Hostname: page-component-78c5997874-dh8gc Total loading time: 0 Render date: 2024-11-10T05:16:44.488Z Has data issue: false hasContentIssue false

Biofilm accumulation in new flexible gastroscope channels in clinical use

Published online by Cambridge University Press:  15 June 2021

Mariusa Gomes Borges Primo
Affiliation:
Clinics Hospital, Federal University of Goias, Goiânia, Goias, Brazil
Anaclara Ferreira Veiga Tipple*
Affiliation:
Faculty of Nursing, Federal University of Goias, Goiânia, Goias, Brazil
Dayane de Melo Costa
Affiliation:
Faculty of Nursing, Federal University of Goias, Goiânia, Goias, Brazil
Simone Vieira Toledo Guadagnin
Affiliation:
Clinics Hospital, Federal University of Goias, Goiânia, Goias, Brazil
Adriana Silva Azevedo
Affiliation:
Clinics Hospital, Federal University of Goias, Goiânia, Goias, Brazil
Lara Stefânia Netto de Oliveira Leão-Vasconcelos
Affiliation:
Institute of Tropical Pathology and Public Health, Federal University of Goias, Goiânia, Goias, Brazil
Michelle Alfa
Affiliation:
Department of Medical Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada
Karen Vickery
Affiliation:
Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
*
Author for correspondence: Anaclara Ferreira Veiga Tipple, E-mail: anaclara_tipple@ufg.br

Abstract

Objective:

Assess the accumulation of protein and biofilm on the inner surfaces of new flexible gastroscope (FG) channels after 30 and 60 days of patient use and full reprocessing.

Design:

Clinical use study of biofilm accumulation in FG channels.

Setting:

Endoscopy service of a public hospital.

Methods:

First, we tested an FG in clinical use before the implementation of a revised reprocessing protocol (phase 1 baseline; n = 1). After replacement of the channels by new ones and the implementation of the protocol, 3 FGs were tested after 30 days of clinical use (phase 2; n = 3) and 3 FGs were tested after 60 days of clinical use (phase 3; n = 3), and the same FGs were tested in phase 2 and 3. Their biopsy, air, water, and air/water junction channels were removed and subjected to protein testing (n = 21), bacteriological culture (n = 21), and scanning electron microscopy (SEM) (n = 28). Air–water junction channels fragments were subjected to SEM only.

Results:

For the FGs, the average number of uses and reprocessing cycles was 60 times. Extensive biofilm was detected in air, water, and air–water junction channels (n = 18 of 28). All channels (28 of 28) showed residual matter, and structural damage was identified in most of them (20 of 28). Residual protein was detected in the air and water channels of all FG evaluated (phases 1–3), except for 1 air channel from phase 2. Bacteria were recovered from 8 of 21 channels, most air or water channels.

Conclusions:

The short time before damage and biofilm accumulation in the channels was evident and suggests that improving the endoscope design is necessary. Better reprocessing methods and channel maintenance are needed.

Type
Original Article
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

PREVIOUS PRESENTATION: An abstract with partial results of this study was presented at the IDWEEK 2020 on October 21, conducted virtually.

References

Endoscope disinfection update: a guide to resource-sensitive reprocessing. World Gastroenterology Organization website. https://www.worldgastroenterology.org/UserFiles/file/guidelines/endoscope-disinfection-english-2019.pdf Published 2019. Accessed July 2, 2020.Google Scholar
Balan, GG, Sfarti, CV, Chiriac, SA, Stanciu, C, Trifan, A. Duodenoscope-associated infections: a review. Eur J Clin Microbiol Infect Dis 2019;38:22052213.CrossRefGoogle ScholarPubMed
Humphries, RM, Yang, S, Kim, S, et al. Duodenoscope-related outbreak of a carbapenem-resistant Klebsiella pneumoniae identified using advanced molecular diagnostics. Clin Infect Dis 2017;65:11591166.10.1093/cid/cix527CrossRefGoogle ScholarPubMed
Ross, AS, Baliga, C, Verma, P, Duchin, J, Gluck, M. A quarantine process for the resolution of duodenoscope-associated transmission of multidrug-resistant Escherichia coli . Gastrointest Endosc 2015;82:477483.CrossRefGoogle ScholarPubMed
Ofstead, CL, Wetzler, HP, Heymann, OL, Johnson, EA, Eiland, JE, Shaw, MJ. Longitudinal assessment of reprocessing effectiveness for colonoscopes and gastroscopes: results of visual inspections, biochemical markers, and microbial cultures. Am J Infect Control 2017;45(2):e26e33.CrossRefGoogle ScholarPubMed
Alfa, MJ, Singh, H. Impact of wet storage and other factors on biofilm formation and contamination of patient-ready endoscopes: a narrative review. Gastrointest Endosc 2020;91:236247.CrossRefGoogle ScholarPubMed
Alfa, M, Howie, R. Modeling microbial survival in buildup biofilm for complex medical devices. BMC Infect Dis 2009;9:114.CrossRefGoogle ScholarPubMed
Pajkos, A, Vickery, K, Cossart, Y. Is biofilm accumulation on endoscope tubing a contributor to the failure of cleaning and descontamination? J Hosp Infect 2004;58:224229.CrossRefGoogle Scholar
Johani, K, Hu, H, Santos, L, et al. Determination of bacterial species present in biofilm contaminating the channels of clinical endoscopes. Infect Dis Health 2018;23:189196.10.1016/j.idh.2018.06.003CrossRefGoogle Scholar
Lee, DH, Kim, DB, Kim, HY, et al. Increasing potential risks of contamination from repetive use of endoscope. Am J Infect Control 2015;43:e1e5.10.1016/j.ajic.2015.01.017CrossRefGoogle Scholar
Vickery, K, Ngo, QD, Zou, J, Cossart, E. The effect of multiple cycles of contamination, detergent washing, and disinfection on the development of biofilm in endoscope tubing. Am J Infect Control 2009;37:470475.CrossRefGoogle ScholarPubMed
Ministério da Saúde. Resolução no. 6, de 10 de março de 2013. Dispõe sobre os requisitos de boas práticas de funcionamento para os serviços de endoscopia com via de acesso ao organismo por orifícios exclusivamente naturais. Agência Nacional de Vigilância Sanitária website. http://bvsms.saude.gov.br/bvs/saudelegis/anvisa/2013/rdc0006_10_03_2013.html. Published 2013. Accessed January 13, 2020.Google Scholar
Azevedo, AS. Protocol for flexible endoscope processing: qualifying the clinical practice. Master’s thesis. Goiânia, Goiás: Professional Master’s of the Federal University of Goiás, 2018.Google Scholar
Berbel, NAN. A problematização e a aprendizagem baseada em problemas: diferentes termos ou diferentes caminhos? Interface (Botucatu) 1998;2:139154.CrossRefGoogle Scholar
Primo, MGB, Guadagnin, SVT, Azevedo, AS, Costa Luciano, C, Costa, DM, Tipple, AFV. Experience in implementing a protocol for processing endoscopes using an active methodology. Com Ciências Saúde 2020;31:189196.Google Scholar
Sociedade Brasileira Enfermagem em Endoscopia Gastrointestinal. Manual de limpeza e desinfecção de aparelhos endoscópicos. Agência Nacional de Vigilância Sanitária website. http://www.anvisa.gov.br/servicosaude/manuais/sobeeg_manual.pdf. Published 2006. Accessed January 3, 2020.Google Scholar
Li, XZ, Webb, JS, Kjelleberg, S, Rosche, B. Enhanced benzaldehyde tolerance in Zymomonas mobilis biofilms and the potential of biofilm applications in fine-chemical production. Appl Environ Microbiol 2006;72:16391644.10.1128/AEM.72.2.1639-1644.2006CrossRefGoogle ScholarPubMed
Chowdhury, D, Rahman, A, Hu, H, Jensen, SO, Deva, AK, Vickery, K. The effect of disinfectant formulation and organic soil on the efficacy of oxidising disinfectants against biofilms. J Hosp Infect 2019;103:e33ee41.CrossRefGoogle Scholar
Performance standards for antimicrobial susceptibility testing, 27th edition. CLSI supplement M100 S27. Clinical and Laboratory Standards Institute website. https://clsi.org/media/1795/catalog2017_web.pdf. Published 2017. Accessed May 14, 2020.Google Scholar
Ren-Pei, W, Hui-Jun, Xi, Ke, Qi, et al. Correlation between the growth of bacterial biofilm in flexible endoscopes and endoscopes reprocessing methods. Am J Infect Control 2014;42:12031206.10.1016/j.ajic.2014.07.029CrossRefGoogle ScholarPubMed
Guidelines for decontamination of equipment for gastrointestinal endoscopy. The report of a working party of the British Society of Gastroenterology Endoscopy Committee. British Society of Gastroenterology website. https://www.bsg.org.uk/clinical-resource/guidance-on-decontamination-of-equipment-for-gastrointestinal-endoscopy-2017-edition/. Published 2017. Accessed January 14, 2020.Google Scholar
Ribeiro, MM, Graziano, KU, Olson, N, França, R, Alfa, MJ. The polytetrafluoroethylene (PTFE) channel model of cyclic-buildup biofilm and traditional biofilm: the impact of friction, and detergent on cleaning and subsequent high-level disinfection. Infect Control Hosp Epidemiol 2020;41:172180.Google ScholarPubMed
Thaker, AM, Kim, S, Sedarat, A, Watson, RR, Muthusamy, VR. Inspection of endoscope instrument channels after reprocessing using a prototype borescope. Gastrointest Endosc 2018;88:612619.CrossRefGoogle ScholarPubMed
Hervé, RC, Keevil, CW. Persistent residual contamination in endoscope channels; a fluorescence epimicroscopy study. Endoscopy 2016;48:609616.Google ScholarPubMed
Costa, DM, Lopes, LKO, Hu, H, Tipple, AFV, Vickery, K. Alcohol fixation of bacteria to surgical instruments increases cleaning difficulty and may contribute to sterilization inefficacy. Am J Infect Control 2017;45:e81e86.CrossRefGoogle ScholarPubMed
Kovaleva, J, Peters, FTM, Van der Mei, HC, Degenera, JE. Transmission of infection by flexible gastrointestinal endoscopy and bronchoscopy. Clin Microbiol Rev 2013;26:231254.CrossRefGoogle ScholarPubMed
Costa, DM, Lopes, LKO, Tipple, AFV, et al. Evaluation of stainless-steel surgical instruments subjected to multiple use/processing. Infect Dis Health 2018;23:39.CrossRefGoogle ScholarPubMed
Li, J, Zhao, X. Effects of quorum sensing on the biofilm formation and viable but nonculturable state. Food Res Int 2020;137:109742.10.1016/j.foodres.2020.109742CrossRefGoogle Scholar
Hall-Stoodley, L, Lappin-Scott, H. Biofilm formation by the rapidly growing mycobacterial species Mycobacterium fortuitum . FEMS Microbiol Lett 1998;168:7784.CrossRefGoogle ScholarPubMed
Falkinham, J. Surrounded by mycobacteria: nontuberculous mycobacteria in the human environment. J Appl Microbiol 2009;107:356367.CrossRefGoogle ScholarPubMed
Tortoli, E, Brown-Elliott, BA, Chalmers, JD, et al. Same meat, different gravy: ignore the new names of mycobacteria. Eur Resp J 2019;54:190079.CrossRefGoogle ScholarPubMed
Ribeiro, MM, Oliveira, AC. Analysis of the air/water channels of gastrointestinal endoscopies as a risk factor for the transmission of microorganisms among patients. Am J Infect Control 2012;40:913916.CrossRefGoogle ScholarPubMed
Kovaleva, J. Endoscope drying and its pitfalls. J Hosp Infect 2017;97:319328.CrossRefGoogle ScholarPubMed
Perumpail, RB, Marya, NB, McGinty, BL, Mathusamy, VR. Endoscope reprocessing: comparison of drying effectiveness and microbial levels with an automated drying and storage cabinet with forced filtered air and a standard storage cabinet. Am J Infect Control 2019;47;10831089.CrossRefGoogle Scholar
Beilenhoff, U, Biering, H, Blum, R, Brljak, JM. 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;50:12051234.Google ScholarPubMed