Significant increased bacterial contamination with endoscope overnight and weekend storage times.

BACKGROUND AND AIM: Forced-air drying (FAD) cabinets are recommended for storage of reprocessed endoscopes, but financial constraints prevent their universal application. The study aimed to determine bacterial contamination in flexible gastroscopes (FG) channels after storage, in a cabinet with filtered air and UV lights, but without FAD. METHODS: Eight FG in clinical use in an endoscopy service of a large Brazilian hospital were sampled: immediately "Time zero" (N = 50), 12 h "Time 1" (N = 25), and 60 h "Time 2" (N = 25) after reprocessing. Following a flush-brush-flush of channels, 40-mL sterile water and 3 cm of the brush were collected. Each sample was divided, filtered onto two 0.22-µm membranes, and incubated in media without or with disinfectant neutralizer. Automated method was used for identification and antibiotic resistance test of isolated bacteria. RESULTS: Bacterial contamination in times "1" and "2" was 5.9 and 16.1 times greater than that of "Time zero," respectively. Number of positive cultures in media with and without neutralizer was similar at times "1" and "2," while media with neutralizer produced more positive cultures at "Time zero." Most bacteria isolated at "Time 2" were Gram-negative rods (52.3%) and showed resistance to one or more antibiotics (65%). CONCLUSION: Bacterial contamination was detected on reprocessed FG stored in non-FAD cabinets overnight (12 h) and increased with longer storage time (60 h). The contamination source is likely to be bacteria in biofilm which multiply in the absence of FAD. Evidence-based criteria should be available for storage time according to the cabinet available.

Cleaning of in-hospital flexible endoscopes: Limitations and challenges / Limpeza de endoscópios flexíveis intra-hospitalares: limitações e desafios / Limpieza de endoscopios flexibles intrahospitalarios: limitaciones y desafíos

Abstract Objective: to analyze the cleaning process of gastroscopes, colonoscopes and duodenoscopes in eight in-hospital health services. Method: a cross-sectional study conducted with 22 endoscopes (eight gastroscopes, eight colonoscopes and six duodenoscopes), and microbiological analysis of 60 samples of air/water channels (all endoscopes) and elevator (duodenoscopes), in addition to protein testing. Descriptive statistics with calculation of frequencies and central tendency measures was used in data analysis. Results: the processing of 22 endoscopes was monitored with microbiological analysis for 60 channels. In the pre-cleaning procedure, in 82.3% (14/17) of the devices, gauze was used in cleaning the insertion tube. Incomplete immersion of the endoscope in detergent solution occurred in 72.3% (17/22) of the cases, and in 63.6% (14/22) there was no standardization of filling-in of the channels. Friction of the biopsy channel was not performed in 13.6% (3/22) of the devices. In the microbiological analysis, 25% (7/32) of the samples from the stored endoscopes were positive for microbial growth (from 2x101 to 9.5x104 CFU/mL), while after processing, contamination was 32% (9/28). Protein residues in the elevator channel were detected in 33% of duodenoscopes. Conclusion: the results indicate important gaps in the stages of pre-cleaning and cleaning of endoscopes that, associated with presence of protein residues and growth of microorganisms of epidemiological importance, indicate limitations in safety of the processing procedures, which can compromise the disinfection processes and, consequently, their safe use among patients subjected to such tests.

Resumo Objetivo: analisar o processo de limpeza de gastroscópios, colonoscópios e duodenoscópios em oito serviços de saúde intra-hospitalar. Método: estudo transversal com 22 endoscópios, sendo oito gastroscópios, oito colonoscópios e seis duodenoscópios, e análise microbiológica de 60 amostras dos canais de ar/água (todos os endoscópios) e elevador (duodenoscópios), além de teste de proteína. Na análise dos dados, utilizou-se estatística descritiva, com cálculo de frequências e medidas de tendência central. Resultados: o processamento de 22 endoscópios foi acompanhado com análise microbiológica de 60 canais. Na pré-limpeza, em 82,3% (14/17) dos equipamentos, foi utilizada gaze na limpeza do tubo de inserção. A imersão incompleta do endoscópio em solução detergente ocorreu em 72,3% (17/22) dos casos, e em 63,6% (14/22) não havia padronização do preenchimento dos canais. A fricção do canal de biópsia não foi realizada em 13,6% (3/22) dos equipamentos. Na análise microbiológica, 25% (7/32) das amostras dos endoscópios armazenados foram positivas para crescimento microbiano (2x101 a 9,5x104 UFC/mL), enquanto após o processamento, a contaminação foi de 32% (9/28). Resíduos de proteína no canal do elevador foram detectados em 33% dos duodenoscópios. Conclusão: os resultados apontam lacunas importantes nas etapas de pré-limpeza e limpeza dos endoscópios que, associadas à presença de resíduos de proteína e ao crescimento de microrganismo de importância epidemiológica, sinalizam limitações na segurança do processamento, que podem comprometer os processos de desinfecção e consequentemente seu uso seguro entre pacientes submetidos a tais exames.

Resumen Objetivo: analizar el proceso de limpieza de gastroscopios, colonoscopios y duodenoscopios en ocho servicios de salud intrahospitalarios. Método: estudio transversal con 22 endoscopios, de los cuales ocho eran gastroscopios, ocho colonoscopios y seis duodenoscopios, y análisis microbiológico de 60 muestras de los canales de aire/agua (todos los endoscopios) y elevador (duodenoscopios), además de prueba de proteínas. En el análisis de los datos se utilizó estadística descriptiva, con cálculo de frecuencias y medidas de tendencia central. Resultados: el procesamiento de los 22 endoscopios fue monitoreado con el análisis microbiológico de 60 canales. En la prelimpieza, en el 82,3% (14/17) de los equipos se utilizó gasa para limpiar el tubo de inserción. En el 72,3% (17/22) de los casos la inmersión del endoscopio en solución detergente fue incompleta y en el 63,6% (14/22) no hubo estandarización del llenado de los canales. La fricción del canal de biopsia no se realizó en el 13,6% (3/22) de los equipos. En el análisis microbiológico, el 25% (7/32) de las muestras endoscópicas almacenadas dio positivo para crecimiento microbiano (2x101 a 9,5x104 UFC/ml), mientras que después del procesamiento, la contaminación fue del 32% (9/28). Se detectaron residuos de proteína en el canal elevador en el 33% de los duodenoscopios. Conclusión: los resultados indican que hay importantes lagunas en las etapas de prelimpieza y limpieza de los endoscopios que, junto con la presencia de residuos de proteínas y del crecimiento de microorganismos de importancia epidemiológica, indican limitaciones en la seguridad del procesamiento, que pueden comprometer los procesos de desinfección y, por ende, el uso seguro en los pacientes que se someten a esos procedimientos.

[Use of intraoperative enteroscopy as a diagnostic method in patients with obscure gastrointestinal bleeding. Initial experience]. / Uso de la enteroscopía intraoperatoria como método diagnóstico en pacientes con sangrado gastrointestinal de origen oscuro. Experiencia inicial.

Background: Bleeding of dark origin is a rare entity and it is reserved for cases in which exploration of the small intestine has already been performed (endoscopic / radiological) without finding the cause. Currently, the gold standard is the videocapsule which has been described as a safe, useful and effective technique for the diagnosis and treatment of diseases of the small intestine. Objective: The objective was to describe demographic variables, indications, findings, explored segment, treatment and time of the surgical procedure of the intraoperative enteroscopy in 15 patients with a diagnosis of gastrointestinal bleeding of dark origin. Material and methods: 15 adult patients with the diagnosis of bleeding of dark origin with panendoscopy and negative colonoscopy to bleeding were included. All of these underwent exploratory laparotomy and intraoperative enteroscopy with a gastroduodenoscope. Results: 15 intraoperative enteroscopies were performed with a gastroduodenoscope; 10 women and 5 men with an average age of 67.2 years. Third and fourth portions of the duodenum, jejunum, and terminal ileum were explored. The diagnoses found were Crohn's disease 1 (6.66%), Adenomas 2 (13.3%), jejunal diverticulum 6 (40%) and angiectasias in 6 cases (40%). The location was in jejunum, 12 cases (80%) and ileum, 3 cases (20%). Conclusions: Intraoperative enteroscopy is a diagnostic alternative in bleeding of dark origin when there is no double balloon enteroscopy or endoscopic video capsule.

Introducción: el sangrado gastrointestinal de origen oscuro es una entidad poco frecuente y se reserva a los casos en los que ya se ha realizado exploración del intestino delgado (endoscópica/radiológica) sin encontrar la causa. Actualmente el estándar de oro es la videocápsula, que se ha descrito como una técnica segura, útil y eficaz para el diagnóstico y tratamiento de las enfermedades del intestino delgado. Objetivo: describir variables demográficas, indicaciones, hallazgos, segmento explorado, tratamiento y tiempo de procedimiento quirúrgico de la enteroscopía transoperatoria en 15 pacientes con diagnóstico de sangrado de tubo digestivo de origen oscuro. Material y métodos: se incluyeron 15 pacientes adultos con el diagnóstico de sangrado de origen oscuro con panendoscopía y colonoscopía negativa a sangrado. A todos se les realizó laparotomía exploradora y enteroscopía transoperatoria con un gastroduodenoscopio. Resultados: se realizaron 15 enteroscopías transoperatorias con gastroduodenoscopio; 10 en mujeres y 5 en hombres, con promedio de edad de 67.2 años. Se exploró la tercera y cuarta porción del duodeno, yeyuno e íleon terminal. Los diagnósticos encontrados fueron enfermedad de Crohn en 1 paciente (6.66%), adenomas en 2 (13.3%), divertículo yeyunal en 6 (40%) y angiectasias en 6 casos (40%). La localización fue en yeyuno [12 casos (80%)] e íleon [3 casos (20%)]. Conclusiones: la enteroscopía intraoperatoria es una alternativa diagnóstica en el sangrado de origen oscuro cuando no se cuente con la enteroscopía doble balón o la videocápsula endoscópica.

Uso de la enteroscopía intraoperatoria como método diagnóstico en pacientes con sangrado gastrointestinal de origen oscuro. Experiencia inicial / Use of intraoperative enteroscopy as a diagnostic method in patients with obscure gastrointestinal bleeding. Initial experience

Introducción: el sangrado gastrointestinal de origen oscuro es una entidad poco frecuente y se reserva a los casos en los que ya se ha realizado exploración del intestino delgado (endoscópica/radiológica) sin encontrar la causa. Actualmente el estándar de oro es la videocápsula, que se ha descrito como una técnica segura, útil y eficaz para el diagnóstico y tratamiento de las enfermedades del intestino delgado. Objetivo: describir variables demográficas, indicaciones, hallazgos, segmento explorado, tratamiento y tiempo de procedimiento quirúrgico de la enteroscopía transoperatoria en 15 pacientes con diagnóstico de sangrado de tubo digestivo de origen oscuro. Material y métodos: se incluyeron 15 pacientes adultos con el diagnóstico de sangrado de origen oscuro con panendoscopía y colonoscopía negativa a sangrado. A todos se les realizó laparotomía exploradora y enteroscopía transoperatoria con un gastroduodenoscopio. Resultados: se realizaron 15 enteroscopías transoperatorias con gastroduodenoscopio; 10 en mujeres y 5 en hombres, con promedio de edad de 67.2 años. Se exploró la tercera y cuarta porción del duodeno, yeyuno e íleon terminal. Los diagnósticos encontrados fueron enfermedad de Crohn en 1 paciente (6.66%), adenomas en 2 (13.3%), divertículo yeyunal en 6 (40%) y angiectasias en 6 casos (40%). La localización fue en yeyuno [12 casos (80%)] e íleon [3 casos (20%)]. Conclusiones: la enteroscopía intraoperatoria es una alternativa diagnóstica en el sangrado de origen oscuro cuando no se cuente con la enteroscopía doble balón o la videocápsula endoscópica.

Background: Bleeding of dark origin is a rare entity and it is reserved for cases in which exploration of the small intestine has already been performed (endoscopic / radiological) without finding the cause. Currently, the gold standard is the videocapsule which has been described as a safe, useful and effective technique for the diagnosis and treatment of diseases of the small intestine. Objective: The objective was to describe demographic variables, indications, findings, explored segment, treatment and time of the surgical procedure of the intraoperative enteroscopy in 15 patients with a diagnosis of gastrointestinal bleeding of dark origin. Material and methods: 15 adult patients with the diagnosis of bleeding of dark origin with panendoscopy and negative colonoscopy to bleeding were included. All of these underwent exploratory laparotomy and intraoperative enteroscopy with a gastroduodenoscope. Results: 15 intraoperative enteroscopies were performed with a gastroduodenoscope; 10 women and 5 men with an average age of 67.2 years. Third and fourth portions of the duodenum, jejunum, and terminal ileum were explored. The diagnoses found were Crohn's disease 1 (6.66%), Adenomas 2 (13.3%), jejunal diverticulum 6 (40%) and angiectasias in 6 cases (40%). The location was in jejunum, 12 cases (80%) and ileum, 3 cases (20%). Conclusions: Intraoperative enteroscopy is a diagnostic alternative in bleeding of dark origin when there is no double balloon enteroscopy or endoscopic video capsule.

Endoscope reprocessing using glutaraldehyde in endoscopy services of Goiânia, Brazil / O reprocessamento de endoscópios pelo uso do glutaraldeído: a realidade em serviços de endoscopia de Goiânia, GO

CONTEXT: The endoscopic procedure safety depends on the use of an adequately reprocessed device which quality is related to each of its operational steps. OBJECTIVE: To characterize the reprocessing of endoscopes using glutaraldehyde in endoscopy services METHODS: Study was conducted by observing the reprocessing of 60 endoscopes from 20 medical practices of the municipality of Goiânia, GO, central area of Brazil. RESULTS: This study showed failure in all reprocessing steps. The pre-washing was performed in 24 (40.0 percent) of the endoscope. In the cleaning steps, was identify the improper use of enzymatic detergent, and in 27 (45.0 percent) cases, the brushing of internal channels was not performed. All 60 endoscopes were submitted to this disinfectant. However, for 33 (55.0 percent) of the cases the internal channels was not filled. The total immersion of endoscope in the glutaraldehyde was not performed in 39 (65.0 percent) cases. The recommended minimum total immersion time for exposure to 2 percent glutaraldehyde solution was followed only for 12 (20.0 percent) endoscopes. There was no filter for water treatment used in the rinse of most endoscopes 54 (90.0 percent) and to dry the internal channels only 6 (10.0 percent) of them used compressed air. Adequate storing conditions were identified. CONCLUSION: Considering the particularities of the endoscope and its reprocessing, it is imperative to establish protocols to ensure the quality of the disinfection and the prevention of cross-contamination.

CONTEXTO: A segurança do procedimento endoscópico depende do uso de um aparelho adequadamente reprocessado e a qualidade do reprocessamento está relacionada a cada uma das etapas operacionais desse processo. OBJETIVO: Caracterizar o reprocessamento de endoscópios pelo uso do glutaraldeído em serviços de endoscopia. MÉTODOS: Estudo conduzido em 20 serviços de endoscopia digestiva do município de Goiânia, GO. A amostra se constituiu de endoscópios utilizados para endoscopia digestiva alta. Os dados foram obtidos mediante observação direta de 60 reprocessamentos de endoscópios. Resultado - Foram observadas falhas em todas as etapas do reprocessamento. Em 24 (40,0 por cento) endoscópios foi realizada a pré-lavagem. Na etapa da limpeza, foi identificado o uso inadequado do detergente enzimático e em 27 (45,0 por cento) não foi realizada a escovação dos canais internos. Todos os 60 endoscópios foram submetidos ao desinfetante, entretanto para 33 (55,0 por cento) não foi aspirado o produto nos canais internos. O tempo de exposição ao glutaraldeído foi observado apenas para 12 (20 por cento) dos endoscópios. O enxágue de 54 (90,0 por cento) dos endoscópios ocorreu com o uso de água não-filtrada e, para a secagem dos canais internos, apenas 6 (10,0 por cento) utilizaram o ar comprimido. Foram identificadas condições adequadas para o armazenamento. CONCLUSÃO: Considerando as particularidades do reprocessamento dos endoscópios é imperativo estabelecer protocolos para assegurar a qualidade da desinfecção e a prevenção da contaminação cruzada.