Original article
Clinical endoscopy
Inspection of endoscope instrument channels after reprocessing using a prototype borescope

https://doi.org/10.1016/j.gie.2018.04.2366Get rights and content

Background and Aims

Visual inspection of the instrument channel has been proposed as a quality assurance step during endoscope reprocessing. However, the nature and severity of findings in a broad array of endoscopes (gastroscopes, colonoscopes, duodenoscopes, and echoendoscopes) after systemic implementation of an inspection protocol remain unknown. In addition, a study using borescope inspection in upper endoscopes and colonoscopes raised concerns about persistent simethicone residue despite full reprocessing.

Methods

A pilot inspection study using a prototype borescope (SteriCam Inspection Scope; SteriView Inc, San Rafael, Calif) was performed on routinely used endoscopes after high-level disinfection, manual forced-air dry of the instrument channel, and overnight vertical storage. Video recordings 1.5 to 2 minutes in duration were reviewed for visible moisture, debris, discoloration, scratches, channel shredding (scratches that result in strips or filaments of the channel lining protruding into the lumen), and visible evidence of biofilm or simethicone residue.

Results

A total of 97 inspections of 59 endoscopes were reviewed. The most common finding was scratches, seen in 51 devices (86%). Channel shredding was found in 35 devices (59%). Intrachannel debris was identified in 22 (23%) of the 97 inspections. No moisture was seen (0%) in the 74 inspections performed after forced-air dry and overnight vertical storage compared with moisture in 5 of 18 inspections (28%) performed after storage alone. No visual evidence of biofilm or simethicone residue was discovered despite its frequent use in our unit.

Conclusion

Internal defects of the instrument channel appear to occur frequently. Manual forced-air drying of the channel appears to be highly effective in eliminating moisture compared with overnight hang drying alone. Video inspection of the endoscope channel may be useful to audit reprocessing performance and to identify damaged endoscopes.

Section snippets

Methods

A pilot study was developed using a prototype video camera, the SteriCam Inspection Scope (SteriView Inc, San Rafael, Calif). This device is a reusable flexible borescope that connects via a universal serial bus cable to a laptop with proprietary software to view and record live video and images. The borescope captures a digital image with a native resolution of 400 × 400 pixels, processed to 800 × 800 pixels for display. The outer diameter is 2.3 mm with a 110-cm working length, allowing it to

Results

A total of 111 inspections of 59 unique devices was performed. Five duodenoscopes and 6 curved linear-array echoendoscopes were produced by Pentax Medical (Tokyo, Japan), and the remaining 48 devices were made by Olympus Corporation. Five inspections used in the run-in period were excluded from the final analysis. An additional 9 videos were excluded because of loss of data or poor video quality (eg, inspection speed was too rapid). The findings of the remaining 97 inspections of 59 unique

Discussion

In this pilot study, systematic video inspection of the working channels of routinely used endoscopes revealed a high prevalence of visible defects in the channel lining and leftover debris despite manual cleaning, HLD, and forced-air drying. Compared with prior case reports, this study incorporated a larger number and variety of endoscopes, with a particular focus on elevator-containing devices, which were implicated in numerous outbreaks of patient infections.14

Among the most prominent

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    During this study, visual inspection with magnification and borescopes identified actionable defects that could interfere with reprocessing effectiveness in 100% of fully processed endoscopes. Previous publications described defects discovered by researchers,12,17,19,20,23 rather than nursing staff or reprocessing technicians. In this study, endoscopy personnel mastered the use of visual inspection tools with just a few hours of training and support by the research team.

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DISCLOSURE: The following authors disclosed financial relationships relevant to this publication: S. Kim, A. Sedarat: Consultant for Boston Scientific. V.R. Muthusamy: Consultant for Boston Scientific and Medivators. All other authors disclosed no financial relationships relevant to this publication. The Inspection Scope and computer for video recordings for this study were provided by SteriView Inc.

If you would like to chat with an author of this article, you may contact Dr Muthusamy at [email protected].

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