Análise da estrutura interna de endoscópios gastrointestinais por inspeção visual com auxílio de um boroscópio e sua relação com a segurança no processamento desses equipamentos

Abstract

Introduction: Gastrointestinal endoscopes have a complex structure with long channels and several lumens, and their decontamination comprises multiple steps to be followed to ensure the safety of their reuse. Their conformation prevents visual inspection of the channels to validate the effectiveness of reprocessing. Although indicated, inspection of the internal channels of the equipment using a borescope has not been a reality in clinical practice. Objective: To verify the conditions of the internal channels of endoscopes stored after high-level disinfection in gastrointestinal endoscopy services and to relate the findings to the practices performed and the results of testing for adenosine triphosphate and protein residue. Methods: This was a cross-sectional study, approved by the Research Ethics Committee (Opinion number 4516596/2021), carried out in endoscopy services in Belo Horizonte in three concomitant phases, with the completion of a semi-structured form, followed by the evaluation of biopsy channels using a borescope and the execution of validation tests for adenosine triphosphate and protein in the inspected channels. The data were tabulated and analyzed using descriptive statistics such as frequency and measures of central tendency, Pearson's chi square and Spearman's Correlation non-parametric tests. Results: Ten institutions were visited, with inspection of 71 endoscopes, totaling 74 biopsy channels. As for the endoscopes processing, 40% of the services reported performing the leak test before each processing. No service had the irrigation adapters as recommended by the manufacturer. The reuse of cleaning brushes was a practice found in all services, and failures were observed in all steps. Regarding the storage time of endoscopes, 60% of the services did not present a defined time protocol. Records of maintenance and equipment life history were found in 60% of the services. For the inspections of the endoscopes conducted in this study, all the channels evaluated presented alterations: 95% with the presence of stains, 100% with grooves, 69% fluid, 91.1% residues or debris, 12.2% structural deformities, and in 87.8% channel fragments were found. Findings were also noted in the biopsy, air and water channel ports, and accessories such as water jet and elevator. Protein was found in 75% of the equipment channels, and 18% of the adenosine triphosphate tests showed results above 15 RLU, 45.5% between 1 and 14 RLU, and 36.5% showed no adenosine triphosphate in the reading. The amount of protein found was significantly related to the average use of equipment and the occurrence of residues was related to the interval between pre-cleaning and manual cleaning. Conclusion: The findings of this study point to failures and omissions in the execution of the processing steps, increasing the risk of cross-contamination from the use of such equipment, as well as contributing to the formation of biofilms. Given the high frequency of stains, grooves, residues, fluids, structural deformities, and channel fragments identified by the use of the borescope, the verification of process validation methods, and audits of the processing steps may be complementary tools to direct practices and develop important process improvements for patient safety.