Two Novel Protocols For Cleaning Residual Simethicone And Fluid In Patient-Ready Duodenoscopes

Background and Aim Approximately 42-95% of working channels have been reported to show the presence of residual fluid despite endoscope reprocessing. The aim of this study was to design two novel protocols for cleaning residual simethicone and demonstrate its efficiency by evaluating the residual fluid and cleanliness in the working channels of patient-ready duodenoscopes.Methods The designed protocol for cleaning residual simethicone was implemented in manual cleaning and/or high-level disinfection (HLD). The residual fluid inside the working channels was estimated by visual inspection. Adenosine triphosphate (ATP) values were evaluated to determine cleanliness after manual cleaning.Results Manual cleaning with novel simethicone cleaning protocol demonstrated a significant decrease in fluid droplets (14.6 +/- 29.9 vs 0 +/- 0, P < 0.001) and ATP values (157 +/- 196 relative light units [RLUs] vs 52 +/- 41 RLUs, P = 0.031). HLD with simethicone cleaning protocol, using either enzymatic detergent with effective for cleaning simethicone or cleaning time set in the automatic endoscope reprocessor program for 8 min, demonstrated significant decrease in the number of fluid droplets. Follow-up after the implementation of the simethicone cleaning protocol showed a significant decrease in fluid droplets (37.4 +/- 41.0 vs 2.1 +/- 5.5, P = 0.003) and ATP values (271 +/- 268 RLUs vs 82 +/- 136 RLUs, P = 0.021).Conclusions Simethicone cleaning protocol is advantageous for significantly decreasing fluid droplets and ATP values within endoscope working channels. After manual cleaning with the simethicone cleaning protocol, in particular, no retained fluid droplet was observed in patient-ready duodenoscopes.