopes includes duodenoscopes, rhinolaryngoscopes, bronchoscopes and cystoscopes. Ambu plans to quadruple its innovation pipeline and launch more than 20 new flexible endoscopy products in the next three years. More than 1 million Ambu single-use endoscopes were sold in fiscal year 2020. "It is a big shakeup for the market," Dr. Adler said of single-use endoscopes. "I call it the ultimate disruptive technology. n Ambu has been bringing the solutions of the future to life since 1937 and a decade ago launched the world's first single-use flexible bronchoscope, the Ambu® aScope™. Today, millions of patients and healthcare professionals worldwide depend on the efficiency, safety and performance of our single-use endoscopy, anaesthesia, and patient monitoring & diagnostics solutions. Headquartered near Copenhagen in Denmark, Ambu employs approximately 4,000 people in Europe, North America and the Asia Pacific.

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