NY Times Puts Spotlight on Duodenoscope Sterilization Challenges

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A recent article in The New York Times examines the difficulty healthcare providers face in properly sterilizing duodenoscopes.

The article — "Why Are These Medical Instruments So Tough to Sterilize?" — begins by noting the tremendous value of using duodenoscopes. It then describes the unusual and sometimes unsatisfactory cleaning process these devices must undergo. When this process comes up short, causing a duodenoscope to retain bacteria, patient safety is jeopardized. Numerous patients have become ill from contracting infections — including antibiotic-resistant infections — from dirty duodenoscopes.

As a result, the article notes, some medical experts have reached out to the U.S. Food and Drug Administration (FDA), pressing the agency to either require manufacturers to develop duodenoscopes that can be properly sterilized or take them off the market. Supporting this request is data that recently showed one in 20 duodenoscopes retained bacteria after undergoing proper cleaning processes.

In the piece, UNC Health Care's Dr. David Jay Weber, medical director for UNC, is quoted as saying, "Would you go on an airplane if the pilot said, 'By the way, there is a 5% chance the engines will fail'? Would you go in a car if the manufacturer said, 'There are airbags, but 5% of the time they won't deploy'?"

Infection Control Consulting Services (ICCS) regularly draws attention to duodenoscope infection prevention challenges. While duodenoscopes are designed differently from colonoscopes and gastroscopes, performing appropriate high-level disinfection that comply with manufacturers' instructions for use (IFUs) and nationally recognized guidelines remains critical for these scopes as well. Any shortcomings in following IFUs and guidelines can significantly increase infection risks. If your organization requires assistance with central sterile processing, learn how ICCS can help.

WHO Calls on Countries to Eliminate Hepatitis Through Investments

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The World Health Organization (WHO) is calling on countries worldwide to come together and eliminate hepatitis.

As a WHO news release notes, a new study published in Lancet Global Health finds that investing $6 billion annually to eliminate the disease in 67 low- and middle-income countries would prevent 4.5 million premature deaths by 2030, and more than 26 million deaths beyond. WHO concludes that about $60 billion is required to eliminate viral hepatitis as a public health threat in these countries by 2030, which would require a reduction in new hepatitis infections by 90% and deaths by 65%.

The plea from WHO comes at a time when the organization says the costs associated with diagnosing and treating viral hepatitis have declined. The organization noted that countries, such as India and Pakistan, are already taking advantage of reduced costs to undertake new hepatitis-focused initiatives.

The call for action came in conjunction with World Hepatitis Day. As WHO Director-General Dr Tedros Adhanom Ghebreyesus stated in the release, "Today, 80% of people living with hepatitis can't get the services they need to prevent, test for and treat the disease. On World Hepatitis Day, we’re calling for bold political leadership, with investments to match. We call on all countries to integrate services for hepatitis into benefit packages as part of their journey towards universal health coverage."

Infection Prevention Tip: Breaking Down Endoscope Bioburden

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The Infection Control Consulting Services (ICCS) team has become aware of companies that develop endoscope reprocessors incorporating a "modified manual cleaning" process that "allows for quicker and easier reprocessing, automating over half of the manual cleaning steps, including flushing of the endoscope channels."

In reviewing the instructions for use (IFUs) of a company with the "automated modified manual cleaning" option, this process should not replace or provide a "shortcut" for a full manual cleaning. ICCS strongly advises organizations to continue performing a complete, manual cleaning of every scope, especially when this step is highlighted in the endoscope manufacturer’s IFUs and other reprocessing standards.

Facilities must follow IFUs developed by the scope manufacturers, scope reprocessor equipment manufacturers and manufacturers of cleaning and high-level disinfection (HLD) products. In addition, standards and recommendations of nationally recognized organizations, associations and agencies, if selected by the facilities, must be taken into consideration.

For example, the Centers for Disease Control and Prevention (CDC) through the Healthcare Infection Control Practices Advisory Committee (HICPAC) released recommendations in 2016 with an update in 2017 titled "Essential Elements of a Reprocessing Program for Flexible Endoscopes." Its recommendations include the following: "Manual cleaning is the most critical step in the disinfection process since residual organic material can reduce the effectiveness of HLD and sterilization."

AORN, SGNA and AAMI provide standards for reprocessing scopes, which also include manual cleaning in their guidance.

ICCS advises facilities to perform scope cleaning verification as another critical step in assuring reprocessing effectiveness. There are several verification methods and products available to assist facilities with the goal of effective reprocessing of scopes.

Study: Educating Cleaning Staff Lowers Risk of C. Diff Infection

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The results of a study show that better educating environmental services workers leads to an improvement in surface cleaning and decrease in hospital-onset C. difficile infection (CDI).

The study, titled "Sustained improvement in hospital cleaning associated with a novel education and culture change program for environmental services workers" and published in Infection Control & Hospital Epidemiology, was conducted across multiple hospitals. It involved more than 350 frontline service workers participating in educational programs.

The programs combined education techniques, such as videos, demonstrations and role-playing, to cover a wide range of topics, including hand hygiene, isolation precautions, personal protective equipment, cleaning protocols and barriers to cleaning.

Researchers evaluated the effects of the education on workers' performance in cleaning individual high-touch surfaces. The results showed that the frequency of cleaning such surfaces in occupied rooms increased from 26% to 62%, with improvement sustained for a year following the education.

Furthermore, a significant decrease in CDI was associated with the program.