‘Brushes in Brazil’ Study Highlights Key Concerns for Endoscope Sterile Processing

A pair of researchers from the School of Nursing at the Federal University of Minas Gerais in Belo Horizonte have noted that sterile processing departments studied in Brazil continue to take grave risks in their use of brushes when cleaning flexible endoscopes.

Their research study, “Criteria for the Use, Processing, and Disposal of Flexible Endoscope Cleaning Brushes,” was published in BI&T , the journal of health technology and sterilization from the Association for the Advancement of Medical Instrumentation (AAMI).

“Brushing is an essential step … and can be impaired by external factors, including pressure to clean equipment quickly so it can be returned to patient care, the force used in cleaning, inattention to detail, inadequate time spent cleaning, poor training, and omission of proper cleaning due to lack of knowledge of or commitment to the importance of the activity,” the researchers wrote.

Over the course of six months, Professor Adriana Cristina de Oliveira, Ph.D., and Naiara Bussolotti Garcia, MSc, surveyed the sterile processing staff at 51 endoscopy facilities in Brazil. They determined that, while more than half of the facilities used disposable brushes when cleaning device channels, none of the faculties actually disposed of these brushes after use.

Rather, 70% of the facilities reported discarding disposable brushes after noticeable bristle wear, 20% discarded the brushes at the end of a single workday, and 10% reportedly had no disposal protocols at all. When the researchers then inspected 10 hospital sterile processing departments that regularly repurpose flexible endoscopes, only one was equipped with brushes that had no signs of wear or damage.

Oliveira and Garcia explained how current processing guidelines, including the FDArecognized standard ANSI/AAMI ST91:2021, Flexible and semi-rigid endoscope processing in health care facilities, recommend using disposable cleaning brushes which are designed to be discarded after a single use.

“However, our results showed that even brushes marketed as disposable after a single use were being reused in the facilities studied. This increases the risk of damage and contamination and diverges from the purpose of singleuse brushes,” they wrote. The pair observed that damaged brushes may not adequately remove residue from the channels of an endoscopic device before its next step in reprocessing, increasing the risk of contamination and patient infection.

Additionally, the researchers observed that, “without wellestablished criteria for reuse,” even the facilities using brushes designed for reuse did not have an established routine for cleaning brushes between uses, despite device instructions for use (IFUs) calling for it. In fact, the researchers observed other disregard for instruction during their in-person inspections, including the use of kitchen sponges and other domestic supplies for the cleaning of endoscope channels.

“These sponges have the potential to detach lint and retain moisture, which … increases the risk of adverse events in patient care,” the researchers noted with concern.

So, is there a solution for these Brazilian facilities? Can they serve as an example of how sterile processing departments can improve across the world? The authors called on manufacturers to help lift this burden, validating the manual cleaning processes for their devices and writing clear and easy-tounderstand IFUs. They wrote that the survey, while small, “indicates the urgent need” for hospitals to conduct internal audits and improve training regarding the acquisition and care of endoscope processing equipment.