How Endoscope Technology Is Changing to Address Superbug Outbreaks

By Barry Eitel

Over the past few years, hospitals are experiencing a rising trend in patients becoming sick because of infections contracted after an endoscopy procedure. Some 180 patients were exposed to a superbug at Ronald Reagan UCLA Medical Center in 2015, an infection that proved fatal for at least three people.

A resulting investigation by members of the United States Senate in early 2016 found that one type of scope, which proved hard to clean and disinfect, was linked to at least 25 superbug outbreaks worldwide. And last year, the family members of a patient who died of a scope-related infection in 2013 were awarded $1 million by a Seattle-area jury.

The issue of effective cleaning of scopes is extremely serious, but the technology is now changing. Fortunately, information and training are becoming more readily available.

“In order to undergo effective high-level disinfection or sterilization, flexible endoscopes must be properly cleaned and free of bioburden and biofilms,” said Rebecca Taylor Alvino, an infection control practitioner at UCSF Health.

Alvino will join Carolyn Caughell, another UCSF Health perioperative infection control practitioner, at the APIC Conference, held June 13 to 15 in Minneapolis, to lead a pre-conference Interactive Skills Lab. The workshop will be held on June 12 and is titled “Practical Solutions to Reduce Infection Risk and Ensure Compliance Through Live Clinical Simulations.” The pair will share their extensive knowledge about the latest reprocessing techniques during an engaging educational session.

The Changing Technologies

Scope cleaning and disinfection processes are changing in an attempt to halt the spread of superbugs. Manufacturers are updating instructions for use (IFU) to ensure that scopes are more efficiently cleaned and disinfected. Methods for cleaning scopes are becoming more sophisticated, as well.

“New technologies for ensuring effective cleaning are emerging into the marketplace, including checks for biological remnants that are not always visible to gross examination and that provide more immediate data than culturing of endoscopes,” Alvino said.

Alvino sees that single-use, sterile microbial sheaths for scopes are becoming more popular in hospitals across the country. Manufacturers themselves are also releasing scopes that are more disposable.

“The FDA-approved devices claim to reduce the disinfection need from high level to intermediate between patient uses, so long as the single-use sheath remains intact and no evidence of moisture is noted on the endoscope underneath,” Alvino explained. “As a means of reducing, or even eliminating the need for reprocessing, more device manufacturers are developing and taking single-use and single-patient-use flexible endoscopes to market.”

Caughell added that technology allows for more comprehensive chemical sterilization of scopes. Other systems allow practitioners to better recognize that devices are devoid of dangerous bacteria.

“Some of the biggest shifts in cleaning and disinfection of scopes have been in the discussion surrounding liquid chemical sterilization and microbial culturing with quarantine until negative culture,” Caughell said.

The Changing Challenge

Of course, challenges remain with adopting and implementing these new scope and cleaning technologies.

Caughell and Alvino agreed that a huge challenge is ensuring that IFU actually explain how to effectively disinfect scopes. Alvino cited studies that show infections occurred even when IFU were followed exactly, a factor that can prove demoralizing for staff.

“For the technician cleaning that scope, that can impart a feeling of futility,” she said. “Even following some of these IFU to the letter is not effective; evaluating reliable methods beyond gross examination for achieving cleanliness is necessary and should be embraced as a potential tool for helping to ensure device safety.”

Communicating new standards for cleanliness will require attention, believes Caughell.

“Some of the challenges in making these shifts relate to personally reaching the employee who is performing this work and gaining buy-in,” Caughell noted. “It is hard to communicate that, despite following an IFU and performing your job exactly as described, the scope is not clean based on a new metric.”

The Changing Training

To support this level of communication and training, Alvino and Caughell believe leadership of healthcare organizations needs to stress the importance of keeping endoscopes safe for every patient use and encourage training in the latest methods of scope cleaning.

“Buy-in to the importance of flexible endoscope safety—from the hands that reprocess to the device users to the leaders making system-level decisions—is critical,” Alvino said.

“The criticality of effective endoscope reprocessing, including the time, training, and equipment requirements for reprocessing endoscopes, and the magnitude of infection risk when poorly performed, must be clearly communicated to engage senior leaders and device users.”

Effective cleaning for scopes needs to be an organization-wide goal.

“Building a strong program starts at the top,” Caughell said. “It is imperative for leadership of either the healthcare organization or the practice setting to truly appreciate the hard work required to properly reprocess these complex instruments. Leadership can then ensure that staff have sufficient resources, both human and material, to do the job correctly by following a manufacturer’s IFU.”

Attending APIC

The pre-conference interactive lab led by Alvino and Caughell at this year’s APIC Conference is an example of such holistic training in the latest techniques. When asked who should attend their skills lab, the two had the same answer: “Everyone.”

“Everyone who feels unsure about what to look for when assessing endoscope reprocessing spaces and procedures, or who just wants to learn more about the intricacies of device reprocessing,” Alvino said. “It doesn’t matter the size of the facility or the experience an attendee may have in infection prevention.”

“The APIC Interactive Skills Lab allows attendees to visualize and feel the complexities of device reprocessing, and provides a safe space for questions to be answered,” she added. “The hands-on training provides the opportunity for attendees to see elements of device reprocessing and identify what’s right, what’s wrong, and how to approach inquiries that can come from senior leaders, device users, and reprocessing partners about providing the safest devices for use in patient care.”

Caughell added that the information shared at the lab will be easy to understand.

“I think that everyone should attend this Interactive Skills Lab,” she said. “Every IP who has any reprocessing oversight will find this lab both educational and entertaining. We are going to make a seemingly overwhelming and scary topic tangible, and will provide participants with tools that they can bring back and use in their facilities.”

Join thousands of healthcare professionals from around the world to expand your network and learn about evidence-based advances in infection prevention at APIC 2018, June 13 to 15, in Minneapolis. Register today.