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267 Inspection of Endoscope Instrument Channels After Reprocessing Using a Prototype Video Camera: A Pilot Study
Abstracts
and quarantine method in February 2014 until end of recent study period (32 months). See an overall downtrend in the number of positive cultures with a HLD defect rate reaching 0.00% after withdrawal of the third serially positive duodenoscope. Positive culture frequency for both culprit scopes noted with black/white circles and dates of scope withdrawal from clinical service indicated with patterned circle. 267 Inspection of Endoscope Instrument Channels After Reprocessing Using a Prototype Video Camera: A Pilot Study Adarsh M. Thaker*, Stephen Kim, Alireza Sedarat, Rabindra R. Watson, V. Raman Muthusamy Division of Digestive Diseases, David Geffen School of Medicine, UCLA, Los Angeles, CA Background: Visual inspection of the instrument channel has been proposed as a quality assurance step during endoscope reprocessing in light of recent duodenoscope-related infections and changes in reprocessing methods. The range and severity of potential findings is unknown. Methods: We implemented a pilot inspection program using a prototype digital video camera (SteriCamÔ, SteriView Inc., San Rafael, CA) passed through the instrument channel of a variety of endoscopes. Each inspection consisted of a 90-120 second video recording by endoscopy technicians anterograde through the instrument channel port and retrograde through the channel from the distal tip. Inspection was performed after full reprocessing, which included manual cleaning and high-level disinfection (HLD). In preparation for ethylene oxide gas sterilization, the duodenoscopes and linear echoendoscopes further underwent manual air blowout followed by hanging overnight in a passive ventilation cabinet prior to inspection. Manual air blowout was not performed on gastroscopes and colonoscopes. The videos were later reviewed by four expert endoscopists and scored by severity (none, mild, severe) for moisture, debris, stains or discoloration, scratches, and channel shredding (damage that results in strips or filaments of the channel lining protruding into the lumen) (Figure 1). Results: A total of 87 inspections were performed on 49 endoscopes (Table 1). The most common finding was scratches, seen in 38 (79.6%) of the endoscopes. They were rated severe in 13 (26.5%) endoscopes. Channel shredding was found in 27 endoscopes (55.1%), including 5 out of 6 gastroscopes, especially in the bending section. Stains or discoloration were found in 30 endoscopes (61.2%) but rated mild in 27 of these. Stains were mostly in the form of tiny, flat black spots of uncertain significance, but yellow or brown pigmentation near the proximal instrument channel port was also noted. No moisture or fluid was found in any of the 77 duodenoscope or linear echoendoscope inspections, but was found in 5 out of 12 gastroscope and colonoscope inspections, only when drying time was less than 24 hours. Debris was found in 20 inspections (23.5%) and was considered severe on 3 inspections (3.5%). No visual evidence of simethicone residue was discovered despite its frequent use in our unit. No visible biofilm or other evidence of residual bioburden was observed. Conclusions: 1. An inspection program with a prototype video camera device revealed that internal damage and/or discoloration of the instrument channel appears to occur frequently, even in newer endoscopes. 2. Manual air blowout of the channel appears highly effective for eliminating moisture compared to overnight hang drying alone. 3. Video inspection of the endoscope channel may be useful to audit reprocessing performance and to identify damaged endoscopes.
Table 1: Results of endoscope channel inspections after reprocessing. Number of inspections*, n (%) Total inspections (n [ 87) Moisture/ fluid Debris
Duodenoscopes (n [ 40)
Echoendoscopes (n [ 35)
Gastroscopes (n [ 6)
Colonoscopes (n [ 6)
5 (5.7)
0 (0)
0 (0)
2 (33)
3 (50)
20 (23)
10 (25)
9 (25.7)
0 (0)
1 (16.7)
Number of endoscopes*, n (%)
Stain/ Discoloration Scratches Channel shredding
Total endoscopes (n [ 49)
Duodenoscopes (n [ 15)
Echoendoscopes (n [ 23)
Gastroscopes (n [ 6)
Colonoscopes (n [ 5)
30 (61.2)
11 (73.3)
12 (52.2)
2 (33.3)
2 (40)
38 (79.6) 27 (55.1)
11 (73.3) 7 (46.7)
19 (82.6) 13 (56.5)
5 (83.3) 5 (83.3)
4 (80) 2 (40)
*Reported on a per-inspection basis (top) and per-endoscope basis (bottom) to exclude duplicate reporting of stains, scratches, and shredding in a single endoscope
AB66 GASTROINTESTINAL ENDOSCOPY Volume 85, No. 5S : 2017
Figure 1: Instrument channel inspection findings: a) retained fluid in a colonoscope, b) debris in a linear echoendoscope, c) staining and discoloration in a duodenoscope, d) scratches and shredding in the bending section of a gastroscope
268 Remote Video Auditing With Feedback in an Ambulatory Endoscopy Suite: Impact on Compliance With Endoscope Cleaning Protocols Gloria Lan*1, Steven Tsistrakis2, Brett B. Bernstein1 1 Digestive Diseases, Mount Sinai Beth Israel, New York, NY; 2Internal Medicine, Mount Sinai Beth Israel, New York, NY Background: Failure to correctly clean endoscopes has been associated with multiple cases of Carbapenamase-resistant Enterobacteriaceae (CRE) infection following endoscopic procedures. This is especially problematic with procedures involving elevator scopes, which contain many small working parts and lead to difficulty adhering to the manufacturer’s multi-step manual cleaning guidelines. Breaks in cleaning protocols of regular endoscopes have also required multiple endoscopy units to send out letters to patients advising them about potential harmful exposures and recommending testing for transmissible pathogens. These events undermine patients’ confidence in their physicians, the quality and cleanliness of the equipment being used, and could result in liability actions. One method being investigated to increase compliance to cleaning protocols is remote video auditing (RVA) with feedback. We evaluated technician compliance with endoscope cleaning and sterilization protocols with the use of remote video auditing with and without feedback. Methods: This was a retrospective review from June 2016 to November 2016 comparing endoscope cleaning compliance rates and completion times for RVA with and without feedback at an ambulatory endoscopy unit. Cleaning procedures for colonoscopes and elevator scopes were recorded and sent to third party offsite video auditors (Arrowsight, Inc.). Auditors used a checklist based on endoscope instructions for use (IFU) to determine the number of steps that were performed correctly. Compliance rates were calculated based on the percentage of correctly performed steps. From June to mid-July, RVA was performed without feedback. From late-July to November, feedback was initiated, which consisted of daily to weekly performance reports sent to endoscopy managers and the lead technician. Weekly meetings were subsequently held with technicians to review inadequately performed steps in the cleaning protocol. Results: We examined the cleaning of 2,147 colonoscopes and 50 elevator scopes. Compliance rates increased from 70% in the pre-feedback period to 97% in the post-feedback period with colonoscopes. Similarly, compliance rates increased from 67% in the prefeedback period to 93% in the post-feedback period with elevator scopes. Time to clean colonoscopes was 11 minutes in the pre-feedback period and 12 minutes in the post-feedback period. Time to clean elevator scopes was 17 minutes in the prefeedback period and 17 minutes in the post-feedback period. Conclusions: Our
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and quarantine method in February 2014 until end of recent study period (32 months). See an overall downtrend in the number of positive cultures with a HLD defect rate reaching 0.00% after withdrawal of the third serially positive duodenoscope. Positive culture frequency for both culprit scopes noted with black/white circles and dates of scope withdrawal from clinical service indicated with patterned circle. 267 Inspection of Endoscope Instrument Channels After Reprocessing Using a Prototype Video Camera: A Pilot Study Adarsh M. Thaker*, Stephen Kim, Alireza Sedarat, Rabindra R. Watson, V. Raman Muthusamy Division of Digestive Diseases, David Geffen School of Medicine, UCLA, Los Angeles, CA Background: Visual inspection of the instrument channel has been proposed as a quality assurance step during endoscope reprocessing in light of recent duodenoscope-related infections and changes in reprocessing methods. The range and severity of potential findings is unknown. Methods: We implemented a pilot inspection program using a prototype digital video camera (SteriCamÔ, SteriView Inc., San Rafael, CA) passed through the instrument channel of a variety of endoscopes. Each inspection consisted of a 90-120 second video recording by endoscopy technicians anterograde through the instrument channel port and retrograde through the channel from the distal tip. Inspection was performed after full reprocessing, which included manual cleaning and high-level disinfection (HLD). In preparation for ethylene oxide gas sterilization, the duodenoscopes and linear echoendoscopes further underwent manual air blowout followed by hanging overnight in a passive ventilation cabinet prior to inspection. Manual air blowout was not performed on gastroscopes and colonoscopes. The videos were later reviewed by four expert endoscopists and scored by severity (none, mild, severe) for moisture, debris, stains or discoloration, scratches, and channel shredding (damage that results in strips or filaments of the channel lining protruding into the lumen) (Figure 1). Results: A total of 87 inspections were performed on 49 endoscopes (Table 1). The most common finding was scratches, seen in 38 (79.6%) of the endoscopes. They were rated severe in 13 (26.5%) endoscopes. Channel shredding was found in 27 endoscopes (55.1%), including 5 out of 6 gastroscopes, especially in the bending section. Stains or discoloration were found in 30 endoscopes (61.2%) but rated mild in 27 of these. Stains were mostly in the form of tiny, flat black spots of uncertain significance, but yellow or brown pigmentation near the proximal instrument channel port was also noted. No moisture or fluid was found in any of the 77 duodenoscope or linear echoendoscope inspections, but was found in 5 out of 12 gastroscope and colonoscope inspections, only when drying time was less than 24 hours. Debris was found in 20 inspections (23.5%) and was considered severe on 3 inspections (3.5%). No visual evidence of simethicone residue was discovered despite its frequent use in our unit. No visible biofilm or other evidence of residual bioburden was observed. Conclusions: 1. An inspection program with a prototype video camera device revealed that internal damage and/or discoloration of the instrument channel appears to occur frequently, even in newer endoscopes. 2. Manual air blowout of the channel appears highly effective for eliminating moisture compared to overnight hang drying alone. 3. Video inspection of the endoscope channel may be useful to audit reprocessing performance and to identify damaged endoscopes.
Table 1: Results of endoscope channel inspections after reprocessing. Number of inspections*, n (%) Total inspections (n [ 87) Moisture/ fluid Debris
Duodenoscopes (n [ 40)
Echoendoscopes (n [ 35)
Gastroscopes (n [ 6)
Colonoscopes (n [ 6)
5 (5.7)
0 (0)
0 (0)
2 (33)
3 (50)
20 (23)
10 (25)
9 (25.7)
0 (0)
1 (16.7)
Number of endoscopes*, n (%)
Stain/ Discoloration Scratches Channel shredding
Total endoscopes (n [ 49)
Duodenoscopes (n [ 15)
Echoendoscopes (n [ 23)
Gastroscopes (n [ 6)
Colonoscopes (n [ 5)
30 (61.2)
11 (73.3)
12 (52.2)
2 (33.3)
2 (40)
38 (79.6) 27 (55.1)
11 (73.3) 7 (46.7)
19 (82.6) 13 (56.5)
5 (83.3) 5 (83.3)
4 (80) 2 (40)
*Reported on a per-inspection basis (top) and per-endoscope basis (bottom) to exclude duplicate reporting of stains, scratches, and shredding in a single endoscope
AB66 GASTROINTESTINAL ENDOSCOPY Volume 85, No. 5S : 2017
Figure 1: Instrument channel inspection findings: a) retained fluid in a colonoscope, b) debris in a linear echoendoscope, c) staining and discoloration in a duodenoscope, d) scratches and shredding in the bending section of a gastroscope
268 Remote Video Auditing With Feedback in an Ambulatory Endoscopy Suite: Impact on Compliance With Endoscope Cleaning Protocols Gloria Lan*1, Steven Tsistrakis2, Brett B. Bernstein1 1 Digestive Diseases, Mount Sinai Beth Israel, New York, NY; 2Internal Medicine, Mount Sinai Beth Israel, New York, NY Background: Failure to correctly clean endoscopes has been associated with multiple cases of Carbapenamase-resistant Enterobacteriaceae (CRE) infection following endoscopic procedures. This is especially problematic with procedures involving elevator scopes, which contain many small working parts and lead to difficulty adhering to the manufacturer’s multi-step manual cleaning guidelines. Breaks in cleaning protocols of regular endoscopes have also required multiple endoscopy units to send out letters to patients advising them about potential harmful exposures and recommending testing for transmissible pathogens. These events undermine patients’ confidence in their physicians, the quality and cleanliness of the equipment being used, and could result in liability actions. One method being investigated to increase compliance to cleaning protocols is remote video auditing (RVA) with feedback. We evaluated technician compliance with endoscope cleaning and sterilization protocols with the use of remote video auditing with and without feedback. Methods: This was a retrospective review from June 2016 to November 2016 comparing endoscope cleaning compliance rates and completion times for RVA with and without feedback at an ambulatory endoscopy unit. Cleaning procedures for colonoscopes and elevator scopes were recorded and sent to third party offsite video auditors (Arrowsight, Inc.). Auditors used a checklist based on endoscope instructions for use (IFU) to determine the number of steps that were performed correctly. Compliance rates were calculated based on the percentage of correctly performed steps. From June to mid-July, RVA was performed without feedback. From late-July to November, feedback was initiated, which consisted of daily to weekly performance reports sent to endoscopy managers and the lead technician. Weekly meetings were subsequently held with technicians to review inadequately performed steps in the cleaning protocol. Results: We examined the cleaning of 2,147 colonoscopes and 50 elevator scopes. Compliance rates increased from 70% in the pre-feedback period to 97% in the post-feedback period with colonoscopes. Similarly, compliance rates increased from 67% in the prefeedback period to 93% in the post-feedback period with elevator scopes. Time to clean colonoscopes was 11 minutes in the pre-feedback period and 12 minutes in the post-feedback period. Time to clean elevator scopes was 17 minutes in the prefeedback period and 17 minutes in the post-feedback period. Conclusions: Our
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