Consumption of resistant potato starch produces changes in gut microbiota that correlate with improvements in abnormal bowel symptoms: a secondary analysis of a clinical trial.

Background: Studies have linked a lack of dietary fibre, including resistant starch (RS), to disease-associated changes in intestinal bacteria. Healthy people often report abnormal bowel symptoms (ABS), including bloating, constipation, abdominal pain, and diarrhea, however, connections between these symptoms and the gut microbiota are poorly understood. Determining correlations between ABS and taxonomic groups may provide predictive value for using prebiotics to mitigate ABS in combination with stool microbiome testing.

Consumption of Solnul Resistant Potato Starch Produces a Prebiotic Effect in a Randomized, Placebo-Controlled Clinical Trial.

The effects of resistant starch at high doses have been well-characterized, but the potential prebiotic effects of resistant starch at doses comparable to oligosaccharide prebiotics have not been evaluated. A three-arm randomized, double-blind, placebo-controlled clinical trial was conducted to evaluate the effect of 3.5 g and 7 g daily doses of Solnul resistant potato starch (RPS) on beneficial populations of gut bacteria and stool consistency after a 4-week period.

A prospective, multicenter, clinical study of duodenoscope contamination after reprocessing.

Objective: Several clinical procedures utilize duodenoscopes, which are processed for reuse after the procedures are completed. However, infection outbreaks due to improper duodenoscope processing occur frequently. To address this, we aimed to assess the contamination rates of duodenoscopes after reprocessing in nonoutbreak settings.

Contaminated flexible endoscopes: Review of impact of channel sampling methods on culture results and recommendations for root-cause analysis.

Recently, infection transmission risk associated with contaminated, patient-ready flexible endoscopes has attracted attention. Outbreaks of multidrug-resistant organisms resulting in infection and/or colonization have been particularly concerning. Recent CDC and FDA recommendations focus on reducing "exogenous" infection transmission and specifically recommend that endoscopy sites have quality systems in place for endoscope reprocessing.

Increasing levels of Parasutterella in the gut microbiome correlate with improving low-density lipoprotein levels in healthy adults consuming resistant potato starch during a randomised trial.

Background: Prebiotics, defined as a substrate that is selectively utilized by host microorganisms conferring a health benefit, present a potential option to optimize gut microbiome health. Elucidating the relationship between specific intestinal bacteria, prebiotic intake, and the health of the host remains a primary microbiome research goal.

Objective: To assess the correlations between gut microbiota, serum health parameters, and prebiotic consumption in healthy adults.

Quality Systems Approach for Endoscope Reprocessing: You Don't Know What You Don't Know!

Several factors affect the efficacy of endoscope reprocessing, including human factors, inadequate cleaning, simethicone residuals, moisture in channels during storage, and biofilm or buildup biofilm formation. These factors all contribute to contamination of patient-ready endoscopes that may contribute to transmission of microorganisms resulting in infection and/or colonization. This article reviews monitoring as part of a quality management system that includes manual cleaning, dry storage, and culture to detect endoscope contamination.

Turbulent fluid flow is a novel closed-system sample extraction method for flexible endoscope channels of various inner diameters.

Overview: Effective sample extraction from endoscope channels is crucial for monitoring manual cleaning adequacy as well as for ensuring optimal sensitivity for culture after disinfection. The objective of this study was to compare the efficacy of Turbulent Fluid Flow (TFF) to Flush (F) or Flush-Brush-Flush (FBF) methods.

Materials & Methods: Pseudomonas aeruginosa and Enterococcus faecalis in artificial test soil-2015 (ATS2015) were used as bacterial markers while protein and carbohydrate were the organic markers for biofilm formed inside 3.

The polytetrafluoroethylene (PTFE) channel model of cyclic-buildup biofilm and traditional biofilm: The impact of friction, and detergent on cleaning and subsequent high-level disinfection.

Objective: To evaluate the efficacy of detergent and friction on removal of traditional biofilm and cyclic-buildup biofilm (CBB) from polytetrafluoroethylene (PTFE) channels and to evaluate the efficacy of glutaraldehyde to kill residual bacteria after cleaning.

Methods: PTFE channels were exposed to artificial test soil containing 108 CFU/mL of Pseudomonas aeruginosa and Enterococcus faecalis, followed by full cleaning and high-level disinfection (HLD) for five repeated rounds to establish CBB. For traditional biofilm, the HLD step was omitted.

Impact of wet storage and other factors on biofilm formation and contamination of patient-ready endoscopes: a narrative review.

The 2019 U.S. Food and Drug Administration report indicates that the clinical studies undertaken by the 3 main GI endoscope manufacturers demonstrate 5.

Biofilms on instruments and environmental surfaces: Do they interfere with instrument reprocessing and surface disinfection? Review of the literature.

There is a growing appreciation for the role of biofilm-embedded microbes in many different aspects of infection transmission. The format of biofilm includes traditional hydrated biofilm, build-up biofilm, and dry surface biofilm. The objectives of this article are to discuss how traditional biofilm differs from build-up biofilm and dry surface biofilm, and to review the evidence supporting infection transmission from biofilm that accumulates in reprocessed instruments and from dry biofilm that forms environmental reservoirs.

Medical instrument reprocessing: current issues with cleaning and cleaning monitoring.

The complexity of medical devices has increased over the past 10 years, and outbreaks of infections due to contaminated devices have focused attention on the need to adequately clean medical devices in order to ensure the adequacy of disinfection and sterilization. There has been a paradigm shift in reprocessing of medical devices, with increased emphasis on a quality management systems approach that requires validated cleaning instructions from manufacturers and ongoing monitoring by reprocessing personnel to ensure adequacy of cleaning. This article reviews the current issues related to medical device reprocessing and summarizes the approaches used for monitoring cleaning efficacy for surgical instruments and flexible endoscopes.

Evaluation of an overnight non-culture test for detection of viable Gram-negative bacteria in endoscope channels.

 Prevention of infection transmission from contaminated endoscopes would benefit from a rapid test that could detect low levels of viable bacteria after high level disinfection. The aim of this study was to evaluate the rapid NOW! (RN) test's ability to detect endoscope contamination. The RN test kit and the accompanying fluorometer were evaluated.

Multisite evaluation of environmental cleanliness of high-touch surfaces in intensive care unit patient rooms.

The efficacy of discharge cleaning and disinfection of high-touch surfaces of intensive care unit patient rooms in Brazil, Canada, the Netherlands, and the United States was evaluated and the effect of an educational intervention was determined. Significant site-to-site differences in cleaning regimens and baseline cleanliness levels were observed using ATP levels, colony-forming units, and reflective surface marker removal percent pass rates. An educational intervention that includes rapid feedback of the ATP measurements could significantly improve the quality of the cleaning and disinfection regimens.

Evaluation of adenosine triphosphate test for cleaning assessment of gastroscopes and the effect on workload in a busy endoscopy center.

Objective: Using adenosine triphosphate (ATP) tests to assess manual cleaning of gastroscopes and to determine the associated workload in a busy endoscopy unit.

Methods: Patient-used gastroscopes were sampled before and after cleaning to assess ATP levels, bioburden, and protein. Samples were collected by flushing 20 mL of sterile water through the biopsy port to the distal end.

Impact of cleaning monitoring combined with channel purge storage on elimination of Escherichia coli and environmental bacteria from duodenoscopes.

Background And Aims: We aimed to determine whether monitoring of duodenoscope cleaning by rapid adenosine triphosphate (ATP) combined with channel-purge storage could eliminate high-concern microorganisms.

Methods: In a simulated-use study, suction channels, as well as lever recesses, from 2 duodenoscopes models and the unsealed elevator guidewire (EGW) channel from 1 of these 2 duodenoscopes (the other model has a sealed EGW) were perfused with ATS2015 containing approximately 8 Log colony-forming units (CFU)/mL of both Enterococcus faecalis and Escherichia coli. Pump-assisted cleaning was monitored by rapid ATP testing.

A Randomized Placebo Controlled Clinical Trial to Determine the Impact of Digestion Resistant Starch on Glucose, Insulin, and Insulin Resistance in Elderly and Mid-Age Adults.

Introduction: Type 2 diabetes (T2D) has reached epidemic proportions in North America. Recent evidence suggests that prebiotics can modulate the gut microbiome, which then plays an important role in regulating lipid metabolism, blood glucose, and insulin sensitivity. As such, prebiotics are appealing potential therapeutic strategies for prediabetes and T2D.

Sterile Reverse Osmosis Water Combined with Friction Are Optimal for Channel and Lever Cavity Sample Collection of Flexible Duodenoscopes.

Introduction: Simulated-use buildup biofilm (BBF) model was used to assess various extraction fluids and friction methods to determine the optimal sample collection method for polytetrafluorethylene channels. In addition, simulated-use testing was performed for the channel and lever cavity of duodenoscopes.

Materials And Methods: BBF was formed in polytetrafluorethylene channels using , and .

Simulated-Use Polytetrafluorethylene Biofilm Model: Repeated Rounds of Complete Reprocessing Lead to Accumulation of Organic Debris and Viable Bacteria.

OBJECTIVE Biofilm has been implicated in bacterial persistence and survival after endoscope reprocessing. In this study, we assessed the impact of different methods of reprocessing on organic residues and viable bacteria after repeated rounds of biofilm formation when each was followed by full reprocessing. METHODS ATS-2015, an artificial test soil containing 5-8 Log10 colony-forming units (CFU) of Enterococcus faecalis and Pseudomonas aeruginosa, was used to form biofilm in polytetrafluroethylene channels overnight on 5 successive days.

Improper positioning of the elevator lever of duodenoscopes may lead to sequestered bacteria that survive disinfection by automated endoscope reprocessors.

Background: Some outbreaks associated with contaminated duodenoscopes have been attributed to biofilm formation. The objective of this study was to determine whether bacteria within an organic matrix could survive if the elevator lever was improperly positioned in the automated endoscope reprocessor (AER) after 1 round of reprocessing.

Methods: Duodenoscope lever cavities with an open or sealed elevator wire channel were inoculated with 6-7 Log of both Escherichia coli and Enterococcus faecalis in ATS2015 (Healthmark Industries, Fraser, MI) and dried for 2 hours.

A novel polytetrafluoroethylene-channel model, which simulates low levels of culturable bacteria in buildup biofilm after repeated endoscope reprocessing.

Background And Aims: Clinical studies have shown variable culture results from flexible endoscope channels possibly because of low levels of bacteria that are difficult to extract. The aim of this study was to develop a simulated-use buildup biofilm (BBF) model that mimics low levels of viable bacteria after repeated rounds of aldehyde fixation and accumulation.

Methods: New endoscope channels were exposed to 8 days of repeated rounds of biofilm formation using ATS2015 containing Enterococcus faecalis and Pseudomonas aeruginosa, rinsing, fixation with glutaraldehyde, and rinsing.

A randomized trial to determine the impact of a digestion resistant starch composition on the gut microbiome in older and mid-age adults.

Background: The elderly often have a diet lacking resistant starch (RS) which is thought to lead to gut microbiome dysbiosis that may result in deterioration of gut colonocytes.

Objective: The primary objective was to assess if elderly (ELD; ≥ 70 years age) had microbiome dysbiosis compared to mid-age (MID; 30-50 years age) adults and then determine the impact of daily consumption of MSPrebiotic (a RS) or placebo over 3 months on gut microbiome composition. Secondary objectives included assessment of stool short-chain fatty acids (SCFA) and inflammatory markers in ELD and MID Canadian adults.

Simulated-use validation of a sponge ATP method for determining the adequacy of manual cleaning of endoscope channels.

Background: The objective of this study was to validate the relative light unit (RLU) cut-off of adequate cleaning of flexible colonoscopes for an ATP (adenosine tri-phosphate) test kit that used a sponge channel collection method.

Methods: This was a simulated-use study. The instrument channel segment of a flexible colonoscope was soiled with ATS (artificial test soil) containing approximately 8 Log10 Enterococcus faecalis and Pseudomonas aeruginosa/mL.

Current issues result in a paradigm shift in reprocessing medical and surgical instruments.

The objective of this report is to review the available scientific data on reprocessing of medical and surgical instruments and discuss the current issues related to cleaning and disinfection of flexible endoscopes and intracavitary ultrasound probes.

Reproducible elimination of Clostridium difficile spores using a clinical area washer disinfector in 3 different health care sites.

Background: Following a Clostridium difficile infection outbreak, the Infection Prevention and Control team at our institution queried the risk of transmission via bedpans reprocessed in washer disinfectors (WDs). This study's objective was to determine the effectiveness of the mechanical action, detergent, and temperature on the eradication of C difficile spores in 1 type of WD model.

Materials And Methods: Three types of reusable bedpans/pots were inoculated with sterile human feces that contained 1 × 10(7) CFU/mL C difficile spores.

Microfiber cloths reduce the transfer of Clostridium difficile spores to environmental surfaces compared with cotton cloths.

Background: Environmental surfaces in health care facilities contaminated with Clostridium difficile spores can be a reservoir that contribute to transmission of hospital-acquired infections. Microfiber cleaning cloths may improve the effectiveness of surface cleaning. The objective of this study was to assess the removal and transfer of C difficile spores on surfaces cleaned by microfiber compared with cotton cloths.