This SBAR was shared with us and was used at an academic center to move away from simethicone.
We do not endorse products but this SBAR template may be useful for engaging with administration.
Situation
All endoscope manufacturers have distanced themselves from any liability associated with the use of simethicone or other non-water-soluble products. In 2018 we received a letter from Olympus warning us of the risks of simethicone adhering to our scope channels, contributing to biofilm formation, and microbial growth.
We learned from the Stanford and Cori Ofstead studies that simethicone is retained in the scope channel, even when used in low concentrations. This retention supports biofilm formation and microbial growth. Cori Ofstead’s study revealed simethicone retention in the scope channels of 69 fully reprocessed scopes from 4 different hospitals and >50% of those scopes tested positive for microbial cultures. She issued a “Call to Action” to all infection preventionists to determine whether these products are used in their institutions and evaluate methods for removing them.
Water solubility is essential because simethicone, regardless of how it is administered, results in a buildup of residue in our scope channels. Dimethicone, an ingredient in simethicone, is used in products specifically to retain moisture and is used to treat headlice because it prevents water evaporation and drowns the lice. Dry scope channels are essential to avoid biofilm formation and microbial growth.
Background
It is crucial to have an effective product to eliminate bubbles during endoscopy procedures to allow the physicians to visualize the GI tract to diagnose, remove adenomas, and properly treat patients. Studies show that 45-55% of polyps are obscured by bubbles and pose a risk to our patients of missed lesions. We must have a product to eliminate bubbles that is in alignment with scope manufacturer’s recommendations, which are water-soluble, with no sugars, thickeners, or binding agents.
Johns Hopkins published a post-endoscopic infection study in 2018. They followed patients who underwent colonoscopy and EGD for 30 days and found post-endoscopic infections were more common than previously thought and occur without being detected.
Assessment
An IRB approved study, published in AJIC showed a water-soluble alternatives exist that meet the scope manufacturer’s recommendations and are also showed 98% efficacy at putting out bubbles, allowing for visualization.
Recommendation
It is our responsibility to advocate for our patient’s safety and mitigate the risk of biofilm formation and microbial growth in our scopes. We recommend staying in compliance with the scope manufacturer’s recommendations and only using products that are water-soluble, alcohol-soluble, easily cleaned from the scope, that also allow for visualization.