Antibacterial strategies in digestive endoscopes: key to avoiding cross-infection
Abstract: Indigestion endoscopy is of paramount importance in the diagnosis and treatment of diseases in the digestive system. However, because of the complexity of the endoscopy structure, the special material and the frequency of its use, there is a high risk of cross-infection if disinfection is not complete. The present paper elaborates on the critical situation of co-infections associated with digestive endoscopy, common pathogens and their means of transmission, and explores in depth the current standard process of impregnation and sterilisation of the endoscopy, including the main points and concerns of pre-cleaning, enzyme washing, bleaching, disinfection and drying. At the same time, the classification of endoscopy attachments and the prospects for the application of new antibacterial materials and technologies in the field of digestive endoscopy were presented. The aim was to emphasize the critical importance of strict application of antibacterial strategies for ensuring the safety of patients and improving the quality of care, and to provide a comprehensive and practical reference base for insulating endoscopy care providers and associated medical workers.
Introduction
The rapid development of the digestive endoscopy technology has led to a wider use of clinical treatments, such as stomach mirrors, colonoscopy, mesmeric lenses, etc., which not only observe intuitively internal pathologies in the digestive tract, but also perform a variety of micro-surgery operations, such as biopsy, salivation and bleeding under the endoscopy. But the attendant risk of cross-infection has also become a medical safety issue that cannot be ignored. In the event of a cross-infection, it may lead to an increase in the patient ‘ s condition, an extension of the treatment cycle, or even a serious outbreak of hospital infections, causing significant damage to the patient ‘ s health and the reputation of medical institutions. Therefore, in-depth study and rigorous application of anti-bacterial strategies in digestive endoscopy are extremely relevant.
II. Status of co-infections associated with digestive endoscopy
In recent years, there have been reports of cross-infection due to irregularities in digestive endoscopy. In some hospitals, for example, there have been cases of bacteria (CRE) transmission of carbon-resistant carcinoliacacteria (CRE) due to gestoscopy, resulting in several infections and causing widespread concern. In addition, common pathogens, such as cholesterol, Hepatitis B virus, Hepatitis C virus and various intestinal pathogens, are likely to spread between patients through contaminated endoscopy. The relatively high incidence of cross-infection in health-care facilities with high endoscopy levels and gaps in disinfection management highlights the urgency of strengthening antibacterial strategies for digestive endoscopy.
III. Phenomenons for digestion of endoscopy intersectional infections and means of transmission
1. Common pathogens
• Sphinx (Hp): A high rate of infection among patients with stomach diseases, which can be transmitted through endoscopy surfaces, biopsy, etc., and, if disinfection is incomplete, can easily cause infection between patients, leading to Hp eradication treatment failure or re-infection.
Viruses: Hepatitis B (HBV) and Hepatitis C (HCV) are mainly transmitted by blood, and when a person suffers from mucous membrane bleeding during an endoscopy examination, the residual virus is likely to be infected with the patient for the follow-up examination if the endoscopy is disinfected. In addition, there is a similar risk of transmission of the human immunodeficiency virus (HIV), which, despite its relatively low probability of transmission, has extremely serious consequences when it occurs.
• Bacteria: In addition to CRE, there are fungus common intestines, such as yellow grapes and coliform. These bacteria can cause infection in the body at the time of the patient ‘ s examination, after they have been planted in the inner lenses and in the prostheses. 2. Means of dissemination
• Direct exposure: Direct contact with contaminated endoscopy surfaces, accessories (e.g., biopsy, entraps, etc.) is the most important means of transmission. For example, the pathogen of the disease in the last patient is attached to the inner mirror, and the next patient is likely to be infected at the time of the examination without thorough cleaning.
• Indirect exposure transmission: transmission of pathogens through indirect exposure through contaminated endoscopy washing equipment, disinfectants, storage containers, etc. If the cleaning equipment itself is not in place, the pathogen may be transmitted to the inner mirrors during the cleaning process; the non-qualified disinfectant cannot effectively kill the pathogens, but may instead become the vector of the pathogens; and the storage containers are vulnerable to contamination if they are not periodically disinfected.
IV. Standard procedures for the disinfection and sterilization of digestive endoscopy
Pre-cleaning
Pre-cleaning should be carried out immediately after the end of the endoscope examination, so as to prevent the drying of the lens surfaces and pipes, such as secretions, blood, etc., from becoming more difficult to clean. The primary removal of large amounts of contaminants is generally done using the exterior surfaces of the liquid water rinsing lenses, biopsy vents, attracting pipes, etc. In doing so, care should be taken to avoid contamination of the surrounding environment by splattering pollutants. 2. Enzymes
• Use of suitable polyase washing agents to impregnate the inner mirrors, which can decompose organic pollutants such as proteins, fats and carbohydrates, and improve the cleaning effect. The immersion time is 5 – 10 minutes, as required by the scrubber instructions. The immersion process ensures that all parts of the endoscope are fully exposed to the detergent, and that, through syringes, the detergent is injected into the active pores, attracts pipes, etc., so that the piping is also adequately cleaned. Floating
• After enzymes are washed, the inner mirrors are thoroughly washed with liquid water, and residual enzyme cleaners and contaminants are removed. Flowing should be done with pure or sterile water to prevent further impurities in the water from contaminating the inner lens. For the piping component, there is also a need for repeated washing with a large amount of water injected with syringes to ensure that there are no detergents and residual contaminants. 4. Sterilization
• Select appropriate sterilization methods based on the type and use of endoscopy.
• High-level disinfection: Most digestive endoscopes, such as stomach mirrors, colonoscopy, etc., use high-level disinfection. The most common disinfectants are 2% alkaline pedaldehyde, phenylenedialdehyde (OPA), etc. Sterilization is performed strictly in accordance with the requirements of the sterilizer ‘ s use concentration, time of operation and temperature. For example, 2 per cent of alkaline peptodiadehyde impregnated gastric lenses typically take not less than 10 minutes, and phenylenedisol impregnated for 5 minutes. In the course of disinfection, it is ensured that the endoscopy is completely immersed in the disinfectant and that the concentrations of the disinfectant are regularly monitored and replaced in a timely manner when the concentration is below the effective concentration.
• Vaccination: Endoscopy and accessories, such as abdominal lenses, joint lenses, etc., must be treated. Common methods of sterilization include Ethylene-Ethylene Ethylene (Ethylene-Ethylene-Ethylene-Ethylene-Ethylene-Ethylene-Ethylene-Ethylene-Ethylene-Ethylene-Ethylene-Ethylene-Ethylene-Ethylene-Ethylene-Ethylene-Ethylene-Ethylene-Ethylene-Ethylene-Ethylene-Ethylene-Ethylene-Ethylene-Ethylene-Ethylene-Ethylene-Ethylene-Ethylene-Ethylene-Ethylene-Cylene-Cylene-Cylene-Cyridium-Cylene-Cyridium-Cylene-Cylene-Cylene-Cymyl-Cymyl-Cylene-Cylene-Cylene-Cymyl-Cymyl-Cymyl-C-A-A-C Ethylene oxide has a long cycle and generally takes 10 – 16 hours, including pre-treatment, sterilisation, ventilation, etc., and epoxyethane is of a certain toxicity and needs to be performed in specialized antibacterial equipment and to be strictly controlled at environmental concentrations. The cryogenic plasma sterilisation is relatively rapid and is normally completed in 30 – 60 minutes, but there are certain requirements for the content and structure of the endoscopy, not all of which are applicable. Dry
• The impregnated endoscopy should be thoroughly dry, with the use of compressed air drying or non-bacterial veils for dry endoscopy surfaces, while syringes are used to inject air into active pores, attract pipes, etc., and to blow water into dry pipes. Post-dry endoscopy should be stored in a dedicated endoscopy cabinet, which should be regularly cleaned, kept dry and ventilated and prevented from being contaminated again.
V. Treatment of digestive endoscopy attachments
1. One-time annex
• One-time biopsy, entrapment, injection, etc., should be used and collected, packaged and rendered harmless by qualified medical waste treatment facilities, in strict compliance with medical waste treatment requirements. One-time annexes are strictly prohibited for reuse in order to avoid the occurrence of cross-infection. 2. Duplicate use of annexes
• Repeated use of accessories, such as biopsy, after which they should be cleaned separately from endoscopy. Pre-cleaning is first carried out to remove surface contaminants and then treat them with the same cleaning and disinfection process as the endoscopy, i.e. enzyme washing, bleaching, disinfection and drying. Sterilization methods can be selected according to the material and tolerance of the annexes, e.g. high-temperature biopliers may be used for high-pressure vapour and high-temperature impregnated chemicals, etc. In the process, particular attention should be paid to the decontamination of the parts of the annex, such as joints, rodents and so forth, to ensure that no pathogens remain.
VI. Prospects for application of new antibacterial materials and technologies in digestive endoscopy
Some new antibacterial coatings such as nanosilver coatings and antibacterium coatings are gradually being applied in the digestive endoscopy field. Nanosil has broad-spectral antibacterial properties that inhibit the growth and reproduction of many bacteria, viruses and fungi. After covering the nanosilver coatings on the periscope surface, antibacterial effects can be sustained over a period of time and the implantation of pathogens on the iniscope can be reduced. Antibacterium is an antibacterial micrometeoroid with the advantage of rapid bacterial enzyme and resistance, and in-sight application research is also deepening and is expected to become a new antibacterial means of digestion in the future. 2. Improvement of automated cleaning and decontamination equipment
As technology develops, automated cleaning and decontamination equipment is being upgraded. New types of equipment are more intelligent and accurate in the cleaning process, and are able to automatically adjust sterilisation parameters to the type of endoscopy, such as current pressure, the amount of washing agent used, the time of disinfection, etc., thus increasing the effectiveness and consistency of sterilisation. At the same time, equipment has increased the monitoring function of the clean-up process, such as real-time monitoring of disinfectant concentrations, water temperature, plumbing pressure, etc., and timely alerts in case of anomalies, which ensures the safety and reliability of the clean-up process.
Conclusion
Antibacterial strategies in digestive endoscopes are key to ensuring the safety of patients and preventing cross-infection. Strict implementation of the standard process of sterilisation and sterilization of the digestive endoscopy, proper handling of the endoscopy annexes and active exploration of the application of new antibacterial materials and technologies are of great importance in reducing the incidence of cross-infection associated with the digestive endoscopy. Indigenoscopy care providers and medical institutions should give high priority to the implementation of anti-bacterial strategies, strengthen training and management, conduct regular quality monitoring and evaluation, and ensure that every endoscopy is performed in a safe and sterile environment, thus providing quality medical care to patients and promoting the healthy development of digestive endoscopy technology in clinical consultations.
Diseases of the digestive system, not specifically.
