Their design also includes a tight, small space around the forceps
"elevator" mechanism that is especially hard to clean. Any malfunc-
tion in the manual cleaning process can leave behind infectious bacte-
ria, which can then colonize on the device and contaminate the next
patient.
If any good has come out of the superbug outbreak, it's that it's now
clear that redesigning duodenoscopes so that they're easier to clean
must be a top priority for manufacturers. They're under a lot of pres-
sure from customers and the government to figure this out, and my
sense is that they're hard at work on it. Fujifilm Medical Systems,
USA, 1 of the 3 U.S. manufacturers selling duodenoscopes, last month
published revised, validated reprocessing instructions for the
ED-530XT, one of its duodenoscope models (osmag.net/Rn5CCn). The
cleaning instructions call for a new disposable cleaning brush to be
used to clean the duodenoscope's distal tip, forceps elevator and ele-
vator recess.
Designed to be easier to reprocess?
That doesn't sound like much until you consider that most recent duo-
denoscopes advancements seem to have been geared more toward
making them more efficient and effective, and less toward making
them easier to clean and reprocess.
Can they be made easier to reprocess — without adding substantial-
ly to the already hefty $40,000-per-scope price tag? Well, yes, it may be
possible to make parts of them disposable. Designing them in such a
way that the lumens could be completely removed between cases
could also greatly reduce the risk. Some have toyed with the idea of
making parts of the scope in such a way that they could be disassem-
bled for cleaning. But there are potential drawbacks there. When you
disassemble a tiny mechanism, there's a good chance you won't
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