Overcoming Biofilm: Controlling Endoscope Reprocessing

Biofilms and Bioburden - Definitions

Biofilms are complex matrices of bacterial, fungal or protozoan cells that form on medical devices and can cause nosocomial infections. Bioburden is the number of microorganisms on a surface or in a material which, if left to dry, can make cleaning difficult and lead to biofilm formation.

The Challenges in Endoscopy

As scientific knowledge advances and infection control measures are addressed, the reprocessing of endoscopes is becoming more intricate and time-consuming. According to a 2017 article, the average hands-on time needed per endoscope during reprocessing was reported as 76 minutes. As new technologies are introduced to enhance the safety of endoscope reprocessing, this time requirement may further increase.

This time commitment is key to understanding the risk. The longer an endoscope has to dry post procedure, the greater the chance of biofilm formation.

The best way to prevent the formation of mature biofilms is to adhere to the endoscope manufacturer’s instructions for verified cleaning and the guidelines produced by the FDA and industry bodies such as the SGNA and AORN.

What do the FDA and leading manufacturers say?

Their positions are clear and unambiguous - A maximum dwell time of 60 minutes between pre-cleaning and manual cleaning. This means that as soon as the endoscope insertion tube is removed from the patient and pre-cleaning is performed, the user has 1 hour to commence manual cleaning to minimise the risk of biofilm formation. Should this timing be missed, a prolonged soaking stage must be undertaken before progressing to manual cleaning.

Facilities must establish a procedure for documenting the timing of reprocessing steps and ensure effective communication among staff members. Failure to communicate the pre-cleaning time between the technician in the procedure room and the reprocessing room staff undermines the purpose of documentation and increases the likelihood of errors. Emphasising patient safety, proper and efficient reprocessing is vital in preventing hospital-acquired infections.

"It's essential that you evaluate the effectiveness of each reprocessing step in preventing contamination. Take action today."