Automated endoscope cleaning with turbulent hydro-aeric flow: Evaluation of infection control, ergonomics, workflow, and environmental impact

Background: Time-consuming, burdensome and prone to human error, manual cleaning is the first step of endoscope reprocessing and remains mandatory. Devices automating this step using turbulent hydro-aeric flow (THAF) could bring organizational and environmental benefits. We performed a multiscale evaluation of THAF-assisted cleaning. Methods: The four-pronged assessment of THAF-assisted cleaning comprised: (1) a multicenter microbiological study comparing protein/hemoglobin residue and bacterial contamination after THAF-assisted vs manual cleaning; (2) an ergonomic study of hardship factors associated with cleaning; (3) an efficiency study of time consumption and organizational impact; (4) a life cycle assessment comparing the environmental impact of THAF and manual cleaning methods. Results: Protein/hemoglobin residue was detected after cleaning in 8/50 endoscopes (16%) with manual and 8/34 (24%) with THAF (p=0.41). After complete reprocessing, alert-level contamination occurred in 2/50 (4%) vs 2/34 (6%) (p=1.0) and action-level in 4/50 (8%) vs 6/34 (18%) (p=0.30). THAF halved cleaning time, reduced observed exposure to repetitiveness, moisture, detergent and constrained working postures, and enabled one nurse to operate two stations. In a medium-sized center cleaning 6,800 endoscopes a year, THAF would add €1,890 while avoiding emissions of 1.79 metric-tons CO₂e, 250kg of medical waste and the consumption of 306L of detergent and 200,804L of water. Conclusion: THAF-assisted cleaning reduced dedicated cleaning time, exposure to occupational hardship factors, greenhouse gas emissions, water and detergent consumption as well as waste production. In this exploratory study, which was not powered to establish non-inferiority, contamination rates were not statistically different from those observed after manual cleaning.