Kavel Visrodia - Academia.edu (original) (raw)

Papers by Kavel Visrodia

Catheterization and Cardiovascular Interventions, Mar 1, 2011

Coronary artery aneurysm (CAA) is an uncommon and often incidental finding on coronary angiograph... more Coronary artery aneurysm (CAA) is an uncommon and often incidental finding on coronary angiography but can present with symptoms related to myocardial ischemia. The most common etiology is atherosclerosis, accounting for over 50% of cases, but CAAs can also be congenital or secondary to percutaneous coronary artery revascularization procedures, inflammatory arterial diseases, connective tissue disorders, and perhaps drug-eluting-stent (DES) implantation. A current lack of uniform guidelines for their therapeutic management, especially in the setting of DES, leaves their optimum treatment somewhat controversial. Polytetrafluoroethylene-covered stents have gained popularity in recent years for percutaneous treatment of CAAs; however, their failure to endothelialize is associated with increased risk of thromboocclusive events. We describe two symptomatic patients presenting with large CAAs, one forming after DES implantation, that we treated using the double-stent method, in which one stent is placed within another. The intent is to reduce stent permeability across the aneurysm and promote blood stasis within it, thereby encouraging aneurysm thrombosis and meanwhile preserving the stents' ability to endothelialize. The immediate angiographic result revealed markedly reduced filling of the aneurysms and aneurysm thrombosis was later confirmed at follow-up. Both patients have remained asymptomatic during at least 9 months of follow-up. To the best of our knowledge, this is the first case report describing the use of the double-stent method as an alternative to treat CAAs percutaneously. V C 2011 Wiley-Liss, Inc.

American journal of infection control, 2015

Pathogens have been transmitted via flexible endoscopes that were reportedly reprocessed in accor... more Pathogens have been transmitted via flexible endoscopes that were reportedly reprocessed in accordance with guidelines. Researchers observed reprocessing activities to ensure guideline compliance in a large gastrointestinal endoscopy unit. Contamination was assessed immediately after bedside cleaning, manual cleaning, high-level disinfection, and overnight storage via visual inspection, aerobic cultures, and tests for adenosine triphosphate (ATP), protein, carbohydrate, and hemoglobin. All colonoscopes and gastroscopes were reprocessed in accordance with guidelines during the study. Researchers collected and tested samples during 60 encounters with 15 endoscopes. Viable microbes were recovered from bedside-cleaned (92%), manually cleaned (46%), high-level disinfected (64%), and stored (9%) endoscopes. Rapid indicator tests detected contamination (protein, carbohydrate, hemoglobin, or ATP) above benchmarks on bedside-cleaned (100%), manually cleaned (92%), high-level disinfected (73%...

American Journal of Infection Control, 2014

Catheterization and Cardiovascular Interventions, 2011

Coronary artery aneurysm (CAA) is an uncommon and often incidental finding on coronary angiograph... more Coronary artery aneurysm (CAA) is an uncommon and often incidental finding on coronary angiography but can present with symptoms related to myocardial ischemia. The most common etiology is atherosclerosis, accounting for over 50% of cases, but CAAs can also be congenital or secondary to percutaneous coronary artery revascularization procedures, inflammatory arterial diseases, connective tissue disorders, and perhaps drug-eluting-stent (DES) implantation. A current lack of uniform guidelines for their therapeutic management, especially in the setting of DES, leaves their optimum treatment somewhat controversial. Polytetrafluoroethylene-covered stents have gained popularity in recent years for percutaneous treatment of CAAs; however, their failure to endothelialize is associated with increased risk of thromboocclusive events. We describe two symptomatic patients presenting with large CAAs, one forming after DES implantation, that we treated using the double-stent method, in which one stent is placed within another. The intent is to reduce stent permeability across the aneurysm and promote blood stasis within it, thereby encouraging aneurysm thrombosis and meanwhile preserving the stents' ability to endothelialize. The immediate angiographic result revealed markedly reduced filling of the aneurysms and aneurysm thrombosis was later confirmed at follow-up. Both patients have remained asymptomatic during at least 9 months of follow-up. To the best of our knowledge, this is the first case report describing the use of the double-stent method as an alternative to treat CAAs percutaneously. V C 2011 Wiley-Liss, Inc.

Gastrointestinal Endoscopy, 2016

Data Revues 00165107 V75i4ss S0016510712014927, May 17, 2012

Background: The performance of rapid on-site evaluation (ROSE) of endoscopic ultrasound fine need... more Background: The performance of rapid on-site evaluation (ROSE) of endoscopic ultrasound fine needle aspiration (EUS-FNA) samples by an attending cytopathologist to determine specimen adequacy has been shown to minimize additional procedures, optimize associated costs, and reduce complications. However, due to financial and manpower limitations, ROSE by an attending cytopathologists is not available at many centers and the realtime assessment of adequacy of EUS-FNA specimens is done by pathology trainees (resident or fellow) or cytotechnologists. The aim of this study is to compare the performance of pathology trainees and cytotechnologists in the determination of EUS-FNA specimen adequacy. Methods: A prospective database was developed in January 2010 following the establishment of two new academic ultrasound programs, one at Los Angeles County Hospital Medical Center (LAC), and the other at the USC Keck and Norris Hospitals (USC), a tertiary referral medical center. Among 365 consecutive patients, 221 anatomic targets were biopsied via EUS-FNA. EUS was performed at both centers by the same endosonographer and the same team of attending cytopathologists evaluated the samples after completion of the procedures. Real time adequacy of EUS-FNA samples at LAC was determined by pathology trainees, while at USC this was determined by non-physician cytotechnologists. The final assessment of the attending cytopathologist was the gold standard used to compare the performance of the trainees versus the cytotechnologists. Results: During the bedside evaluation all of the FNA samples were felt to be adequate at both institutions. However, final review of the samples by an attending pathologist determined that the adequacy of the specimens was 65.2% at LAC and 70.5% at USC ). There was no significant difference in the assessment of specimen adequacy by pathology trainees compared to experienced technologists (Pϭ0.462). No difference in the performance of cytology trainees and the technicians was seen when the comparison was stratified by FNA target including pancreas masses, lymph nodes, or subepithelial lesions. Impression: These results suggest that there is no difference in the determination of diagnostic adequacy by a pathology trainee (resident or fellow) compared to an experienced non-physician cytology technician. Nonetheless, assessment of adequacy by both groups was suboptimal, which further underscores the need for an attending cytopathologist to determine the adequacy of EUS acquired fine needle aspirates in real-time. Other alternatives including telecytology, which allows for microscope images to be dynamically transmitted to a remotely located pathologist during EUS-FNA, are important considerations in health care systems where pathology resources are limited.

Mayo Clinic Proceedings, Jul 1, 2014

World Journal of Gastrointestinal Endoscopy, 2015

Endoscopic evaluation of indeterminate biliary strictures (IDBSs) has evolved considerably since ... more Endoscopic evaluation of indeterminate biliary strictures (IDBSs) has evolved considerably since the development of flexible fiberoptic endoscopes over 50 years ago. Endoscopic retrograde cholangiography pancreatography (ERCP) was introduced nearly a decade later and has since become the mainstay of therapy for relieving obstruction of the biliary tract. However, longstanding methods of ERCP-guided tissue acquisition (i.e., biliary brushings for cytology and intraductal forceps biopsy for histology) have demonstrated disappointing performance characteristics in distinguishing malignant from benign etiologies of IDBSs. The limitations of these methods have thus helped drive the search for novel techniques to enhance the evaluation of IDBSs and thereby improve diagnosis and clinical care. These modalities include, but are not limited to, endoscopic ultrasound, intraductal ultrasound, cholangioscopy, confocal endomicroscopy, and optical coherence tomography. In this review, we discuss established and emerging options in the evaluation of IDBSs.

Gastroenterology, Jan 24, 2015

A proportion of patients with Barrett's esophagus (BE) are diagnosed with esophageal adenocar... more A proportion of patients with Barrett's esophagus (BE) are diagnosed with esophageal adenocarcinoma (EAC) within 1 year of an endoscopic examination that produced negative findings. These cases of missed cancers have not been well studied, despite current surveillance strategies for BE. We performed a systematic review and meta-analysis to determine the magnitude of missed EAC in cohorts of patients with BE. We searched MEDLINE, EMBASE, and Web of Science from their inception to May 31, 2015 to identify cohort studies of adults with BE (baseline non-dysplastic BE [NDBE] ± BE with low-grade dysplasia) and at least a 3 year follow-up period, providing data on missed and incident EACs (diagnosed within 1 year, and >1 year after the initial endoscopy in which BE was diagnosed, respectively). The main outcome measure was pooled proportion of missed and incident EACs (of all EACs detected after initial endoscopy) among BE cohorts, using a random effects model. In a meta-analysis of...

World journal of gastrointestinal endoscopy, Jan 25, 2015

Endoscopic management of biliary obstruction has evolved tremendously since the introduction of f... more Endoscopic management of biliary obstruction has evolved tremendously since the introduction of flexible fiberoptic endoscopes over 50 years ago. For the last several decades, endoscopic retrograde cholangiopancreatography (ERCP) has become established as the mainstay for definitively diagnosing and relieving biliary obstruction. In addition, and more recently, endoscopic ultrasonography (EUS) has gained increasing favor as an auxiliary diagnostic and therapeutic modality in facilitating decompression of the biliary tree. Here, we provide a review of the current and continually evolving role of gastrointestinal endoscopy, including both ERCP and EUS, in the management of biliary obstruction with a focus on benign biliary strictures.

American journal of infection control, 2015

Pathogens have been transmitted via flexible endoscopes that were reportedly reprocessed in accor... more Pathogens have been transmitted via flexible endoscopes that were reportedly reprocessed in accordance with guidelines. Researchers observed reprocessing activities to ensure guideline compliance in a large gastrointestinal endoscopy unit. Contamination was assessed immediately after bedside cleaning, manual cleaning, high-level disinfection, and overnight storage via visual inspection, aerobic cultures, and tests for adenosine triphosphate (ATP), protein, carbohydrate, and hemoglobin. All colonoscopes and gastroscopes were reprocessed in accordance with guidelines during the study. Researchers collected and tested samples during 60 encounters with 15 endoscopes. Viable microbes were recovered from bedside-cleaned (92%), manually cleaned (46%), high-level disinfected (64%), and stored (9%) endoscopes. Rapid indicator tests detected contamination (protein, carbohydrate, hemoglobin, or ATP) above benchmarks on bedside-cleaned (100%), manually cleaned (92%), high-level disinfected (73%...

Digestive diseases and sciences, Jan 9, 2015

The yield of early repeat endoscopy in patients with Barrett's esophagus (BE) is not well est... more The yield of early repeat endoscopy in patients with Barrett's esophagus (BE) is not well established. To determine how often early repeat endoscopy detected missed dysplasia or esophageal adenocarcinoma (EAC) in a population-based cohort of patients with BE. Secondary aims were to identify risk factors for missed dysplasia/EAC and compare detection of prevalent versus incident HGD/EAC. A population-based cohort of BE subjects in Olmsted County, MN, was studied. Patients with initial non-dysplastic BE or low-grade dysplasia (LGD) who underwent repeat endoscopy within 24 months were included. Those with a worse histologic diagnosis on repeat endoscopy were considered to have missed dysplasia/EAC. Baseline characteristics among patients with and without missed dysplasia/EAC were compared. The absolute numbers of asymptomatic prevalent or missed, and incident HGD/EAC in the entire cohort were ascertained. Of 488 BE cases, 210 were included for the primary aim of this study. Repeat ...

Gastrointestinal Endoscopy, 2015

Gastrointestinal Endoscopy, 2015

Infection Control and Hospital Epidemiology, 2014

Outbreaks of multidrug-resistant organisms have been linked to endoscope reprocessing lapses. Met... more Outbreaks of multidrug-resistant organisms have been linked to endoscope reprocessing lapses. Meticulous manual cleaning before high-level disinfection (HLD) is essential in reducing residual contamination that can interfere with HLD. Current reprocessing guidelines state that visual inspection is sufficient to confirm adequate cleaning. Our aim was to evaluate contamination of clinically used endoscopes, using visual inspection and rapid indicator tests before and after manual cleaning. A second objective was to determine which rapid indicator instruments and methods could be used for quality improvement initiatives in endoscope reprocessing. Clinical use study of endoscope reprocessing effectiveness. Tertiary care teaching hospital with an inpatient endoscopy center. Researchers sampled endoscopes used for gastrointestinal procedures before and after manual cleaning. The external surfaces and 1 channel of each endoscope were visually inspected and tested with rapid indicators to measure protein, blood, and adenosine triphosphate (ATP) contamination levels. Multiple components were sampled during 37 encounters with 12 unique endoscopes. All bedside-cleaned endoscopes had high levels of ATP and detectable blood or protein, whether or not any residue was visible. Although there was no visible residue on any endoscopes after manual cleaning, 82% had at least 1 positive rapid indicator test. Relying solely on visual inspection of endoscopes prior to HLD is insufficient to ensure reprocessing effectiveness. For quality assurance initiatives, tests of different endoscope components using more than 1 indicator may be necessary. Additional research is needed to validate specific monitoring protocols.

American Journal of Infection Control, 2014

Infection Control and Hospital Epidemiology, 2014

Mayo Clinic Proceedings, 2014

Catheterization and Cardiovascular Interventions, Mar 1, 2011

Coronary artery aneurysm (CAA) is an uncommon and often incidental finding on coronary angiograph... more Coronary artery aneurysm (CAA) is an uncommon and often incidental finding on coronary angiography but can present with symptoms related to myocardial ischemia. The most common etiology is atherosclerosis, accounting for over 50% of cases, but CAAs can also be congenital or secondary to percutaneous coronary artery revascularization procedures, inflammatory arterial diseases, connective tissue disorders, and perhaps drug-eluting-stent (DES) implantation. A current lack of uniform guidelines for their therapeutic management, especially in the setting of DES, leaves their optimum treatment somewhat controversial. Polytetrafluoroethylene-covered stents have gained popularity in recent years for percutaneous treatment of CAAs; however, their failure to endothelialize is associated with increased risk of thromboocclusive events. We describe two symptomatic patients presenting with large CAAs, one forming after DES implantation, that we treated using the double-stent method, in which one stent is placed within another. The intent is to reduce stent permeability across the aneurysm and promote blood stasis within it, thereby encouraging aneurysm thrombosis and meanwhile preserving the stents' ability to endothelialize. The immediate angiographic result revealed markedly reduced filling of the aneurysms and aneurysm thrombosis was later confirmed at follow-up. Both patients have remained asymptomatic during at least 9 months of follow-up. To the best of our knowledge, this is the first case report describing the use of the double-stent method as an alternative to treat CAAs percutaneously. V C 2011 Wiley-Liss, Inc.

American journal of infection control, 2015

Pathogens have been transmitted via flexible endoscopes that were reportedly reprocessed in accor... more Pathogens have been transmitted via flexible endoscopes that were reportedly reprocessed in accordance with guidelines. Researchers observed reprocessing activities to ensure guideline compliance in a large gastrointestinal endoscopy unit. Contamination was assessed immediately after bedside cleaning, manual cleaning, high-level disinfection, and overnight storage via visual inspection, aerobic cultures, and tests for adenosine triphosphate (ATP), protein, carbohydrate, and hemoglobin. All colonoscopes and gastroscopes were reprocessed in accordance with guidelines during the study. Researchers collected and tested samples during 60 encounters with 15 endoscopes. Viable microbes were recovered from bedside-cleaned (92%), manually cleaned (46%), high-level disinfected (64%), and stored (9%) endoscopes. Rapid indicator tests detected contamination (protein, carbohydrate, hemoglobin, or ATP) above benchmarks on bedside-cleaned (100%), manually cleaned (92%), high-level disinfected (73%...

American Journal of Infection Control, 2014

Catheterization and Cardiovascular Interventions, 2011

Coronary artery aneurysm (CAA) is an uncommon and often incidental finding on coronary angiograph... more Coronary artery aneurysm (CAA) is an uncommon and often incidental finding on coronary angiography but can present with symptoms related to myocardial ischemia. The most common etiology is atherosclerosis, accounting for over 50% of cases, but CAAs can also be congenital or secondary to percutaneous coronary artery revascularization procedures, inflammatory arterial diseases, connective tissue disorders, and perhaps drug-eluting-stent (DES) implantation. A current lack of uniform guidelines for their therapeutic management, especially in the setting of DES, leaves their optimum treatment somewhat controversial. Polytetrafluoroethylene-covered stents have gained popularity in recent years for percutaneous treatment of CAAs; however, their failure to endothelialize is associated with increased risk of thromboocclusive events. We describe two symptomatic patients presenting with large CAAs, one forming after DES implantation, that we treated using the double-stent method, in which one stent is placed within another. The intent is to reduce stent permeability across the aneurysm and promote blood stasis within it, thereby encouraging aneurysm thrombosis and meanwhile preserving the stents' ability to endothelialize. The immediate angiographic result revealed markedly reduced filling of the aneurysms and aneurysm thrombosis was later confirmed at follow-up. Both patients have remained asymptomatic during at least 9 months of follow-up. To the best of our knowledge, this is the first case report describing the use of the double-stent method as an alternative to treat CAAs percutaneously. V C 2011 Wiley-Liss, Inc.

Gastrointestinal Endoscopy, 2016

Data Revues 00165107 V75i4ss S0016510712014927, May 17, 2012

Background: The performance of rapid on-site evaluation (ROSE) of endoscopic ultrasound fine need... more Background: The performance of rapid on-site evaluation (ROSE) of endoscopic ultrasound fine needle aspiration (EUS-FNA) samples by an attending cytopathologist to determine specimen adequacy has been shown to minimize additional procedures, optimize associated costs, and reduce complications. However, due to financial and manpower limitations, ROSE by an attending cytopathologists is not available at many centers and the realtime assessment of adequacy of EUS-FNA specimens is done by pathology trainees (resident or fellow) or cytotechnologists. The aim of this study is to compare the performance of pathology trainees and cytotechnologists in the determination of EUS-FNA specimen adequacy. Methods: A prospective database was developed in January 2010 following the establishment of two new academic ultrasound programs, one at Los Angeles County Hospital Medical Center (LAC), and the other at the USC Keck and Norris Hospitals (USC), a tertiary referral medical center. Among 365 consecutive patients, 221 anatomic targets were biopsied via EUS-FNA. EUS was performed at both centers by the same endosonographer and the same team of attending cytopathologists evaluated the samples after completion of the procedures. Real time adequacy of EUS-FNA samples at LAC was determined by pathology trainees, while at USC this was determined by non-physician cytotechnologists. The final assessment of the attending cytopathologist was the gold standard used to compare the performance of the trainees versus the cytotechnologists. Results: During the bedside evaluation all of the FNA samples were felt to be adequate at both institutions. However, final review of the samples by an attending pathologist determined that the adequacy of the specimens was 65.2% at LAC and 70.5% at USC ). There was no significant difference in the assessment of specimen adequacy by pathology trainees compared to experienced technologists (Pϭ0.462). No difference in the performance of cytology trainees and the technicians was seen when the comparison was stratified by FNA target including pancreas masses, lymph nodes, or subepithelial lesions. Impression: These results suggest that there is no difference in the determination of diagnostic adequacy by a pathology trainee (resident or fellow) compared to an experienced non-physician cytology technician. Nonetheless, assessment of adequacy by both groups was suboptimal, which further underscores the need for an attending cytopathologist to determine the adequacy of EUS acquired fine needle aspirates in real-time. Other alternatives including telecytology, which allows for microscope images to be dynamically transmitted to a remotely located pathologist during EUS-FNA, are important considerations in health care systems where pathology resources are limited.

Mayo Clinic Proceedings, Jul 1, 2014

World Journal of Gastrointestinal Endoscopy, 2015

Endoscopic evaluation of indeterminate biliary strictures (IDBSs) has evolved considerably since ... more Endoscopic evaluation of indeterminate biliary strictures (IDBSs) has evolved considerably since the development of flexible fiberoptic endoscopes over 50 years ago. Endoscopic retrograde cholangiography pancreatography (ERCP) was introduced nearly a decade later and has since become the mainstay of therapy for relieving obstruction of the biliary tract. However, longstanding methods of ERCP-guided tissue acquisition (i.e., biliary brushings for cytology and intraductal forceps biopsy for histology) have demonstrated disappointing performance characteristics in distinguishing malignant from benign etiologies of IDBSs. The limitations of these methods have thus helped drive the search for novel techniques to enhance the evaluation of IDBSs and thereby improve diagnosis and clinical care. These modalities include, but are not limited to, endoscopic ultrasound, intraductal ultrasound, cholangioscopy, confocal endomicroscopy, and optical coherence tomography. In this review, we discuss established and emerging options in the evaluation of IDBSs.

Gastroenterology, Jan 24, 2015

A proportion of patients with Barrett's esophagus (BE) are diagnosed with esophageal adenocar... more A proportion of patients with Barrett's esophagus (BE) are diagnosed with esophageal adenocarcinoma (EAC) within 1 year of an endoscopic examination that produced negative findings. These cases of missed cancers have not been well studied, despite current surveillance strategies for BE. We performed a systematic review and meta-analysis to determine the magnitude of missed EAC in cohorts of patients with BE. We searched MEDLINE, EMBASE, and Web of Science from their inception to May 31, 2015 to identify cohort studies of adults with BE (baseline non-dysplastic BE [NDBE] ± BE with low-grade dysplasia) and at least a 3 year follow-up period, providing data on missed and incident EACs (diagnosed within 1 year, and >1 year after the initial endoscopy in which BE was diagnosed, respectively). The main outcome measure was pooled proportion of missed and incident EACs (of all EACs detected after initial endoscopy) among BE cohorts, using a random effects model. In a meta-analysis of...

World journal of gastrointestinal endoscopy, Jan 25, 2015

Endoscopic management of biliary obstruction has evolved tremendously since the introduction of f... more Endoscopic management of biliary obstruction has evolved tremendously since the introduction of flexible fiberoptic endoscopes over 50 years ago. For the last several decades, endoscopic retrograde cholangiopancreatography (ERCP) has become established as the mainstay for definitively diagnosing and relieving biliary obstruction. In addition, and more recently, endoscopic ultrasonography (EUS) has gained increasing favor as an auxiliary diagnostic and therapeutic modality in facilitating decompression of the biliary tree. Here, we provide a review of the current and continually evolving role of gastrointestinal endoscopy, including both ERCP and EUS, in the management of biliary obstruction with a focus on benign biliary strictures.

American journal of infection control, 2015

Pathogens have been transmitted via flexible endoscopes that were reportedly reprocessed in accor... more Pathogens have been transmitted via flexible endoscopes that were reportedly reprocessed in accordance with guidelines. Researchers observed reprocessing activities to ensure guideline compliance in a large gastrointestinal endoscopy unit. Contamination was assessed immediately after bedside cleaning, manual cleaning, high-level disinfection, and overnight storage via visual inspection, aerobic cultures, and tests for adenosine triphosphate (ATP), protein, carbohydrate, and hemoglobin. All colonoscopes and gastroscopes were reprocessed in accordance with guidelines during the study. Researchers collected and tested samples during 60 encounters with 15 endoscopes. Viable microbes were recovered from bedside-cleaned (92%), manually cleaned (46%), high-level disinfected (64%), and stored (9%) endoscopes. Rapid indicator tests detected contamination (protein, carbohydrate, hemoglobin, or ATP) above benchmarks on bedside-cleaned (100%), manually cleaned (92%), high-level disinfected (73%...

Digestive diseases and sciences, Jan 9, 2015

The yield of early repeat endoscopy in patients with Barrett's esophagus (BE) is not well est... more The yield of early repeat endoscopy in patients with Barrett's esophagus (BE) is not well established. To determine how often early repeat endoscopy detected missed dysplasia or esophageal adenocarcinoma (EAC) in a population-based cohort of patients with BE. Secondary aims were to identify risk factors for missed dysplasia/EAC and compare detection of prevalent versus incident HGD/EAC. A population-based cohort of BE subjects in Olmsted County, MN, was studied. Patients with initial non-dysplastic BE or low-grade dysplasia (LGD) who underwent repeat endoscopy within 24 months were included. Those with a worse histologic diagnosis on repeat endoscopy were considered to have missed dysplasia/EAC. Baseline characteristics among patients with and without missed dysplasia/EAC were compared. The absolute numbers of asymptomatic prevalent or missed, and incident HGD/EAC in the entire cohort were ascertained. Of 488 BE cases, 210 were included for the primary aim of this study. Repeat ...

Gastrointestinal Endoscopy, 2015

Gastrointestinal Endoscopy, 2015

Infection Control and Hospital Epidemiology, 2014

Outbreaks of multidrug-resistant organisms have been linked to endoscope reprocessing lapses. Met... more Outbreaks of multidrug-resistant organisms have been linked to endoscope reprocessing lapses. Meticulous manual cleaning before high-level disinfection (HLD) is essential in reducing residual contamination that can interfere with HLD. Current reprocessing guidelines state that visual inspection is sufficient to confirm adequate cleaning. Our aim was to evaluate contamination of clinically used endoscopes, using visual inspection and rapid indicator tests before and after manual cleaning. A second objective was to determine which rapid indicator instruments and methods could be used for quality improvement initiatives in endoscope reprocessing. Clinical use study of endoscope reprocessing effectiveness. Tertiary care teaching hospital with an inpatient endoscopy center. Researchers sampled endoscopes used for gastrointestinal procedures before and after manual cleaning. The external surfaces and 1 channel of each endoscope were visually inspected and tested with rapid indicators to measure protein, blood, and adenosine triphosphate (ATP) contamination levels. Multiple components were sampled during 37 encounters with 12 unique endoscopes. All bedside-cleaned endoscopes had high levels of ATP and detectable blood or protein, whether or not any residue was visible. Although there was no visible residue on any endoscopes after manual cleaning, 82% had at least 1 positive rapid indicator test. Relying solely on visual inspection of endoscopes prior to HLD is insufficient to ensure reprocessing effectiveness. For quality assurance initiatives, tests of different endoscope components using more than 1 indicator may be necessary. Additional research is needed to validate specific monitoring protocols.

American Journal of Infection Control, 2014

Infection Control and Hospital Epidemiology, 2014

Mayo Clinic Proceedings, 2014