Beyond Endoscopes: Pilot Study of Surgical Instrument Lumen Inspection

Objective: Borescope examinations of endoscope channels are commonly described in literature, but no studies on surgical instrument lumen inspection have been published recently.Inadequately processed surgical instruments have been implicated in patient infections.This study assessed the utility of borescopes for inspecting surgical instruments. Methods:The study team inspected and photographed sterilized, patient-ready arthroscopic shaver handpieces and suction tips using a tablet camera and borescopes to characterize internal anatomy, defects found in lumens, and the impact of recleaning on debris or residues.Results: Ten suctions and eight shavers were inspected.All suctions had internal ridges and suction holes that were perpendicular to the lumen.All shavers had visible ridges, elbows, and lever mechanisms inside lumens.Of the 18 instruments, 16 (88%) had internal features that appeared rough or jagged and 17 (94%) had visible debris or discoloration in the lumens.Recleaning efforts generally were effective for suctions, but multiple rounds of recleaning with enhanced steps were less effective for shavers, which were replaced.Researchers documented retained soil and brush bristles in several new shavers despite following manufacturer instructions for cleaning and found visible damage and discoloration within five uses.Discussion: This study demonstrated the value of borescope examinations for surgical instrument lumens.Visual inspections identified anatomical features that could influence cleaning effectiveness and detected residual soil, discoloration, and debris in most instruments.The findings suggested that manufacturer cleaning instructions were insufficient and additional cleaning was not always effective.In response, the site's multidisciplinary team strengthened risk assessment protocols and enhanced their cleaning practices.Numerous studies have demonstrated the utility of visual inspection with borescopes for identifying defects in endoscope channels.Upon initiating borescope examinations, investigators in diverse healthcare institutions and departments have detected defects in 100% of endoscopes, including residual fluid, damage, soil, and debris.[1][2][3][4][5][6][7][8][9][10] Recent standards and guidelines have incorporated new research on visual inspection into recommendations for endoscope processing.11,12 In response to strengthened recommendations, one study evaluated a model for training sterile processing technicians on performing visual inspection.5 After a group of certified sterile processing technicians received 10 hours of training on visual inspection using lighted magnification and borescopes, all of the trained technicians identified clinically relevant defects in some of the "patient-ready" endoscopes in their facility's inventories.The findings resulted in actions, such as device recleaning, repair, or replacement and trialing new technologies, to improve the effectiveness of cleaning and drying methods.Borescopic inspection of interior lumens and surfaces of surgical instruments was first reported following a 2009 outbreak investigation.In this outbreak, seven patients were infected with Pseudomonas aeruginosa during knee or shoulder surgery, and arthroscopic shaver handpieces ("shavers") were implicated as the cause.13 Investigators observed retained tissue and brush bristles in the lumens, despite processing performed per manufacturer instructions for use (IFUs).They concluded that the P. aeruginosa that caused the patient infections after arthroscopic surgery was the same strain found in the decontamination sink and likely had survived sterilization due to the retained debris in shaver lumens.