Rinse water quality’s marked impact in focus

Speaking at the IHEEM 2017 Cardiff Regional Conference and Exhibition at Cardiff City Stadium, Christina Bradley, Laboratory manager at the Hospital Infection Research Laboratory at Queen Elizabeth Hospital Birmingham, discussed the topic, ‘Endoscopy: are we safe to rinse endoscopes in the water as supplied?’ As HEJ editor, Jonathan Baillie, reports, her presentation provided valuable advice for professionals ranging from estates and facilities personnel to infection control, CSSD, and clinical staff, on ensuring that the final rinse water used in washer-disinfectors is kept safe and, as far as possible, bacteria-free, to protect patients undergoing endoscopic procedures against infection. 

Christina Bradley opened her presentation by saying how pleased she was to have been invited by IHEEM ‘to talk about a subject with which I have been involved with for many years, and feel very passionate about’. Beginning with some background on how today’s endoscopes have evolved, she said: “Endoscopes have been around for many decades, and we have seen significant evolution in their development and complexity, plus the introduction of washer-disinfectors to decontaminate them.” As a cautionary tale of what can happen without sufficient care, she showed a slide of a £70,000 endoscope ‘that had unfortunately got autoclaved – not a pretty sight’. She said: “The damage to this expensive piece of equipment underlines the importance of training when dealing with these instruments. Today’s endoscopes – supplied by specialist companies such as Olympus Medical – have numerous channels, used for insufflation, washing of mucosa, sucking out debris, taking biopsies, and diathermy, and are extremely intricate (Fig 1). A typical colonoscope may incorporate 2.5 metres of narrow channels, ranging from 2-4 mm in diameter, so they are intrinsically tricky to clean (Fig 2). There are also the more complex scopes used for ERCP, a procedure that involves removing stones from the gall bladder and examining the bile duct.” The latter, Christina Bradley explained, have a very complex end, with a razor bridge, and there have been a number of outbreaks, especially in the US and parts of Europe, associated with these endoscopes and multidrug-resistant Gram-negative organisms. The speaker said: “The manufacturers introduced the complexity to these instruments by increasing what you could actually do with them, which in turn increased the number of issues associated with their decontamination.”

Poorly used at times