The challenges of endoscope sterilization

The sterilization of endoscopes poses such problems that they can be classified among the most complex reusable medical devices to sterilize. Aurora offers a solution to sterilize surgical endoscopes. This solution is reliable, energy efficient and safe for users.

Aurora Cold Plasma Sterilisation

What are endoscopes used for ?

An endoscope is a medical device that allows to look inside a patient’s body, to perform a diagnosis or a surgical operation.

Endoscopes have very different lengths and constructions, depending on the organ to be reached: cystoscope (for the bladder), colonoscope (for the colon), bronchoscope (for the lungs), ureteroscope (for the urethra), etc. The longest is the duodenoscope (for the duodenum) which reaches more than 2.5m in length.

They can be rigid or flexible, with 1, 3 or 5 channels. Some integrate optics, liquid or air injectors, or even surgical tools.

Their common point is complex shapes and fragile elements. Most are reusable and passed from one patient to another, hence contaminating patients among themselves. Therefore endoscopes pose problems for sterilization.

75% of endoscopes are not sterilized

Sterilization obligations normally apply to endoscopes, as to any invasive medical device. But it is impossible to sterilize most endoscopes because hospitals and medical centers do not have suitable endoscope sterilization techniques.

Most hospital sterilization departments don’t use ethylene oxide anymore, and none use gamma rays : these techniques are too dangerous for a healthcare center.

For its part, the moist heat of autoclaves damages the polymers and optics that make up many endoscopes.

Finally, despite its temperature (50-60°C) and its ease of use, sterilization with vaporized hydrogen peroxide is reserved for the sterilization of small endoscopes, because it does not penetrate beyond 89cm. It also raises questions about its dosage and its condensation, which alter its performance.

n the absence of suitable sterilization, endoscopes therefore currently benefit from an exception: high-level disinfection. But…

the arrival of Aurora Cold Plasma increases the possibilities for the highest quality endoscope reprocessing, ie true endoscope sterilization.

cold sterilization

What is the difference between disinfection and sterilization of endoscopes?

Sterilization is a 0.000001% (1 in 1 million) probability of finding a contaminated endoscope – regardless of the original biological load.

Disinfection is a simple reduction of the microbial load present in the endoscope. High-level disinfection aims for such a reduction by a factor of 10,000. Non-sterilizable endoscopes undergo today such disinfection.

The safety provided to the patient by these reprocessing processes is not comparable.

Considering that there are 1 million bacteria present in an endoscope before reprocessing, only one would remain after sterilization, and 100 remain after high-level disinfection.

Translated into terms of risk, the patient would be 100 times less exposed to a postoperative infection involving a sterilized endoscope than with a disinfected endoscope.

But this example is a fiction, because it compares a probability with a factor reduction – two data of very different nature.

Endoscope sterilization is 6 million times safer than disinfection.

Themost recent study shows that the real situation is much worse than that. To take the case of duodenoscopes alone, Lionel Pineau (Eurofins-Germande, France) has established that 6% of duodenoscopes are contaminated by “high concern organisms” in the context of the disinfection practiced today.This rate rises to nearly 30% for other endoscopes.

6% versus 0.000001% is a ratio of 1 to 6 million. This is the impact of the sterilization of duodenoscopes in terms of health safety and the reduction of contamination.

Aurora Cold Plasma Sterilisation

The advantages of plasma over other methods of sterilization

Aurora plasma takes over chemical sterilizing agents (ethylene oxide, hydrogen peroxide) by its ability to penetrate complex shapes.

The size of the oxygen ions explains this penetrating force, but also the vacuum descent process: it is pushed so low that it purges the medical device of any atmosphere and humidity. The plasmogenic gas then takes the place of these voids before being ionized. Thus, the plasma acts in situ on the device, without the constraints of fluid mechanics encountered by chemical agents or steam from the autoclave.

On the other hand, plasma acts on the surface of materials. It therefore leaves the mass of materials intact, unlike moist heat or gamma rays. It is also compatible with a very wide range of materials.

Finally, Aurora uses only oxygen and nitrogen to create its plasma – gases that are cheap and non-toxic to the environment and to humans.