How effective are the alcohol flush and drying cycles of automated endoscope reprocessors? Stripped endoscope model.

BACKGROUND: Effective drying of the internal channels of endoscopes is essential to prevent the growth of water-borne pathogens and to assure adequate sterilization with vaporized hydrogen peroxide or ethylene oxide. The aim of this study was to evaluate the dryness of endoscopes after a routine disinfection process in an automated endoscope reprocessor. METHODS: Stripped endoscopes (SE) that allow for visual inspection of the inside channels were reprocessed per protocol in a large urban medical center, with a 3-minute or 10-minute air flush following reprocessing. SE was hung and observed for any water within the channels after reprocessing and after a week of ambient storage. Ready-for-use endoscopes were also randomly spot-checked for moisture visually and with moisture detection paper. RESULTS: All SE were grossly wet after HLD with a 3-minute air flush, despite alcohol flush and drying cycle. The 10-minute air flush was effective at drying the biopsy/suction channel, but not the air/water channels. Hanging had limited effect, being most effective in the biopsy/suction channels. Of the 77 ready-for-use respiratory and gastrointestinal endoscopes assessed, 37 (48.1%) showed evidence of retained moisture. CONCLUSIONS: Air flush cycles commonly used in the final steps of automated endoscope reprocessing may not adequately dry endoscope channels, particularly the narrower diameter air/water channels. An extended 10-minute air flush appears effective at drying the larger biopsy/suction channel, but has limited effect on the air/water channels.

Melanoma in situ: a case report from the patient's perspective.

INTRODUCTION: Melanoma can be a fatal form of skin cancer. The prognosis rapidly deteriorates from the in situ stage (stage 0) to stage 4. As such, early detection and treatment are key. CASE PRESENTATION: A middle-aged patient, who was also a chiropractor, self-identified a small skin lesion using the Chiropractors Guide to Skin Cancer. The primary care physician made a dermatology referral, and biopsy identified melanoma. Surgery was subsequently booked and the lesion was excised with a 5 mm margin. The final pathology report confirmed a diagnosis of melanoma in situ. SUMMARY: As primary contact health care providers chiropractors can play a significant role in the potential identification and initiation of investigations into various possible dermatological disorders including skin cancer. Efforts should be made to diagnose melanoma at the in situ stage to ensure the best outcome.

INTRODUCTION: Le mélanome est un cancer de la peau pouvant être fatal. Le pronostic s'assombrit rapidement entre le stade 0 (mélanome in situ) et le stade 4. Un dépistage et un traitement précoces sont essentiels. PRÉSENTATION DU CAS: Un patient d'âge mûr, qui était aussi un chiropraticien, a décelé chez lui une petite lésion cutanée à l'aide du Chiropractors Guide to Skin Cancer (guide servant à aider le chiropraticien à dépister un cancer de la peau). Un médecin de premier recours l'a dirigé vers un dermatologue; l'examen de la biopsie a révélé un mélanome. Un rendez-vous en chirurgie a été pris. La lésion et une marge chirurgicale de 5 mm ont été excisées. Le rapport final du laboratoire de pathologie a confirmé le diagnostic d'un mélanome in situ. RÉSUMÉ: À titre de fournisseurs de soins de santé primaires, les chiropraticiens peuvent jouer un rôle important dans le dépistage de diverses affections cutanées dont le cancer de la peau et l'amorce des examens exploratoires. On devrait déployer des efforts pour que le mélanome soit diagnostiqué au stade 0 (mélanome in situ) pour assurer la meilleure issue possible.