Off-label use of simethicone, lubricants, and tissue glue contributes to endoscope reprocessing failures

Editor's Note

The off-label use of defoaming agents, lubricants, and tissue glue is common, and these insoluable substances are not removed during reprocessing, this study finds.

Of 69 fully reprocessed endoscopes examined in four hospitals, microbial cultures were positive for 50% or more.

The researchers, led by Cori Ofstead, MSPH, found:

• cloudy, shimmery fluid resembling simethicone inside endoscope channels and under a duodenoscope elevator mechanism
• white fragments resembling crystallized simethicone protruding from a gastroscope water jet outlet
• oily, sticky residue near instrument ports on endoscopes
• a three-dimensional mass that was probably tissue glue inside an ultrasound endoscope.

More research is needed to determine the prevalence of use of these off-label products and their effect on reprocessing and patient safety, the researchers note.