DS 38 - The Scoop on Scopes: Microbial Culturing and Borescope Examination of Endoscopes to Increase Patient Safety in an Acute Care Hospital

Background: Endoscopes are diagnostic tools used for imaging and biopsies in healthcare settings. These devices contain complex channels and components that can be difficult to clean and assess for damage. Literature describes endoscopes as a potential vector for transmission of multi-drug resistant organism outbreaks and hospital acquired infections (HAIs) if improperly reprocessed. A comprehensive endoscope maintenance program involving microbiologic cultures (MC) and borescope examination (BE) of the internal channel can increase patient safety and prevent HAIs.

Methods: A schedule was created, and risk assessment done to determine the frequency of BE and MC. The BE was performed in an antegrade and retrograde approach followed by endoscopic culture. A BE competency was developed to establish metrics for the degree of moisture, internal denting, channel shredding and debris. These metrics created a threshold to recommended endoscopes for repair depending on severity of BE observations. MC were performed using an aseptic “flush, brush, flush” method. Endoscopes that had positive cultures of concern or showed signs of damage were quarantined and sent for manufacturer repair.

Results: Between January 2022 and December 2023, 283 MCs were performed with 84 (30%) having at least one colony of bacterial growth. BE was performed on 177 endoscopes with findings of 43 (24%) with moisture, 47 (27%) with internal denting, 54 (31%) with channel shredding, and 20 (11%) with debris. Thirty endoscopes required repair within this 2-year timeframe based on positive culture results and/or the BE threshold established by the competency.

Conclusions: MC of endoscopes monitors device reprocessing and enhances surveillance of potential contamination to reduce the risk of HAIs related to endoscope transmission events. BE ensures device quality monitoring and when used with an established competency, helps to determine the need for repair. In summary, MC and BE can provide safer diagnostic care in healthcare settings.