Becker's Clinical Quality & Infection Control

12 INFECTION CONTROL & PATIENT SAFETY Accepted Endoscope Reprocessing Regimens Aren't Always Effective, Study Shows By Anuja Vaidya E xisting endoscope reprocessing tech- niques are not consistently effective, according to a study published in the American Journal of Infection Control. Researchers used a longitudinal study design, performing three assessments of 20 endo- scopes over seven months. e assessments were used to identify the scopes that needed further cleaning, and they included: • Visual inspections with a tiny camera • Microbial cultures • Biochemical tests to detect protein and ad- enosine triphosphate (a marker that identi- fies organic matter) e study shows all 20 endoscopes had visu- al irregularities, such as fluid, discoloration and debris in channels aer reprocessing. Additionally, 12 of the 20 showed microbial growth and 20 percent of each type of endo- scope (gastrointestinal, urological and respi- ratory) exceeded the benchmarks for ATP and protein detection aer cleaning. Also, the study shows ATP levels were higher for gastroscopes than the endoscopes used for colonoscopy. Significantly, the study indicates that endo- scopes reprocessed using current recom- mended guidelines as well as those that were cleaned at least twice before high-level dis- infection showed similar microbial culture results. "Since the same technicians used the same techniques to clean and disinfect these scopes, the findings and our visual obser- vations suggest that something is happen- ing to gastroscopes during procedures that changes the surfaces and causes reprocess- ing failures," said Cori Ofstead, the lead study author. Endoscope reprocessing was thrown into the limelight in late 2014 and 2015 when several facilities across the country saw outbreaks of carbapenem-resistant Enterobacteriaceae in- fections related to duodenoscopes, including at Los Angeles-based Cedars-Sinai Medical Cen- ter and UCLA Ronald Reagan Medical Center. Additionally, another study published in the journal Infection Control and Hospital Epide- miology in October showed that removing all contamination from robotic surgical instru- ments, even aer cleaning multiple times, is close to impossible. n How Far Do Germs Travel After a Sneeze? It's Farther Than You Think By Heather Punke S neezes abound during cold and flu season, and those sneezes are vehicles for germs — in some cases, sneezes can spread germs up to 26 feet away, according to research in the New England Journal of Medicine. Researchers from Cambridge, Mass.-based MIT used high-speed imaging to record sneezes and slowed the video down to see how far sneeze droplets traveled. While the largest droplets from the sneeze settled about 3 to 6 feet away from the sneezer, smaller and evaporating droplets remain suspended lon- ger and can wind up 26 feet away. "The smaller and evaporating droplets are trapped in the turbulent puff cloud, remain suspended, and, over the course of a second to a few minutes, can travel the dimensions of a room and land up to [19 to 26 feet] away," the study reads. "We say distance is a barrier," Scott Davies, MD, the chief of the department of medicine at Hennepin County Medical Center in Min- neapolis, told the Star Tribune. "When some- one isn't feeling well but they're not staying home, we like to keep 3 feet of distance." n Fujifilm to Pull 4 Older Duodenoscope Models From Use By Heather Punke F ujifilm Medical Systems plans to remove four legacy duodenos- cope models from clinical use "based on the limited number cur- rently in use," according to a Food and Drug Administration safe- ty alert issued Jan. 13. The four models are Fuji ED-250XL5, ED-250XT5, ED-450XL5 and ED- 450XT5. Fuji will replace any of the retired models with the ED-530XT duodenoscope as well as necessary accessories, like brushes, at no cost to the facility. Duodenoscopes are notoriously difficult to clean and have been linked to roughly 350 superbug infections in the U.S., the FDA found. Howev- er, in the letter Fujifilm sent to customers, the company said it "is not conducting this product removal due to a known safety risk." The letter continues to say that Fujifilm "has not received any recent reports of adverse events associated with these legacy scopes," and is instead taking this action to give U.S. customers the must recent model of the scope. The FDA recommends all provider organizations take Fujifilm up on its offer to return the old scopes. The FDA's other recommendations include: • Train staff on Fujifilm's reprocessing instructions for the new model and implement them as soon as possible • Immediately remove duodenoscopes from service if they show signs of damage like loose parts, damaged channel walls or kinks in the tubing • Contact a Fujifilm sales representative with any questions n

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