the February American Journal of Infection Control
(osmag.net/C8WRex), raised the frightening possibility that you can't
count on current reprocessing practices to consistently decontami-
nate your scopes — even if, and it's a mighty big if, your techs meticu-
lously follow reprocessing guidelines and don't take shortcuts.
"The study was kind of chilling, but I was not shocked by it," says
Chris Lavanchy, the engineering director of ECRI Institute's Health
Devices Group. "Many people have long been suspicious that the manu-
al cleaning process is not 100% reliable."
Twelve of the 20 reprocessed scopes examined during the 7-month
study tested positive for microbial growth, indicating a failure of the
disinfection process, despite being disinfected using the current
guidelines. Researchers found that all 20 endoscopes had visual irreg-
ularities, such as fluid, discoloration and debris in the channels. The
finding of residual fluid was significant because any bacteria present
will flourish in a moist environment and lead to the development of
biofilm — which can be difficult or impossible to remove, says lead
study author Cori Ofstead, MSPH, an epidemiologist and president
and CEO of Ofstead & Associates in St. Paul, Minn.
"If the scope's not clean, it can't be disinfected or sterilized. If the
scope is damaged, it can't be disinfected or sterilized," says Ms.
Ofstead.
In implicating the critical point-of-use precleaning and cleaning
steps that precede the disinfection cycle as the weak links in the
reprocessing chain, the study hammers home the point that you can't
disinfect a dirty scope.
"Ever tried to wash a plate that has a bit of dried egg on it?" asks Mr.
Lavanchy in a fitting dishwashing analogy. "There's so much emphasis
on the disinfection process that we often overlook the cleaning step. But
if you don't clean properly, you can't ensure that you can effectively dis-
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