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Shirley L. Raltz - One of the best experts on this subject based on the ideXlab platform.
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Contamination of single-use Biopsy Forceps: a prospective in vitro analysis.
Gastrointestinal endoscopy, 2002Co-Authors: Timothy P Kinney, Richard A. Kozarek, Shirley L. Raltz, Fouad M. AttiaAbstract:It has been suggested that single-use Biopsy Forceps prevent interpatient transmission of infection during endoscopy. Passage of sterile Forceps through the accessory channel of the endoscope may lead to contamination, however, if the endoscope has been inadequately processed. The potential for contamination of single-use Biopsy Forceps at various stages of endoscope reprocessing was prospectively evaluated. A total of 50 disposable Biopsy Forceps were passed through the accessory channels of 10 colonoscopes at the following stages of reprocessing: (1) before use in patients to establish a baseline of high-level disinfection, (2) directly after colonoscopy to confirm contamination with use, (3) after manual cleaning and flushing of the accessory channel to support the claim that manual cleaning significantly decreases bioburden, (4) after manual cleaning and a 2-minute soak in 2% glutaraldehyde to assess for contamination after an inadequate cleaning time, and (5) after manual cleaning and a 20-minute soak in 2% glutaraldehyde. The Forceps were then sealed in sterile plastic bags after adding 20 mL of thioglycollate broth medium. The suspension was passed through a 0.2-micron vacuum filter and the filters were cultured. All cultures were incubated more than 48 hours. Biopsy Forceps underwent a total of 50 aerobic and 50 anaerobic cultures. Colony-forming units too numerous to count of GI flora, including Escherichia coli, Klebsiella, Pseudomonas, and Clostridium species, grew on 19 of 20 culture plates from Biopsy Forceps passed through colonoscopes immediately after use. One plate in this group grew 3 colony-forming units of E coli. Persistence of GI flora was noted on 5 of 20 plates after manual cleaning of the colonoscopes. No GI flora were found on Forceps after the colonoscopes after soaking in gluteraldehyde for 2 and 20 minutes. Environmental contaminants including diptheroids, Staphylococcus, and Streptococcus species grew on 16 culture plates. (1) Single-use Biopsy Forceps are highly susceptible to contamination during passage through the accessory channels of improperly cleaned endoscopes. (2) Disinfection of the colonoscopes in this study prevented contamination of the Forceps at baseline and after reprocessing. (3) Proper endoscope reprocessing may be the most important factor in preventing Biopsy Forceps-related interpatient infection.
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Reusable Biopsy Forceps: a prospective evaluation of cleaning, function, adequacy of tissue specimen, and durability.
Gastrointestinal endoscopy, 2001Co-Authors: Richard A. Kozarek, Shirley L. Raltz, Fouad M. Attia, Stanford E. Sumida, T.j. Ball, Shannon K. Roach, Drew B. Schembre, John J. Brandabur, Michael Gluck, Geoffrey C. JiranekAbstract:Recent studies have indicated that reusable Biopsy Forceps remain contaminated after reprocessing and can only be used a mean of 12 to 25 times without malfunction. Because this contradicts traditional endoscopic practice, our study investigated the ability to sterilize a type of commercially available Biopsy Forceps and prospectively evaluated their function in vivo until malfunction and/or breakage. Thirty reusable Biopsy Forceps were studied, 15 of which were contaminated for 5 trials each with 10(6) Bacillus stearothermophilus, and 15 of which were prospectively evaluated clinically over an 18-month period (9/98-3/00). Contaminated Forceps were reprocessed by using a standard protocol and placed in a sterile bag containing soy broth. The latter was passed through a 0.2 micron filter and was subsequently cultured. In vivo data included Biopsy site, size, adequacy, problems obtaining a Biopsy specimen, and reasons for ultimate Forceps failure. After contamination, all Biopsy Forceps yielded a heavy growth of B stearothermophilus. No Forceps, including 5 that were piecemeal dismantled with a wire cutter, had residual bacteria after reprocessing. In the in vivo study, 1507 Biopsy sessions were undertaken in 1339 procedures. Forceps were categorized as new or like-new in 1259 of 1339 (94%) procedures, some loss of function but usable in 72 of 1339 (5.4%), and inadequate function or broken at use in 8 of 1339 (0.6%). Histologically, 1501 specimen sets were adequate (99.6%) and mean specimen size was 2.7 +/- 0.1 mm. Mechanical problems were noted in only 38 of 1507 (3%) sessions to include such things as sticky Forceps, and the mean number of uses to malfunction or breakage was 91 +/- 15 (SEM) (range 19-132). This reusable Biopsy Forceps can be sterilized and used a mean of 91 times with adequate tissue sampling. Mechanical problems were minor to time of breakage. Contingent on acquisition and reprocessing costs as well as the number of procedures performed, this reusable Forceps has the potential for significant cost savings.
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3341 Single-use Biopsy Forceps: does sterility upon insertion prevent contamination at time of Biopsy?
Gastrointestinal Endoscopy, 2000Co-Authors: Timothy P Kinney, Richard A. Kozarek, Stanford E. Sumida, Shirley L. RaltzAbstract:Background: It has been suggested that single-use Biopsy Forceps will prevent inter-patient transmission of infection during endoscopy. Passage of sterile Forceps through the Biopsy channel can lead to contamination, however, if the endoscope is inadequately reprocessed.We prospectively evaluated the potential for contamination of single-use Biopsy Forceps at various stages of endoscope reprocessing. Methods: A total of forty disposable Biopsy Forceps (Microvasive Inc., Natick, MA) were passed through the Biopsy channels of ten colonoscopes at various stages of reprocessing. Ten Forceps were passed through the channels prior to use on patients to establish a baseline of high-level disinfection. Ten Forceps were passed directly after colonoscopy to confirm contamination with use. Ten Forceps were passed after manual cleaning and flushing of the Biopsy channel to evaluate the effectiveness of manual cleaning to reduce bioburden. Finally ten were passed through the Biopsy channel after either a 2- or 20-minute soak in 2% glutaraldehyde (Cidex™, Johnson & Johnson, Arlington, TX). The Forceps were then sealed in sterile plastic bags and 15 ml of soy broth was added. The suspension was passed through a 0.2-micron filter, and the filters were cultured. All cultures were incubated more than 48 hours. Results: Biopsy Forceps underwent a total of 40 aerobic and 40 anaerobic cultures. TNTC gastrointestinal flora grew on 19 of 20 plates from Biopsy Forceps passed through colonoscopes immediately after use (one plate grew only 3 colonies). Persistent gastrointestinal flora was noted on 5 of 20 plates from Forceps passed through colonoscopes after manual cleaning alone. No gastrointestinal flora was found on Forceps after the colonoscopes were exposed to gluteraldehyde soaks of 2 or 20 minutes. Nonpathogenic organisms including diptheroids, staphylococcus, and streptococcus grew on 16 plates. Conclusions: 1) Disposable Biopsy Forceps are highly susceptible to contamination from passage through the Biopsy channels of improperly cleaned endoscopes. 2) High-level disinfection of the colonoscopes in this study prevented contamination of the Forceps with pathogenic organisms. 3) Proper endoscope reprocessing may be the most important factor in preventing inter-patient infection, whether new Biopsy Forceps or sterilized reusable Forceps are utilized.
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Risk of contamination of sterile Biopsy Forceps in disinfected endoscopes
Gastrointestinal endoscopy, 1998Co-Authors: Roger M. Lee, Richard A. Kozarek, Stanford E. Sumida, Shirley L. RaltzAbstract:Previous studies have shown that pathogens may persist within bacterial biofilms in endoscope accessory channels despite high-level disinfection. Breaching the gastrointestinal mucosa with Biopsy Forceps contaminated at time of passage has the potential to cause cross-infection between patients. We studied contamination risk of sterilized Biopsy Forceps passed through endoscopes after high-level disinfection. For each trial, five video colonoscopes, duodenoscopes, and gastroscopes were used. All endoscopes had been previously processed and stored for 10 or more hours. Sterile Biopsy Forceps were inserted and retrieved followed by vortexing the tips in 15 mL of soy broth. Under a laminar flow hood, the broth was filtered through a 0.2 microm millipore membrane and plated. Because of minimal bacterial growth resulting from the above, soy broth (> 20 mL) was flushed through two video colonoscopes, duodenoscopes, and gastroscopes on two occasions and collected. The effluent was plated using a sample of 0.1 mL dilution. The remaining suspension was passed through a millipore filter, and the filter was cultured. All cultures were incubated more than 48 hours. Biopsy Forceps underwent a total of 24 anaerobic and 75 aerobic cultures. Microbacterial growth occurred on 17 plates: 7 from gastroscopes, 5 from colonoscopes, and 5 from duodenoscopes. Fifteen plates grew staphylococcus for a total of 21 colonies, 1 plate grew 1 colony of propionibacter, 2 plates grew diphtheroids for a total of 4 colonies, and 1 plate grew a single colony of lactobacillus. Cultures from soy broth flushed through the various endoscopes grew on 5 plates: 3 from gastroscopes and 2 from duodenoscopes grew a total of 8 colonies of staphylococcus. With proper cleaning technique, a 20-minute soak in 2% glutaraldehyde is effective in disinfecting endoscopes. Although current procedures for endoscope disinfection remain imperfect, we found that in this clinical setting, infection of pathogenic gastrointestinal flora is unlikely when using sterile Biopsy Forceps.
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Disposable versus reusable Biopsy Forceps: a prospective evaluation of costs ☆ ☆☆ ★ ★★ ♢
Gastrointestinal endoscopy, 1996Co-Authors: Richard A. Kozarek, Shirley L. Raltz, Linda D. Merriam, Stanford E. SumidaAbstract:Abstract Background: Disposable Biopsy Forceps have been heavily marketed as cost-effective, convenient, and safer to use than conventional Forceps. Methods: In an attempt to define whether disposable or reusable Biopsy Forceps were cheaper to use, we prospectively evaluated the purchase price, number of uses, repair record, and cleaning costs of all reusable Biopsy Forceps used in the outpatient endoscopy unit of a large multispecialty clinic. Results: Over a 12-month period, 1581 Biopsy sessions were undertaken. Seventeen of 119 Forceps required $1890 in repairs over the study period (an average of $1.20 per Biopsy session). Cleaning costs, including technician processing and steam autoclave, approximated $3.46 per use, increasing to $5.61 per use if glutaraldehyde soak was substituted for steam autoclave. Conclusions: Assuming a sixfold difference in purchase price between reusable and disposable Forceps, and a per-use repair and cleaning cost of $1.20 and $3.46, respectively, reusable Biopsy Forceps became cost-effective after seven uses in our institution. (Gastrointest Endosc 1996;43:10-3.)
Richard A. Kozarek - One of the best experts on this subject based on the ideXlab platform.
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Contamination of single-use Biopsy Forceps: a prospective in vitro analysis.
Gastrointestinal endoscopy, 2002Co-Authors: Timothy P Kinney, Richard A. Kozarek, Shirley L. Raltz, Fouad M. AttiaAbstract:It has been suggested that single-use Biopsy Forceps prevent interpatient transmission of infection during endoscopy. Passage of sterile Forceps through the accessory channel of the endoscope may lead to contamination, however, if the endoscope has been inadequately processed. The potential for contamination of single-use Biopsy Forceps at various stages of endoscope reprocessing was prospectively evaluated. A total of 50 disposable Biopsy Forceps were passed through the accessory channels of 10 colonoscopes at the following stages of reprocessing: (1) before use in patients to establish a baseline of high-level disinfection, (2) directly after colonoscopy to confirm contamination with use, (3) after manual cleaning and flushing of the accessory channel to support the claim that manual cleaning significantly decreases bioburden, (4) after manual cleaning and a 2-minute soak in 2% glutaraldehyde to assess for contamination after an inadequate cleaning time, and (5) after manual cleaning and a 20-minute soak in 2% glutaraldehyde. The Forceps were then sealed in sterile plastic bags after adding 20 mL of thioglycollate broth medium. The suspension was passed through a 0.2-micron vacuum filter and the filters were cultured. All cultures were incubated more than 48 hours. Biopsy Forceps underwent a total of 50 aerobic and 50 anaerobic cultures. Colony-forming units too numerous to count of GI flora, including Escherichia coli, Klebsiella, Pseudomonas, and Clostridium species, grew on 19 of 20 culture plates from Biopsy Forceps passed through colonoscopes immediately after use. One plate in this group grew 3 colony-forming units of E coli. Persistence of GI flora was noted on 5 of 20 plates after manual cleaning of the colonoscopes. No GI flora were found on Forceps after the colonoscopes after soaking in gluteraldehyde for 2 and 20 minutes. Environmental contaminants including diptheroids, Staphylococcus, and Streptococcus species grew on 16 culture plates. (1) Single-use Biopsy Forceps are highly susceptible to contamination during passage through the accessory channels of improperly cleaned endoscopes. (2) Disinfection of the colonoscopes in this study prevented contamination of the Forceps at baseline and after reprocessing. (3) Proper endoscope reprocessing may be the most important factor in preventing Biopsy Forceps-related interpatient infection.
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Reusable Biopsy Forceps: a prospective evaluation of cleaning, function, adequacy of tissue specimen, and durability.
Gastrointestinal endoscopy, 2001Co-Authors: Richard A. Kozarek, Shirley L. Raltz, Fouad M. Attia, Stanford E. Sumida, T.j. Ball, Shannon K. Roach, Drew B. Schembre, John J. Brandabur, Michael Gluck, Geoffrey C. JiranekAbstract:Recent studies have indicated that reusable Biopsy Forceps remain contaminated after reprocessing and can only be used a mean of 12 to 25 times without malfunction. Because this contradicts traditional endoscopic practice, our study investigated the ability to sterilize a type of commercially available Biopsy Forceps and prospectively evaluated their function in vivo until malfunction and/or breakage. Thirty reusable Biopsy Forceps were studied, 15 of which were contaminated for 5 trials each with 10(6) Bacillus stearothermophilus, and 15 of which were prospectively evaluated clinically over an 18-month period (9/98-3/00). Contaminated Forceps were reprocessed by using a standard protocol and placed in a sterile bag containing soy broth. The latter was passed through a 0.2 micron filter and was subsequently cultured. In vivo data included Biopsy site, size, adequacy, problems obtaining a Biopsy specimen, and reasons for ultimate Forceps failure. After contamination, all Biopsy Forceps yielded a heavy growth of B stearothermophilus. No Forceps, including 5 that were piecemeal dismantled with a wire cutter, had residual bacteria after reprocessing. In the in vivo study, 1507 Biopsy sessions were undertaken in 1339 procedures. Forceps were categorized as new or like-new in 1259 of 1339 (94%) procedures, some loss of function but usable in 72 of 1339 (5.4%), and inadequate function or broken at use in 8 of 1339 (0.6%). Histologically, 1501 specimen sets were adequate (99.6%) and mean specimen size was 2.7 +/- 0.1 mm. Mechanical problems were noted in only 38 of 1507 (3%) sessions to include such things as sticky Forceps, and the mean number of uses to malfunction or breakage was 91 +/- 15 (SEM) (range 19-132). This reusable Biopsy Forceps can be sterilized and used a mean of 91 times with adequate tissue sampling. Mechanical problems were minor to time of breakage. Contingent on acquisition and reprocessing costs as well as the number of procedures performed, this reusable Forceps has the potential for significant cost savings.
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3341 Single-use Biopsy Forceps: does sterility upon insertion prevent contamination at time of Biopsy?
Gastrointestinal Endoscopy, 2000Co-Authors: Timothy P Kinney, Richard A. Kozarek, Stanford E. Sumida, Shirley L. RaltzAbstract:Background: It has been suggested that single-use Biopsy Forceps will prevent inter-patient transmission of infection during endoscopy. Passage of sterile Forceps through the Biopsy channel can lead to contamination, however, if the endoscope is inadequately reprocessed.We prospectively evaluated the potential for contamination of single-use Biopsy Forceps at various stages of endoscope reprocessing. Methods: A total of forty disposable Biopsy Forceps (Microvasive Inc., Natick, MA) were passed through the Biopsy channels of ten colonoscopes at various stages of reprocessing. Ten Forceps were passed through the channels prior to use on patients to establish a baseline of high-level disinfection. Ten Forceps were passed directly after colonoscopy to confirm contamination with use. Ten Forceps were passed after manual cleaning and flushing of the Biopsy channel to evaluate the effectiveness of manual cleaning to reduce bioburden. Finally ten were passed through the Biopsy channel after either a 2- or 20-minute soak in 2% glutaraldehyde (Cidex™, Johnson & Johnson, Arlington, TX). The Forceps were then sealed in sterile plastic bags and 15 ml of soy broth was added. The suspension was passed through a 0.2-micron filter, and the filters were cultured. All cultures were incubated more than 48 hours. Results: Biopsy Forceps underwent a total of 40 aerobic and 40 anaerobic cultures. TNTC gastrointestinal flora grew on 19 of 20 plates from Biopsy Forceps passed through colonoscopes immediately after use (one plate grew only 3 colonies). Persistent gastrointestinal flora was noted on 5 of 20 plates from Forceps passed through colonoscopes after manual cleaning alone. No gastrointestinal flora was found on Forceps after the colonoscopes were exposed to gluteraldehyde soaks of 2 or 20 minutes. Nonpathogenic organisms including diptheroids, staphylococcus, and streptococcus grew on 16 plates. Conclusions: 1) Disposable Biopsy Forceps are highly susceptible to contamination from passage through the Biopsy channels of improperly cleaned endoscopes. 2) High-level disinfection of the colonoscopes in this study prevented contamination of the Forceps with pathogenic organisms. 3) Proper endoscope reprocessing may be the most important factor in preventing inter-patient infection, whether new Biopsy Forceps or sterilized reusable Forceps are utilized.
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Risk of contamination of sterile Biopsy Forceps in disinfected endoscopes
Gastrointestinal endoscopy, 1998Co-Authors: Roger M. Lee, Richard A. Kozarek, Stanford E. Sumida, Shirley L. RaltzAbstract:Previous studies have shown that pathogens may persist within bacterial biofilms in endoscope accessory channels despite high-level disinfection. Breaching the gastrointestinal mucosa with Biopsy Forceps contaminated at time of passage has the potential to cause cross-infection between patients. We studied contamination risk of sterilized Biopsy Forceps passed through endoscopes after high-level disinfection. For each trial, five video colonoscopes, duodenoscopes, and gastroscopes were used. All endoscopes had been previously processed and stored for 10 or more hours. Sterile Biopsy Forceps were inserted and retrieved followed by vortexing the tips in 15 mL of soy broth. Under a laminar flow hood, the broth was filtered through a 0.2 microm millipore membrane and plated. Because of minimal bacterial growth resulting from the above, soy broth (> 20 mL) was flushed through two video colonoscopes, duodenoscopes, and gastroscopes on two occasions and collected. The effluent was plated using a sample of 0.1 mL dilution. The remaining suspension was passed through a millipore filter, and the filter was cultured. All cultures were incubated more than 48 hours. Biopsy Forceps underwent a total of 24 anaerobic and 75 aerobic cultures. Microbacterial growth occurred on 17 plates: 7 from gastroscopes, 5 from colonoscopes, and 5 from duodenoscopes. Fifteen plates grew staphylococcus for a total of 21 colonies, 1 plate grew 1 colony of propionibacter, 2 plates grew diphtheroids for a total of 4 colonies, and 1 plate grew a single colony of lactobacillus. Cultures from soy broth flushed through the various endoscopes grew on 5 plates: 3 from gastroscopes and 2 from duodenoscopes grew a total of 8 colonies of staphylococcus. With proper cleaning technique, a 20-minute soak in 2% glutaraldehyde is effective in disinfecting endoscopes. Although current procedures for endoscope disinfection remain imperfect, we found that in this clinical setting, infection of pathogenic gastrointestinal flora is unlikely when using sterile Biopsy Forceps.
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Disposable versus reusable Biopsy Forceps: a prospective evaluation of costs ☆ ☆☆ ★ ★★ ♢
Gastrointestinal endoscopy, 1996Co-Authors: Richard A. Kozarek, Shirley L. Raltz, Linda D. Merriam, Stanford E. SumidaAbstract:Abstract Background: Disposable Biopsy Forceps have been heavily marketed as cost-effective, convenient, and safer to use than conventional Forceps. Methods: In an attempt to define whether disposable or reusable Biopsy Forceps were cheaper to use, we prospectively evaluated the purchase price, number of uses, repair record, and cleaning costs of all reusable Biopsy Forceps used in the outpatient endoscopy unit of a large multispecialty clinic. Results: Over a 12-month period, 1581 Biopsy sessions were undertaken. Seventeen of 119 Forceps required $1890 in repairs over the study period (an average of $1.20 per Biopsy session). Cleaning costs, including technician processing and steam autoclave, approximated $3.46 per use, increasing to $5.61 per use if glutaraldehyde soak was substituted for steam autoclave. Conclusions: Assuming a sixfold difference in purchase price between reusable and disposable Forceps, and a per-use repair and cleaning cost of $1.20 and $3.46, respectively, reusable Biopsy Forceps became cost-effective after seven uses in our institution. (Gastrointest Endosc 1996;43:10-3.)
Stanford E. Sumida - One of the best experts on this subject based on the ideXlab platform.
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Reusable Biopsy Forceps: a prospective evaluation of cleaning, function, adequacy of tissue specimen, and durability.
Gastrointestinal endoscopy, 2001Co-Authors: Richard A. Kozarek, Shirley L. Raltz, Fouad M. Attia, Stanford E. Sumida, T.j. Ball, Shannon K. Roach, Drew B. Schembre, John J. Brandabur, Michael Gluck, Geoffrey C. JiranekAbstract:Recent studies have indicated that reusable Biopsy Forceps remain contaminated after reprocessing and can only be used a mean of 12 to 25 times without malfunction. Because this contradicts traditional endoscopic practice, our study investigated the ability to sterilize a type of commercially available Biopsy Forceps and prospectively evaluated their function in vivo until malfunction and/or breakage. Thirty reusable Biopsy Forceps were studied, 15 of which were contaminated for 5 trials each with 10(6) Bacillus stearothermophilus, and 15 of which were prospectively evaluated clinically over an 18-month period (9/98-3/00). Contaminated Forceps were reprocessed by using a standard protocol and placed in a sterile bag containing soy broth. The latter was passed through a 0.2 micron filter and was subsequently cultured. In vivo data included Biopsy site, size, adequacy, problems obtaining a Biopsy specimen, and reasons for ultimate Forceps failure. After contamination, all Biopsy Forceps yielded a heavy growth of B stearothermophilus. No Forceps, including 5 that were piecemeal dismantled with a wire cutter, had residual bacteria after reprocessing. In the in vivo study, 1507 Biopsy sessions were undertaken in 1339 procedures. Forceps were categorized as new or like-new in 1259 of 1339 (94%) procedures, some loss of function but usable in 72 of 1339 (5.4%), and inadequate function or broken at use in 8 of 1339 (0.6%). Histologically, 1501 specimen sets were adequate (99.6%) and mean specimen size was 2.7 +/- 0.1 mm. Mechanical problems were noted in only 38 of 1507 (3%) sessions to include such things as sticky Forceps, and the mean number of uses to malfunction or breakage was 91 +/- 15 (SEM) (range 19-132). This reusable Biopsy Forceps can be sterilized and used a mean of 91 times with adequate tissue sampling. Mechanical problems were minor to time of breakage. Contingent on acquisition and reprocessing costs as well as the number of procedures performed, this reusable Forceps has the potential for significant cost savings.
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3341 Single-use Biopsy Forceps: does sterility upon insertion prevent contamination at time of Biopsy?
Gastrointestinal Endoscopy, 2000Co-Authors: Timothy P Kinney, Richard A. Kozarek, Stanford E. Sumida, Shirley L. RaltzAbstract:Background: It has been suggested that single-use Biopsy Forceps will prevent inter-patient transmission of infection during endoscopy. Passage of sterile Forceps through the Biopsy channel can lead to contamination, however, if the endoscope is inadequately reprocessed.We prospectively evaluated the potential for contamination of single-use Biopsy Forceps at various stages of endoscope reprocessing. Methods: A total of forty disposable Biopsy Forceps (Microvasive Inc., Natick, MA) were passed through the Biopsy channels of ten colonoscopes at various stages of reprocessing. Ten Forceps were passed through the channels prior to use on patients to establish a baseline of high-level disinfection. Ten Forceps were passed directly after colonoscopy to confirm contamination with use. Ten Forceps were passed after manual cleaning and flushing of the Biopsy channel to evaluate the effectiveness of manual cleaning to reduce bioburden. Finally ten were passed through the Biopsy channel after either a 2- or 20-minute soak in 2% glutaraldehyde (Cidex™, Johnson & Johnson, Arlington, TX). The Forceps were then sealed in sterile plastic bags and 15 ml of soy broth was added. The suspension was passed through a 0.2-micron filter, and the filters were cultured. All cultures were incubated more than 48 hours. Results: Biopsy Forceps underwent a total of 40 aerobic and 40 anaerobic cultures. TNTC gastrointestinal flora grew on 19 of 20 plates from Biopsy Forceps passed through colonoscopes immediately after use (one plate grew only 3 colonies). Persistent gastrointestinal flora was noted on 5 of 20 plates from Forceps passed through colonoscopes after manual cleaning alone. No gastrointestinal flora was found on Forceps after the colonoscopes were exposed to gluteraldehyde soaks of 2 or 20 minutes. Nonpathogenic organisms including diptheroids, staphylococcus, and streptococcus grew on 16 plates. Conclusions: 1) Disposable Biopsy Forceps are highly susceptible to contamination from passage through the Biopsy channels of improperly cleaned endoscopes. 2) High-level disinfection of the colonoscopes in this study prevented contamination of the Forceps with pathogenic organisms. 3) Proper endoscope reprocessing may be the most important factor in preventing inter-patient infection, whether new Biopsy Forceps or sterilized reusable Forceps are utilized.
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Risk of contamination of sterile Biopsy Forceps in disinfected endoscopes
Gastrointestinal endoscopy, 1998Co-Authors: Roger M. Lee, Richard A. Kozarek, Stanford E. Sumida, Shirley L. RaltzAbstract:Previous studies have shown that pathogens may persist within bacterial biofilms in endoscope accessory channels despite high-level disinfection. Breaching the gastrointestinal mucosa with Biopsy Forceps contaminated at time of passage has the potential to cause cross-infection between patients. We studied contamination risk of sterilized Biopsy Forceps passed through endoscopes after high-level disinfection. For each trial, five video colonoscopes, duodenoscopes, and gastroscopes were used. All endoscopes had been previously processed and stored for 10 or more hours. Sterile Biopsy Forceps were inserted and retrieved followed by vortexing the tips in 15 mL of soy broth. Under a laminar flow hood, the broth was filtered through a 0.2 microm millipore membrane and plated. Because of minimal bacterial growth resulting from the above, soy broth (> 20 mL) was flushed through two video colonoscopes, duodenoscopes, and gastroscopes on two occasions and collected. The effluent was plated using a sample of 0.1 mL dilution. The remaining suspension was passed through a millipore filter, and the filter was cultured. All cultures were incubated more than 48 hours. Biopsy Forceps underwent a total of 24 anaerobic and 75 aerobic cultures. Microbacterial growth occurred on 17 plates: 7 from gastroscopes, 5 from colonoscopes, and 5 from duodenoscopes. Fifteen plates grew staphylococcus for a total of 21 colonies, 1 plate grew 1 colony of propionibacter, 2 plates grew diphtheroids for a total of 4 colonies, and 1 plate grew a single colony of lactobacillus. Cultures from soy broth flushed through the various endoscopes grew on 5 plates: 3 from gastroscopes and 2 from duodenoscopes grew a total of 8 colonies of staphylococcus. With proper cleaning technique, a 20-minute soak in 2% glutaraldehyde is effective in disinfecting endoscopes. Although current procedures for endoscope disinfection remain imperfect, we found that in this clinical setting, infection of pathogenic gastrointestinal flora is unlikely when using sterile Biopsy Forceps.
-
Disposable versus reusable Biopsy Forceps: a prospective evaluation of costs ☆ ☆☆ ★ ★★ ♢
Gastrointestinal endoscopy, 1996Co-Authors: Richard A. Kozarek, Shirley L. Raltz, Linda D. Merriam, Stanford E. SumidaAbstract:Abstract Background: Disposable Biopsy Forceps have been heavily marketed as cost-effective, convenient, and safer to use than conventional Forceps. Methods: In an attempt to define whether disposable or reusable Biopsy Forceps were cheaper to use, we prospectively evaluated the purchase price, number of uses, repair record, and cleaning costs of all reusable Biopsy Forceps used in the outpatient endoscopy unit of a large multispecialty clinic. Results: Over a 12-month period, 1581 Biopsy sessions were undertaken. Seventeen of 119 Forceps required $1890 in repairs over the study period (an average of $1.20 per Biopsy session). Cleaning costs, including technician processing and steam autoclave, approximated $3.46 per use, increasing to $5.61 per use if glutaraldehyde soak was substituted for steam autoclave. Conclusions: Assuming a sixfold difference in purchase price between reusable and disposable Forceps, and a per-use repair and cleaning cost of $1.20 and $3.46, respectively, reusable Biopsy Forceps became cost-effective after seven uses in our institution. (Gastrointest Endosc 1996;43:10-3.)
Edward Uchio - One of the best experts on this subject based on the ideXlab platform.
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multi institutional evaluation of upper urinary tract Biopsy using backloaded cup Biopsy Forceps a nitinol basket and standard cup Biopsy Forceps
Urology, 2018Co-Authors: Daniel J Lama, Shoaib Safiullah, Roshan M Patel, Thomas K Lee, Jyoti P Balani, Lishi Zhang, Zhamshid Okhunov, Vitaly Margulis, Stephen J Savage, Edward UchioAbstract:Objective To compare the performance of 3 contemporary ureteroscopic Biopsy devices for the histopathologic diagnosis of upper tract urothelial carcinoma (UTUC). Methods We retrospectively reviewed 145 patients who underwent 182 urothelial biopsies using 2.4F backloaded cup Biopsy Forceps, a nitinol basket, or 3F standard cup Biopsy Forceps at 3 tertiary academic centers between 2011 and 2016. Experienced genitourinary pathologists provided an assessment of each specimen without knowledge of the device used for Biopsy. For patients who underwent nephroureterectomy without neoadjuvant chemotherapy within 3 months of Biopsy-proven UTUC diagnosis, the Biopsy grade was compared with both the grade and stage of the surgical specimen. Results Biopsy utilization varied among the 3 institutions (P .05) and was favored over standard cup Forceps specimens. Grade concordance was not affected by specimen size (P >.05), morphology (P >.1), or location (P >.5). No difference existed among the devices in the rate of acquiring a grade concordant Biopsy; however, the backloaded cup Forceps provided concordant biopsies that could be distinguished as low- and high-grade (P = .02). Conclusion The backloaded cup Forceps and nitinol basket obtained a higher quality urothelial specimen compared with standard cup Forceps. Ureteroscopic Biopsy device selection did not significantly impact the accuracy of the histologic diagnosis of UTUC.
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Multi-institutional Evaluation of Upper Urinary Tract Biopsy Using Backloaded Cup Biopsy Forceps, a Nitinol Basket, and Standard Cup Biopsy Forceps
Urology, 2018Co-Authors: Daniel J Lama, Shoaib Safiullah, Roshan M Patel, Thomas K Lee, Jyoti P Balani, Lishi Zhang, Zhamshid Okhunov, Vitaly Margulis, Stephen J Savage, Edward UchioAbstract:To compare the performance of 3 contemporary ureteroscopic Biopsy devices for the histopathologic diagnosis of upper tract urothelial carcinoma (UTUC). We retrospectively reviewed 145 patients who underwent 182 urothelial biopsies using 2.4F backloaded cup Biopsy Forceps, a nitinol basket, or 3F standard cup Biopsy Forceps at 3 tertiary academic centers between 2011 and 2016. Experienced genitourinary pathologists provided an assessment of each specimen without knowledge of the device used for Biopsy. For patients who underwent nephroureterectomy without neoadjuvant chemotherapy within 3 months of Biopsy-proven UTUC diagnosis, the Biopsy grade was compared with both the grade and stage of the surgical specimen. Biopsy utilization varied among the 3 institutions (P <.0001). Significant variabilities in specimen size (P = .001), the presence of intact urothelium (P = .008), and crush artifact (P = .028) were found among the Biopsy devices. The quality of specimens from backloaded cup Forceps was rated similarly to the nitinol basket (P >.05) and was favored over standard cup Forceps specimens. Grade concordance was not affected by specimen size (P >.05), morphology (P >.1), or location (P >.5). No difference existed among the devices in the rate of acquiring a grade concordant Biopsy; however, the backloaded cup Forceps provided concordant biopsies that could be distinguished as low- and high-grade (P = .02). The backloaded cup Forceps and nitinol basket obtained a higher quality urothelial specimen compared with standard cup Forceps. Ureteroscopic Biopsy device selection did not significantly impact the accuracy of the histologic diagnosis of UTUC. Copyright © 2018 Elsevier Inc. All rights reserved.
Daniel J Lama - One of the best experts on this subject based on the ideXlab platform.
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multi institutional evaluation of upper urinary tract Biopsy using backloaded cup Biopsy Forceps a nitinol basket and standard cup Biopsy Forceps
Urology, 2018Co-Authors: Daniel J Lama, Shoaib Safiullah, Roshan M Patel, Thomas K Lee, Jyoti P Balani, Lishi Zhang, Zhamshid Okhunov, Vitaly Margulis, Stephen J Savage, Edward UchioAbstract:Objective To compare the performance of 3 contemporary ureteroscopic Biopsy devices for the histopathologic diagnosis of upper tract urothelial carcinoma (UTUC). Methods We retrospectively reviewed 145 patients who underwent 182 urothelial biopsies using 2.4F backloaded cup Biopsy Forceps, a nitinol basket, or 3F standard cup Biopsy Forceps at 3 tertiary academic centers between 2011 and 2016. Experienced genitourinary pathologists provided an assessment of each specimen without knowledge of the device used for Biopsy. For patients who underwent nephroureterectomy without neoadjuvant chemotherapy within 3 months of Biopsy-proven UTUC diagnosis, the Biopsy grade was compared with both the grade and stage of the surgical specimen. Results Biopsy utilization varied among the 3 institutions (P .05) and was favored over standard cup Forceps specimens. Grade concordance was not affected by specimen size (P >.05), morphology (P >.1), or location (P >.5). No difference existed among the devices in the rate of acquiring a grade concordant Biopsy; however, the backloaded cup Forceps provided concordant biopsies that could be distinguished as low- and high-grade (P = .02). Conclusion The backloaded cup Forceps and nitinol basket obtained a higher quality urothelial specimen compared with standard cup Forceps. Ureteroscopic Biopsy device selection did not significantly impact the accuracy of the histologic diagnosis of UTUC.
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Multi-institutional Evaluation of Upper Urinary Tract Biopsy Using Backloaded Cup Biopsy Forceps, a Nitinol Basket, and Standard Cup Biopsy Forceps
Urology, 2018Co-Authors: Daniel J Lama, Shoaib Safiullah, Roshan M Patel, Thomas K Lee, Jyoti P Balani, Lishi Zhang, Zhamshid Okhunov, Vitaly Margulis, Stephen J Savage, Edward UchioAbstract:To compare the performance of 3 contemporary ureteroscopic Biopsy devices for the histopathologic diagnosis of upper tract urothelial carcinoma (UTUC). We retrospectively reviewed 145 patients who underwent 182 urothelial biopsies using 2.4F backloaded cup Biopsy Forceps, a nitinol basket, or 3F standard cup Biopsy Forceps at 3 tertiary academic centers between 2011 and 2016. Experienced genitourinary pathologists provided an assessment of each specimen without knowledge of the device used for Biopsy. For patients who underwent nephroureterectomy without neoadjuvant chemotherapy within 3 months of Biopsy-proven UTUC diagnosis, the Biopsy grade was compared with both the grade and stage of the surgical specimen. Biopsy utilization varied among the 3 institutions (P <.0001). Significant variabilities in specimen size (P = .001), the presence of intact urothelium (P = .008), and crush artifact (P = .028) were found among the Biopsy devices. The quality of specimens from backloaded cup Forceps was rated similarly to the nitinol basket (P >.05) and was favored over standard cup Forceps specimens. Grade concordance was not affected by specimen size (P >.05), morphology (P >.1), or location (P >.5). No difference existed among the devices in the rate of acquiring a grade concordant Biopsy; however, the backloaded cup Forceps provided concordant biopsies that could be distinguished as low- and high-grade (P = .02). The backloaded cup Forceps and nitinol basket obtained a higher quality urothelial specimen compared with standard cup Forceps. Ureteroscopic Biopsy device selection did not significantly impact the accuracy of the histologic diagnosis of UTUC. Copyright © 2018 Elsevier Inc. All rights reserved.