Biofilm accumulation in new flexible gastroscope channels in clinical use

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.

815. Biofilm Accumulation in New Flexible Gastroscope Channels within 30 Days in Clinical Use

Background Flexible endoscopes are complex-design reusable devices, with long and narrow channels, making reprocessing difficult. Biofilm formation is a key factor for persistent contamination, as it protects microorganism against cleaning and disinfection agents. The aim of this study was to assess the accumulation of biofilm on the inner surfaces of new flexible gastroscope channels after 30 days of patient-use and full reprocessing. Methods Three flexible gastroscopes (FG) (GIF–Q150, OlympusTM) with new internal channels (TeflonTM) were subjected to 30 days of clinical use and reprocessing by trained nursing personnel, using a revised reprocessing protocol, at the endoscopy service of a Brazilian teaching hospital (235 beds). The reprocessing protocol included: pre-cleaning; manual cleaning; automated cleaning and disinfection - 2% Glutaraldehyde; manual drying (forced-air drying) and alcohol rinsing, and storage in vertical position in exclusive cabinets. Then, internal channels were removed from the three patient-ready FG (three biopsy, three air, three water and three air/water junction channels), and the inner surface subjected to bacteriological culture (~30 cm) (n=9) and Scanning Electron Microscopy (SEM) (~1 cm) (n=12). Air/water junctions (~1 cm) were subjected to SEM only. Results The average of use/reprocessing of the FG was 60 times. Bacterial growth was detected in 6/9 channels (three from FG#1 showed residual moisture) and seven bacterial isolates were recovered, most from air or water channels (Fig 1). Inner surface structural damage was identified in 11/12 channels by SEM. Extensive biofilm was detected in air, water and air/water junction channels (7/12) (Fig 2). Residuals matter were detected in all channels (12/12). Fig 1. Distribution of bacterial growth and genera/species identified in new flexible gastroscope channels after 30 days of patient-use and reprocessing at the endoscopy service of a large Brazilian teaching hospital. *FG1: flexible gastroscope nº1 **FG2: flexible gastroscope nº2 ***FG3: flexible gastroscope nº3 ¥Moisture was visually detected inside the channels during longitudinal cutting for SEM. Fig 2. Scanning Electron Micrographs showing extensive biofilm, containing bacilli/rods and/or cocci shape bacteria, on the inner surface of new flexible gastroscope channels after 30 days of patient-use and reprocessing at the endoscopy service of a large Brazilian teaching hospital. *FG1: flexible gastroscope nº1 **FG2: flexible gastroscope nº2 ***FG3: flexible gastroscope nº3 Conclusion The short timeframe before damage and biofilm accumulation in the channels were evident and suggests that improving endoscope design is necessary, while better reprocessing methods and channel maintenance needs to be investigated in detail. Improving design, maintenance and reprocessing of endoscopes will ensure safe use of these devices. Disclosures Michelle J. Alfa, B.Sc., M.Sc., Ph.D, Healthmark (Consultant, Other Financial or Material Support, Royalty monies from University of Manitoba that are provided through a License agreement with Healthmark)Kikkoman (Consultant)Olympus (Consultant, Advisor or Review Panel member, Speaker’s Bureau)STERIS (Consultant, Speaker’s Bureau)

Saints and Sinners Harold Hopkins

In 1951 a fortuitous accident of seating at a dinner party brought together Hugh gainsborough, a gastroenterologist at St george's Hospital, and Harold Hopkins, a young physicist working at Imperial College London. over dinner gainsborough lamented the inadequacies of the gastroscopic instruments of the time. The problem, he said, was that the existing rigid devices had blind spots. one could never be sure that one hadn't missed something when exploring a patient's stomach. What was needed was a flexible gastroscope that could see 'round corners'. Hopkins, a problem-solver by nature, was captivated by the notion and spent the next three years working on a design. By 1954 he had built a prototype of the world's first fibreoptic endoscope, a device that revolutionised the diagnosis and treatment of gastrointestinal ailments. It was the first, but not the last, of hopkins's great contributions to science and, in particular, to surgery.