Healthcare: Technological advancements – “A transition to cure Infection”

Prevention and control of infection has been one of the key focus areas in healthcare, since the discovery of the germ theory in the 18th century. From the early times, sterilization techniques like boiling instruments before using them for medical procedures was common even without an understanding of the concept of microorganisms.

With better understanding of asepsis at the dawn of the 20th century, numerous disinfection and sterilization methods have been incorporated into the surgical practice. Hospital-acquired infections cause substantial patient mortality and morbidity, burdening the healthcare systems with massive costs. Microorganisms could spread from patient to patient by contaminated equipment, from the gut lumen during endoscopy or through the bloodstream to susceptible organs & adjacent tissues.

With the advent of time, the medical interventions were categorized into diagnostic, intervention, and operative modes. Endoscopy was a procedure which has got a foothold in both diagnosis as well as in therapeutics and thus, had its own needs of sterilization.

Endoscopes by nature are fragile instruments having the flexibility to traverse the body anatomy using natural orifices and are ergonomically designed to avoid any possible aberrations inside the body. Effective and reliable infection control mechanisms become paramount to cater to the growing number of endoscopies performed each year, across the world.

During routine endoscopic examinations, the outer surface and internal channels of flexible endoscopes are exposed to various body fluids and numerous contaminants. Disinfecting these reusables, which are flexible instruments could be challenging, because endoscopes are extremely sensitive to higher temperatures. Thus they are not suitable for regular steam sterilization. Therefore, endoscope reprocessing is performed through mechanical and detergent based cleaning, followed by high-level disinfection (HLD), rinsing, and drying.

The recent COVID-19 pandemic has made us reset infection control mechanisms, being used traditionally. Apart from stringent disinfection and sterilization practices for critical and non-critical equipment, hospitals have increasingly started preferring single-use items or utilizing services of off-site reprocessing facilities for effective sterilization on a larger scale in a controlled environment wherever possible to eliminate the potential risk of cross-contamination associated with inadequate reprocessing between patients or procedures.

The various stages of endoscope reprocessing include manual cleaning, HLD/sterilization, rinsing, drying, and storage. Cleaning is the physical removal of organic material using detergent and water. This process removes the microorganisms rather than killing them. Disinfection eradicates most microorganisms and is administered through liquid chemicals. There are 3 disinfection levels depending on the degree of microbial elimination involved. Sterilization eliminates all microbials, including bacterial spores with heat or ethylene oxide (ETO) gas.

Since all these steps were traditionally done manually, human error could creep in as process time and number of cycles are critical in this regard. An automated processor, designed for providing high level disinfection for flexible endoscopes and accessories could resolve such challenges. AER is a compact and portable device that can simultaneously reprocess two or more flexible endoscopes in a short time, starting from ultrasonic cleaning and ending with high level disinfection. It has excellent ergonomics, which facilitates both manual and automatic operation for the user.

With built in safety features, it ensures there are no leakages or contamination throughout the duration of the process. The processing is halted in case any anomaly is detected at any stage of the process. Employing an automated reprocessor for the routine endoscope disinfection could alleviate many challenges associated with manual reprocessing.

One can track the disinfection process in real time, ensuring that all required steps have been followed sequentially. Multiple checkpoints alert the user in case of a technical or operational mishap leading to improper reprocessing. It also enables timely & accurate record keeping for purposes of internal audits or third-party accreditations.