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CC BY-NC-ND 4.0 · Endosc Int Open 2024; 12(01): E68-E77
DOI: 10.1055/a-2185-6035
Original article

Assessment of endoscope reprocessing at World Gastroenterology Organisation training centers using adenosine triphosphate testing

Kavel Visrodia
1   Division of Digestive and Liver Diseases, Columbia University Irving Medical Center – New York Presbyterian Hospital, New York, USA (Ringgold ID: RIN21611)
,
Dianne Jones
2   Department of Gastroenterology & Hepatology, Logan Hospital, Queensland, Australia
,
Melissa Jennings
3   Department of Gastroenterology and Hepatology, Royal Perth Hospital, Perth, Western Australia, Australia (Ringgold ID: RIN6508)
,
Catherine Conway
4   Gastroenterological Nurses College of Australia, New South Wales, Australia
,
Herbert Burgos
5   Gastroclinica WGO Training Center, San Jose, Costa Rica
,
Jioji Malani
6   School of Public Health and Primary Care, Fiji National University, Suva, Fiji (Ringgold ID: RIN227185)
,
Elly Ogutu
7   Department of Internal Medicine, University of Nairobi, Nairobi, Kenya, Africa (Ringgold ID: RIN107854)
,
Nonthalee Pausawasdi
8   Siriraj GI Endoscopy Center and Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand (Ringgold ID: RIN65106)
,
Luis Sabbagh
9   Department of Gastroenterology, Reina Sofia Clinic and Colombia University Clinic, Bogota, Colombia
,
Desmond Leddin
10   Department of Medicine, Dalhousie University, Halifax, Canada (Ringgold ID: RIN3688)
,
Blake Kassmeyer
11   Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, United States (Ringgold ID: RIN6915)
,
Ryan J. Lennon
11   Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, United States (Ringgold ID: RIN6915)
,
Mark D. Topazian
12   Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, United States (Ringgold ID: RIN4352)
› Author AffiliationsSupported by: World Gastroenterology Organisation
Supported by: 3M
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Abstract

Background and study aims Adequacy of endoscope disinfection in resource-limited settings is unknown. Adenosine triphosphate (ATP) testing is useful for evaluation of endoscope reprocessing, and ATP <200 relative light units (RLUs) after manual endoscope cleaning has been associated with adequacy of endoscope disinfection.

Methods Consecutive endoscopes undergoing reprocessing at five World Gastroenterology Organisation (WGO) training centers underwent ATP testing before and after an on-site educational intervention designed to optimize reprocessing practices.

Results A total of 343 reprocessing cycles of 65 endoscopes were studied. Mean endoscope age was 5.3 years (range 1–13 years). Educational interventions, based on direct observation of endoscope reprocessing practices at each site, included refinements in pre-cleaning, manual cleaning, high-level disinfection, and endoscope drying and storage. The percentage of reprocessing cycles with post-manual cleaning ATP ≧200 decreased from 21.4% prior to educational intervention to 14.8% post-intervention (P=0.11). In multivariable logistic modelling, gastroscopes were significantly less likely (odds ratio [OR] 0.04, 95% confidence interval [CI] 0.01–0.19; P<0.001) than colonoscopes to achieve post-manual cleaning ATP < 200. No other factor (educational intervention, study site, endoscope age) was significantly associated with improved outcomes. Endoscope ID was not significantly associated with ATP values, and sites that performed manual versus automated HLD did not have significantly different likelihood of post-manual cleaning ATP <200 (OR 1.18, 95% CI 0.56–2.50; P=0.67).

Conclusions In resource-limited settings, approximately 20% of endoscope reprocessing cycles may result in inadequate disinfection. This was not significantly improved by a comprehensive educational intervention. Alternative approaches to endoscope reprocessing are needed.

Keywords

Quality management - Hygiene - Quality and logistical aspects

Supporting information



Publication History

Received: 11 April 2023

Accepted after revision: 21 September 2023

Accepted Manuscript online:
04 October 2023

Article published online:
08 January 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

Comment to this article:

Endoscopy International Open – recently publishedEndoscopy 2024; 56(03): 246-246
DOI: 10.1055/a-2224-8288

 

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