Insights from Expert Round Table @ PENTAX Medical R&D Center Augsburg
Experts in endoscopy: infection risk mitigation in reprocessing deserves more attention and a holistic approach
AUGSBURG, 21 October 2019 –Flexible endoscope reprocessing is essential for infection risk mitigation in endoscopy. As the importance of Endoscopic retrograde cholangio-pancreatography (ERCP) procedures and their impact on patients’ lives remains unwavering, the medical community is continuously looking for ways to improve this field of expertise. To this end, on October 9th a multidisciplinary expert panel gathered at PENTAX Medical’s R&D Center in Augsburg (Germany), to develop new insights into infection risk mitigation in endoscopy.
The experts, consisting of physicians, nurses, microbiologists, infection control experts, and researchers, exchanged views on topics such as the risk of infection with flexible endoscopes, the role of human factors-validated training, the importance of drying and new FDA recommendations on disposable endoscope components. They concluded that the available data on the risk of infection is only the tip of the iceberg, expressing that infection risk mitigation deserves a holistic and comprehensive approach.
Time pressure reported by 75% of staff
Reprocessing staff play a major role in infection risk mitigation. However, research shows that in 45% of cases key reprocessing steps are skipped (a). Additionally, 75% of the reprocessing staff reported time pressures and non-compliance with guidelines related to reprocessing as a result (b). The experts present agreed that the human factors aspects of reprocessing can never be completely avoided. However, staff can be empowered by measures that can be implemented in the short term to reduce infection risk. For example, simplifying Reprocessing Instructions For Use (IFU), relieving the time pressure on employees, and training on competencies rather than cognitive knowledge only, really explaining why reprocessing is so important.
“Manual cleaning is still the most important step in reprocessing. However, in daily practice this stage is often downgraded to just a simple flush and brush. I call upon the field, to shift from reprocessing quantity to quality” said Paul J Caesar, Infection Control Expert, Tjongerschans Hospital, The Netherlands.
The importance of drying
Drying endoscopes after reprocessing is recognized to be crucial for reducing the risk of infection. Whereas a humid environment facilitates microbial growth during storage (c). The experts underlined that this step should be presented as equally important as any other reprocessing step.
“Across Europe there is not yet a complete consensus on drying recommendations. This leaves the responsibility with the reprocessing staff and may lead to pitfalls in endoscope drying.” said Dr. Helen Griffiths, Endoscopist and Decontamination Advisor at the British Society of Gastroenterology.
In August of this year, the FDA recommended healthcare facilities and manufacturers to begin transitioning to duodenoscopes with disposable components to reduce the risk of patient infection.
“A solution to the risk of infection, is to modify current endoscopes so that they have disposable parts. Especially the parts that are most receptable to contamination. Another solution would be to have disposable endoscopes. This of course introduces questions about pricing and the environmental impact, of which need to be solved by manufacturers and medical facilities before this solution can be used in daily practice” said Dr. Marco Bruno, Endoscopists and Professor at the Erasmus University Rotterdam.
Infection risk mitigation
Generally, ECRP procedures remain very safe for patients and allow the least-invasive manner for diagnosis and treatment for many biliopancreatic disorders and conditions. Yet, post-ERCP infections typically range between 2% and 4% (d).
“At PENTAX Medical we are committed to addressing the medical device hygiene challenges by offering innovative solutions that minimize the risk of infection, improve clinical outcomes, enhance the patients’ experience and healthcare productivity within endoscopy. We do so by using integrated feedback from all clinical stakeholders, optimizing reprocessing processes, and innovating products to directly tackle patient safety and infection prevention needs” said Dr. Hudson Garrett Jr., Global Chief Clinical Officer at PENTAX Medical and Assistant Professor of Medicine in the Division of Infectious Disease at the University of Louisville School of Medicine.
As part of this commitment, PENTAX Medical introduced two innovative product solutions that reduce the risk for infection transmission. The DEC™ Duodenoscope (ED34-i10T2) aims to achieve this by eliminating the riskiest components of the endoscope, the distal end and elevator, and replacing it by a single-patient use sterile, disposable distal cap with integrated elevator. Additionally, using the PlasmaTYPHOON to ensure the device is fully dry reduces the risk for microbial growth and subsequent potential contamination that can result from moisture.
There was a consensus at the expert panel, alluding to PENTAX Medical’s strong commitment to the risk of infection in endoscopy. Recognizing PENTAX Medical’s efforts as pioneers in designing solutions that mitigate the risk of infection. The experts committed to keep raising the importance of infection control, and continuously looking for new solutions.
Would you like to know more about PENTAX Medical’s hygiene commitment? Visit www.the-hygiene-solution-that-fits.com.
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About PENTAX Medical
PENTAX Medical is a division of HOYA Group. Its mission is to improve the standard of patient care and quality of healthcare delivery by providing the best endoscopic products and services with a focus on QUALITY, CLINICALLY RELEVANT INNOVATION, and SIMPLICITY. Through leading edge R&D and manufacturing, PENTAX Medical provides endoscopic imaging devices and solutions to the global medical community. Headquartered in Japan, PENTAX Medical has a worldwide focus and presence with R&D, regional sales, service, and in-country facilities around the globe. For more information, please visit: www.pentaxmedical.com.
Founded in 1941 in Tokyo, Japan, HOYA Corporation is a global technology and med-tech company and a leading supplier of innovative high-tech and medical products. HOYA is active in the fields of healthcare and information technology, providing eyeglasses, medical endoscopes, intraocular lenses, optical lenses, as well as key components for semiconductor devices, LCD panels, and hard disk drives. With over 150 offices and subsidiaries worldwide, HOYA currently employs a multinational workforce of 38,000 people. For more information, please visit http://www.hoya.com.
(a) Ofstead et al. Endoscope reprocessing methods. A prospective study of human factors and automation. Gastrointestinal Nursing. 2010; Vol 33. No 4, pp 304-311
(b) Beilenhoff U et al. Reprocessing in GI Endoscopy: ESGE-ESGENA Position Statement. Endoscopy 2018; 50].
(c) Kovaleva et al: Clinical Microbiology Reviews p. 231–254 2013
(d) Rauwers AW, et al. Gut 2018;0:1–9. doi:10.1136/gutjnl-2017-315082