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The University of Southampton
Biological Sciences

Research project: Development of endoscope decontamination procedures

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At present there are no methods of decontamination that are of proven efficacy for the removal of protein, and more critically prions associated with variant Creutzfeld-Jacob disease (vCJD), from the internal channels of endoscopes. Moreover, studies of biofilms within these channels have demonstrated large deposits of fixed proteinaceous material following cleaning.

Endoscopies are common procedures, but also potential routes of infections. Flexible endoscopes are complex, fragile, heat-labile and expensive instruments. They are used repeatedly and with a rapid turnaround, while presenting difficulties to clean due to their complexity. They are refurbished periodically, though high demand prevents systematic inspection before each use. In addition, current visual methods for assessing instruments cleanliness are poorly sensitive, and not adapted to verifying cleanliness inside endoscope channels. Flexible endoscopes are cleaned according to manufacturers’ recommendations, and there is a thriving market for cleaning chemistries and washer-disinfectors specifically designed for this purpose. However, evidence of efficacy is limited, and there are concerns that current decontamination procedures and chemicals are not sufficient to guarantee the reduction of potential infectivity from resilient pathogens, including prions responsible for the transmission of vCJD.

The new Choice Framework for Policy and Procedures (CFPP) being put in place by the English Department of Health uses a structured approach designed to contribute to the Government’s plans for improving public health through a new public health delivery system, with an emphasis on local choice. The framework structure includes guidance on surgical instrument use, management and decontamination, which is aimed at healthcare professionals.

This project will assess the cleanliness of existing endoscopes and the efficacy of current decontamination procedures, using a new highly sensitive microscopy imaging method to identify and quantify residual contamination from a range of flexible endoscopes, and new cell assays to assess potential prion infectivity. This will provide information on best practice for the CFPP 01-06 which specifically addresses endoscopes, and help maintaining future provision of care in a safe and cost-effective manner. 

Related research groups

Environmental Biosciences
Molecular and Cellular Biosciences
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