EVOTECH® endoscope cleaner and reprocessor (ECR) simulated-use and clinical-use evaluation of cleaning efficacy

<p>Abstract</p> <p>Background</p> <p>The objective of this study was to perform simulated-use testing as well as a clinical study to assess the efficacy of the EVOTECH^®Endoscope Cleaner and Reprocessor (ECR) cleaning for flexible colonoscopes, duodenoscopes, gastroscopes and bronchoscopes. The main aim was to determine if the cleaning achieved using the ECR was at least equivalent to that achieved using optimal manual cleaning.</p> <p>Methods</p> <p>Simulated-use testing consisted of inoculating all scope channels and two surface sites with Artificial Test Soil (ATS) containing 10⁸cfu/mL of <it>Enterococcus faecalis, Pseudomonas aeruginosa </it>and <it>Candida albicans</it>. Duodenoscopes, colonoscopes, and bronchoscopes (all Olympus endoscopes) were included in the simulated use testing. Each endoscope type was tested in triplicate and all channels and two surface sites were sampled for each scope. The clinical study evaluated patient-used duodenoscopes, bronchoscopes, colonoscopes, and gastroscopes (scopes used for emergency procedures were excluded) that had only a bedside flush prior to being processed in the ECR (i.e. no manual cleaning). There were 10 to 15 endoscopes evaluated post-cleaning and to ensure the entire ECR cycle was effective, 5 endoscopes were evaluated post-cleaning and post-high level disinfection. All channels and two external surface locations were sampled to evaluate the residual organic and microbial load. Effective cleaning of endoscope surfaces and channels was deemed to have been achieved if there was < 6.4 μg/cm²of residual protein, < 1.8 μg/cm²of residual hemoglobin and < 4 Log₁₀viable bacteria/cm². Published data indicate that routine manual cleaning can achieve these endpoints so the ECR cleaning efficacy must meet or exceed these to establish that the ECR cleaning cycle could replace manual cleaning</p> <p>Results</p> <p>In the clinical study 75 patient-used scopes were evaluated post cleaning and 98.8% of surfaces and 99.7% of lumens met or surpassed the cleaning endpoints set for protein, hemoglobin and bioburden residuals. In the simulated-use study 100% of the Olympus colonoscopes, duodenoscopes and bronchoscopes evaluated met or surpassed the cleaning endpoints set for protein, and bioburden residuals (hemoglobin was not evaluated).</p> <p>Conclusions</p> <p>The ECR cleaning cycle provides an effective automated approach that ensures surfaces and channels of flexible endoscopes are adequately cleaned after having only a bedside flush but no manual cleaning. It is crucial to note that endoscopes used for emergency procedures or where reprocessing is delayed for more than one hour MUST still be manually cleaned prior to placing them in the ECR.</p

How to last alone at the top : US strategic planning for the unipolar era

This article investigates how key actors within the US defence policy community realigned their interests to forge a new consensus on the redirection of US defence strategy following the 'peace shock' they faced with the collapse of bipolarity. This consensus centred on the idea that achieving US security in the 'age of uncertainty' demanded overwhelming US military power, which was widely interpreted as necessitating military capabilities to fight multiple major theatre wars simultaneously against regional 'Third World' adversaries. This helped to preserve many of the principal pillars of US Cold War defence policy through deflecting calls for more radical organisational changes and deeper cuts to defence budgets

Recovery of critical metals using biometallurgy

The increased development of green low-carbon energy technologies that require platinum group metals (PGMs) and rare earth elements (REEs), together with the geopolitical challenges to sourcing these metals, has spawned major governmental and industrial efforts to rectify current supply insecurities. As a result of the increasing critical importance of PGMs and REEs, environmentally sustainable approaches to recover these metals from primary ores and secondary streams are needed. In this review, we define the sources and waste streams from which PGMs and REEs can potentially be sustainably recovered using microorganisms, and discuss the metal-microbe interactions most likely to form the basis of different environmentally friendly recovery processes. Finally, we highlight the research needed to address challenges to applying the necessary microbiology for metal recovery given the physical and chemical complexities of specific streams