WO2000010476A1

WO2000010476A1 - Endoscope cleaning device

Info

Publication number: WO2000010476A1
Application number: PCT/AU1999/000669
Authority: WO
Inventors: Steven Kritzler
Original assignee: Novapharm Research (Australia) Pty. Ltd.
Priority date: 1998-08-20
Filing date: 1999-08-19
Publication date: 2000-03-02
Also published as: ATE377389T1; NZ509982A; JP2002523131A; CN1132553C; CA2340659A1; PT1105061E; EP1105061A4; ES2297933T3; DE69937496T2; AUPP537098A0; DK1105061T3; ZA200101279B; DE69937496D1; US6699331B1; CN1313738A; ID27671A; CA2340659C; TW577725B; BR9913380A; EP1105061A1

Abstract

Apparatus for wiping a contaminated lumen of an endoscope comprising a cleaning member (4) having at least one radially extending fin (5, 5'), said member being adapted to pass axially through the lumen with at most a small clearance whereby contamination remaining after passage of the member through the lumen is substantially uniformly distributed as a thin film. The invention also relates to a method for cleaning a contaminated lumen of an endoscope comprising the steps of pulling or pushing a cleaning member of the type referred to above axially through the lumen, and treating the uniformly distributed film with a cleaning composition.

Description

ENDOSCOPE CLEANING DEVICE

TECHNICAL FIELD

The present invention relates to cleaning devices and methods, in particular

devices and methods for cleaning the interior cavities of contaminated surgical and

diagnostic instruments.

The invention has been developed primarily for use in cleaning endoscopes and

will be described hereinafter to reference to this application. However, it will be

appreciated that the invention is not limited to this particular field of use.

BACKGROUND ART

An endoscope is an elongate cylindrical instrument that may be rigid or flexible

and which incorporates an optical, or video, system and a light source. The endoscope is

configured such that one end can be inserted to some depth into a surgical incision or

body cavity so surfaces at or near the internally inserted end of the endoscope can be

viewed by an external observer.

For example, at present, the longest commonly used endoscope is a flexible

endoscope called a colonoscope. A colonoscope is used for diagnostic and surgical

procedures of the human colon. The colon insertion portion of the instrument is

approximately 2 metres long and has one or more hollow channels, or lumens. These lumens are typically 2-4 mm in diameter and run the length of the endoscope. They

allow for gas to be injected into the colon to inflate the organ or enable liquids to be

sucked out. Additionally, long flexible instruments can be inserted down these or other

lumens to allow biopsies to be taken and the wound to be cauterised. These biopsy

samples are then drawn back through the lumen and sent for pathology testing.

New endoscopes can achieve exceptional results in performing a variety of

surgical procedures whereby very small (2 cm) incisions are all that is required, rather

than the previous procedures which required incisions of over 20 cm in length.

Furthermore, endoscopic procedures usually enable patients to leave hospital after two or

three days rather than the previously necessary 7 to 10 days. Overall, trauma is

dramatically reduced.

However, a problem inherent with endoscopes is the contamination of the lumen

with biological material from the patient, for example, mucous, saliva, faeces, blood,

pieces of tissue etc.

While endoscopes have developed greatly in recent times, most of the

developments have concentrated on technical aspects such as the use of optical fibres

and lenses, electronic controls and other engineering features. Progress in the cleaning

and disinfection of endoscopes has largely not kept pace with the engineering and

electronics developments. More recently very sophisticated chemical and biochemical

products have been developed, for example, multi-enzyme detergents which digest all

human secretions which may be on endoscope surfaces in order to pre-clean instruments

before they are disinfected. Also relatively recently new sterilising systems using hydrogen peroxide plasma or peracetic acid at elevated temperature have become

available.

All soiled endoscopes require thorough and efficient cleaning (known as "pre

cleaning") prior to disinfection or sterilisation. Disinfection or sterilisation of an

instrument which has not been completely cleaned is impossible and leads to patient

infections.

The current procedure for cleaning an endoscope entails the following steps.

1. Removal of the soiled endoscope from the patient.

2. Rinsing the soiled instrument in a sink with a copious amount of water and wiping

down the outer sheath with a single use paper or non-woven fabric wipe.

3. Rinsing the endoscope lumens with water using a large syringe or other water jet.

4. Brushing the lumens with an endoscope cleaning brush whilst the instrument is

immersed in water.

5. Digestion of the contaminants by immersing the instrument in a multi-enzyme

detergent bath. In some places detergent is used rather than enzymes.

6. Rinsing the instrument and the hollow channels with water and then air blowing to

substantially dry the surfaces in order to avoid dilution of disinfectants..

The endoscope is then ready for disinfection or sterilisation.

In some variations of the procedure, step 4 and 5 are replaced by a step of brushing

while the endoscope is immersed in an enzyme detergent bath.

Typically, the endoscope cleaning brush referred to above has a long flexible

stainless steel body composed of a flexible stainless steel wire core covered by tightly

coiled flexible stainless steel. The diameter of this body section is approximately 1 mm. At the end of the body is a 30 mm section of nylon bristles. These flexible bristles are

usually interwoven with the stainless steel coils. The bristle section is approximately 5

to 6 mm in diameter. The cleaning brush is used to briskly brush backwards and forward

along the whole length of the lumen of the endoscope to remove the maximum amount

of biological matter contamination prior to enzyme digestion.

Typically, cleaning brushes used for endoscope cleaning receive a clean and

disinfection between each cycle of use, in that they are given a water rinse soaked in an

enzyme bath, and usually receive the same disinfection as the endoscope itself. There

are no limits on the number of cycles of use of such cleaning brushes and many remain

in use after most or at least a significant number of bristles have broken away.

Some procedures, for example diagnostic examination of the human oesophagus

and stomach can be accomplished in 10 -15 minutes after the patient is sedated, while

cleaning and disinfecting would require over 30 minutes.

Endoscopes are expensive instruments, many costing up to between $20,000 -

$50,000. Because of this high price, practitioners tend to purchase only the minimum

number of instruments necessary to ensure a smooth work flow. As a result, there is

considerable pressure to disinfect the endoscope for only the shortest effective time.

Any improvement in the time required to disinfect the endoscopes has the potential to

reduce the number of instruments which a practitioner needs to purchase.

It is an object of the present invention to provide a device and method to improve

the speed and/or efficiency of cleaning endoscopes and the like.

DESCRIPTION OF THE INVENTION According to a first aspect the invention consists in apparatus for use in cleaning a

contaminated lumen of an endoscope, said apparatus comprising a wiping member

adapted to pass axially through the lumen with at most a small clearance, whereby

contamination, if any. remaining after passage of the member through the lumen is

substantially uniformly distributed about the interior of the lumen as a thin film.

For preference the wiping member is attachable, or more preferably permanently

attached to an elongate shaft or cable. This may be flexible for flexible endoscopes or

rigid for rigid endoscopes. The member may include wiping elements which are, for

example, a disk disposed orthogonally to the shaft or it may be a cylinder, sphere, cone,

spiral or the like. It is preferred to use one or more disk-shaped fins as wiping elements

as these provide a more effective scraping action.

Wiping members which are not fully circumferential at their trailing member leave

ridges of contaminant when pulled through the endoscope. The number of ridges will

depend upon the design. Even if a number of partially circumferential segments occlude

one another to present a full circumference when viewed end on, the trailing member

will leave ridges in the contaminant film where the edge of the partially circumferential

segment is drawn through the contaminant.

In a particularly preferred embodiment, the wiping member includes

approximately 50 circular segments of similar size in close proximity and disposed at

90° to the shaft.

According to a second aspect the invention consists in a method for cleaning a

contaminated lumen of an endoscope comprising the steps of: Pulling or pushing a wiping member axially through the lumen, the wiping

member being adapted to wipe the internal wall of the lumen or to pass through with a

small clearance whereby remaining contaminants, if any, after passage of the member

are uniformly distributed about the interior wall of the lumen as a thin film; and

treating the uniform film with a cleaning composition.

In the use of the method, the cleaning composition preferably includes one or more

enzymes.

Experiments have been conducted by the present inventor using a transparent tube

of the same diameter as an endoscope lumen contaminated with compositions similar to

those encountered in use and using the prior art cleaning method. This has revealed that

the nature of the bristles mainly serve to move the viscous liquid with its suspended

particular matter backwards and forwards rather than to remove it from the hollow tube.

The thick viscous, non flowing biological material is simply redispersed in an uneven

fashion throughout the lumen, creating in places thick deposits or "ridges" of biological

materials that may not be fully digested by the enzymes in the short period of the

cleaning phase or are digested more slowly than thinner film sections in the "valleys"

between ridges.

The resulting uneven distribution of the contamination increases the overall

cleaning time. The thickness of the deposits is a rate determining factor in the enzyme

digestion step.

The inventor has found that by use of the present method a much greater

proportion of contaminant can be removed in a single pass through the lumen and any remaining contaminant is spread much more uniformly and as a thin film which is

rapidly and uniformly attacked during the digestion step.

According to a third aspect the invention consists in a method for manufacture of

an endoscope cleaning apparatus comprising the step of moulding a wiping member

comprising one or more radially directed fins in situ on an elongated shaft or cable.

The wiping member may be formed integrally with the shaft, or may be made

separately. It may have a solid core or a hollow core.

The invention will now be more particularly described by way of example only

with reference to the accompanying drawings.

BRIEF DESCRIPTION OF THE DRAWINGS

Figure 1 shows a preferred embodiment of an apparatus for use in cleaning a

contaminated lumen of an endoscope in accordance with the present invention.

Figure 2 shows a cross section of the preferred embodiment when inserted into the

lumen of an endoscope.

Figures 3-8 show alternative embodiments of the cleaning member of the present

invention.

BEST MODE FOR CARRYING OUT THE INVENTION

A preferred embodiment of the invention has a long slender body 1 composed of a

flexible material having a pulling end 2 and defining a pulling direction. At or adjacent

the other end 3 is an apparatus 4 comprising a plurality of wiping members 5 which in

the present example consists of axially spaced apart disk shaped fins increasing in

diameter in a direction opposite the pulling direction. The maximum diameter of disk 5'

is very marginally less than the diameter of the lumen. The disks extend radially from a solid flexible core 6 which is a tight fit coaxially on body 1. The end 3 is press formed

so as to retain the fins. The other end of the body 3 is preferably rounded so as not to

damage the interior surface of the lumen. Body 1 has a length at least 20-30 mm greater

than the length of the hollow channel. The round ended body of the device is inserted

into the proximal end of the hollow channel and pushed down until it emerges from the

distal end whereupon it is grasped and pulled through, removing the bulk of the

contamination. Ideally, this procedure does not require repetition. All residual

biological matter is smeared evenly over the internal wall in a thin coating by members 5

which ensures quick easy digestion by the enzymes rather than a previous situation

where the biological matter was dispersed in localised "hills" and "valleys" and required

longer periods of digestion. Ideally, such a device could be made sufficiently

inexpensively so that it could be discarded after use, or at most discarded after a days

use. For preference, the wiping member is injection moulded onto the end of the body

which is also made of a polymer which has been extruded. The melting point of the

portion to be injection moulded is ideally such as to cause a fusion with the extruded

polymer during the injection moulding process, such that the two portions cannot be

separated. The fins are spaced apart on the solid extruded core 6.

Spaced apart fins appear to more efficiently remove contamination than a single fin

due to the rheology of the contaminant mixture.

Typically, the diameter of the lumen of an endoscope in the range 1 to 4.8 mm. It

is preferred that the device according to the present invention has a cleaning member

which is around 0.1 mm narrower, at its widest point, than the endoscope lumen. Given

the expected tolerances in injection moulding, it is expected that the diameter would be within 0.1 mm of the theoretical diameter. However, for lumens of other diameter the

size of the cleaning member can be varied as required. The cleaning or wiping member

may be formed from one or more than one components.

Preferably, the body is composed of polypropylene, nylon, stainless steel spring

tempered wire or the like.

As the inside of the endoscope lumen is usually made of polyurethane in the case

of flexible endoscopes, and stainless steel in the case of rigid endoscopes, it is important

that the cleaning member be selected from a material which will not score this inner

surface of the lumen. Thus, desirably the cleaning member is formed from a material

which is not as hard as the inside of the endoscope.

In a comparative study, a transparent lumen of similar dimension to the lumen of

an endoscope is contaminated with a mucous which is of similar physical characteristics

to those encountered in the normal use of the instrument. Repeated use of a brush of the

kind now commonly employed was found to remove some of the contaminants but left a

substantial quantity within the lumen. The remaining contaminants were very unevenly

distributed both in the axially direction and in the circumferential direction. Digestion in

a solution (eg epizyme rapid bath) required 6 to 12 minutes.

When apparatus according to the invention was used, the interior of the lumen was

substantially wiped clean with a single pull through, leaving a thin film of contaminant

remaining. The thin film was seen to be uniformly distributed both radially and

longitudinally. Because the contaminants are uniformly distributed, the enzymatic

cleaning solution was able to substantially digest the film within 2 to 3 minutes. In the

case of the non-uniform distribution of the remaining contaminants of the prior brushing art, the digestion in areas where contamination is of maximum thickness will take very

much longer to digest than the thin film and the overall time to obtain a satisfactory

decontamination will be greatly lengthened.

Desirably, a plurality of spaced apart disk shaped fins are employed. These fins

are radially extending in the form of either a disk or cone or they may be a succession of

disks or cones graded in diameter. A fin may be of greater diametric dimension than that

of the lumen and in that case will be resilient at least at its periphery. The fin may also

be in the form of a spiral. At least one fin desirably extends circumferentially but a

plurality of fin sectors extending over less than 360° at the circumference and angularly

disposed so as to occlude each other may be employed, provided a homogeneous film

results.

Fins extending in a circumferential direction at their outer periphery may have one

or more space protrusions to maintain the cleaning member at a uniform circumferential

spacing from the lumen wall.

Figure 3-8 show other embodiments of the invention with regards to variations of

the cleaning member 3. For example, figure 3 shows a cleaning member with the fins of

equal size.

Figure 4 shows a cleaning member formed of a single block with circumferential

grooves. The fins do not have to be disposed at 90 ° to the body, for example figure 5

shows a series of cone shaped fins and figure 6 shows a spiral. Figure 7 shows an

embodiment of the invention wherein the fins are larger than the lumen but are

resiliently biased at the edges. Figure 8 shows a cleaning member wherein the wiping

action is produced by a plurality of balls. COMPARATIVE EXAMPLES

TEST METHOD FOR VALIDATING THE EFFICACY OF ENDOSCOPIC

CLEANING DEVICE

The test described herein is derived from a variety of tests used worldwide, for

example, British Standard Test Method BS2745.

TEST CONTAMINATION SAMPLE

In this example, a variety of materials representing the various classes of human

secretions, mixed with bacterial spores at a known level, form the basis for the artificial

contamination. The composition is similar to that described in the abovementioned

British standard test. This contaminant in a known volume is used to contaminate the

lumen to be cleaned. The test organism used is Bacillus subtilis variety globigii. This is

an aerobic spore forming bacteria which is easy to cultivate and grows on nutrient broth

and nutrient agar and is non-hazardous to laboratory personnel. The test organism is

grown on a nutrient broth for two to three days at 37°C. The spores are harvested by

centrifuging and washing four times in sterile distilled water. The final spore wash is

heated to 80°C for 15 minutes to kill any remaining vegetative cells. The yield of spores

will be approximately 10 spores/ml. This spore suspension is stored at 4°C until

required and is not retained for more than one week.

TEST CONTAMINATION MIXTURE

The following is used to prepare the artificial contaminant,

Beef-Steak = 50 g,

Raw egg = 50 g,

Boiled potato = 50 g, Hog Mucin = 2 g,

Water to 500 ml.

The ingredients are dispersed in a blender for 10 minutes.

The spore suspension is then diluted to yield 10 spores/ml. 1.0 ml of the spore

suspension containing 10 spores is mixed with 100 ml of the artificial contaminant.

This serves as the test material.

INTRODUCTION OF CONTAMINANT

10 ml of the contaminant mixture is injected into the biopsy lumen of a

colonoscope. Care is taken so that the contaminant mixture remains inside the biopsy

lumen and is coated over the lumen wall by rotating the endoscope after the introduction

of the contaminant.

PHYSICAL CLEAN USING PRIOR ART CLEANING BRUSH

The soiled endoscope is immersed in a water bath. A standard Pentax cleaning

brush is introduced into the contaminated biopsy lumen and energetically brushed

forwards and backwards for the whole length of the lumen for a period of 30 seconds.

The brush is removed and the endoscope is then removed from the bath, the water

is allowed to drain and the endoscope is submerged in a known volume of an endoscopic

cleaning solution (Epizyme Rapid) diluted according to instruction at a rate of 75:1

water to product. The bath is maintained in the temperature range 25-30°C.

A clean 50 ml syringe is used to ensure that the endoscope channel is filled with

the cleaning solution. The instrument is allowed to stand for 5 minutes, whereupon the

syringe is used to irrigate the channel five times with 50 ml taken from the bath on each

occasion. USE OF ENDOSCOPE CLEANING DEVICE ACCORDING TO THE PRESENT

INVENTION

The soiled endoscope is immersed in a water bath. An endoscope cleaning device

according to the present invention and as shown in figure 1 was introduced into the

proximal end of the contaminated biopsy lumen and pulled from the proximal end

through to the distal end once.

The device is removed and the endoscope is then removed from bath, the water

allowed to drain, and the endoscope submerged in a known volume of endoscopic

cleaning solution (epizyme rapid) diluted according to instructions at a rate of 75:1 water

to product. The bath is maintained in the temperature range 25 to 30°C. A clean 50 ml

syringe is used to ensure that the endoscope channel is filled with the cleaning solution.

The instrument is allowed to stand for 5 minutes, whereupon the syringe is used to

irrigate the channel five times with 50 ml taken from the bath on each occasion.

CONTROL

The contaminated endoscope is emersed without physical cleaning into a fresh

endoscopic cleaning solution bath made up as described above and allowed to soak for 5

minutes as described and then irrigated as described above.

ENUMERATION OF BACTERIAL COUNT

The spore count is determined by taking a 50 ml sample from the cleaning bath

after endoscope removal and agitation of the bath. 1 ml of the sample is diluted to 9 ml

with the nutrient broth and this sample further diluted 1 in 10 and up to 1 in 100,000.

1 ml of the above diluted samples are plated in duplicate in nutrient agar. The plates are

allowed to solidify and are incubated at 37°C for three days. The number of colonies were then determined for all samples and the colony counts converted to log₁₀ for all the

samples.

TIME TAKEN TO REACH THE SPORE COUNT IN THE RANGE OF LOG5 TO

LOG6

As will be understood by those skilled in the art based on the teaching hereof the

invention may be embodied in other forms and may utilise other materials without

departing from the concepts herein described.

Claims

THE CLAIMS OF THE INVENTION ARE AS FOLLOWS :-

1. Apparatus for use in cleaning a contaminated lumen of an endoscope, said

apparatus comprising a wiping member adapted to pass axially through the lumen with

at most a small clearance, whereby contamination, if any, remaining after passage of the

member through the lumen is substantially uniformly distributed about the interior of the

lumen as a thin film.

2. Apparatus according to claim 1 wherein the wiping member is attachable to an

elongate shaft.

3. Apparatus according to claim 1 wherein the wiping member is permanently

attached to an elongate shaft.

4. Apparatus according to any one of the preceding claims wherein the shaft is

flexible.

5. Apparatus according to any one of claims 1 to 3 wherein the shaft is rigid.

6. Apparatus according to any one of the preceding claims wherein the wiping

member includes at least one radially extending fin as a wiping element.

7. Apparatus according to any one of the preceding claims wherein the wiping

member includes a plurality of radially extending fins as wiping elements.

8. Apparatus according to any one of the preceding claims wherein the wiping

member includes a disk shaped wiping element.

9. Apparatus according to any one of claims 1 to 7, wherein the wiping member

includes a cylindrical wiping element.

10. Apparatus according to any one of claims 1 to 7, wherein the wiping member

includes a spherical wiping element.

1 1. Apparatus according to any one of claims 1 to 7, wherein the wiping member

includes a spiral wiping element.

12. Apparatus according to any one of claims 1 to 7 wherein the wiping member

includes a conical or frustoconical wiping element.

13. Apparatus according to any one of the preceding claims wherein the wiping

member has a hollow core

14. Apparatus according to any one of claims 1 to 12 wherein the wiping member has

a solid core.

15. Apparatus according to any one of the preceding claims wherein the wiping

member includes a series of wiping elements graded in diameter.

16. Apparatus according to any one of the preceding claims wherein the wiping

member includes one or more spacer protrusions at its outer periphery.

17. Apparatus according to any one of the preceding claims wherein the wiping

member includes at least one partially circumferential wiping element and a fully

circumferential trailing wiping element.

18. Apparatus according to any one of the preceding claims, wherein the wiping

member is composed of a resilient material and is of greater diametric dimension than

the bore of the lumen.

19. Apparatus according to any one of claims 1 to 17 wherein the full circumference of

the wiping member corresponds to the cross section of the lumen.

20. Apparatus according to any one of claims 1 to 17, wherein the wiping member is

narrower in cross section than the lumen.

21. Apparatus according to any one of the preceding claims, wherein the wiping

member is composed of a non-absorbent material.

22. Apparatus according to any one of the preceding claims, wherein the wiping

member is composed of an elastomeric material.

23. Apparatus according to any one of the preceding claims further including a

rounded end proximal the wiping member.

24. Apparatus according to any one of the preceding claims wherein said apparatus is

disposable.

25. Apparatus for use in cleaning a contaminated lumen of an endoscope, said

apparatus comprising a fully circumferential wiping member adapted to pass axially

through the lumen with at most a small clearance, whereby contamination, if any,

remaining after passage of the member through the lumen is substantially uniformly

distributed about the interior of the lumen as a thin film.

26. A method for cleaning a contaminated lumen of an endoscope comprising the steps

of:

pulling or pushing a wiping member axially through the lumen, the wiping member

being adapted to wipe the internal wall of the lumen or to pass through with a small

clearance whereby remaining contaminants, if any, after passage of the member are

uniformly distributed about the interior wall of the lumen as a thin film; and

treating the uniform film with a cleaning composition.

27. A method according to claim 26 wherein the cleaning composition includes one or

more enzymes.

28. A method according to claim 26 or 27, wherein the thin film is substantially

homogeneous in thickness.

29. A method according to any one of claims 26 to 28 wherein the thin film is

distributed both radially and longitudinally.

30. A method according to any one of claims 26 to 29, wherein the film thickness is

obtained with a single pass of the wiping member through the lumen.

31. A method for manufacture of an endoscope cleaning apparatus as defined in any

one of claims 1 to 25 comprising the step of moulding a wiping member comprising one

or more radially directed fins in situ on an elongated shaft or cable.

32. A method according to claim 31 , wherein the wiping member is moulded onto the

shaft.

33. A method according to claim 31 wherein the wiping member is injection moulded

onto the shaft.

34. A method according to claim 31 , wherein the wiping member and shaft include

complementary engageable threads.

35. A method according to claim 31, wherein the wiping member is press formed onto

the shaft.

36. A method according to any one of claims 31 to 35 wherein the wiping member is

moulded from two or more components.

37. A method according to any one of claims 31 to 36 wherein the wiping member is

fused to the shaft.

38. A kit including apparatus according to any one of claims 1 to 25, and an enzyme

cleaning composition, said apparatus and said cleaning composition selected to provide a predetermined residue thickness on the inside of the lumen and requiring a

predetermined digestion time thereof.