Reviewer's report
Title:Computer-aided recording of automatic endoscope washing and
disinfection processes as an integral part of medical documentation for quality
assurance purposes
Version: 2Date:4 June 2010
Reviewer: Ottmar Leiss
Reviewer's report:
Although the authors comments on all major compulsory revisions, minor
essential revisions or discretionary revisions of the reviewers, they have done
this in a very minimalistic way.
The importance of the manual cleaning is underlined and stressed that the
computer program only documents the automatic cleaning and disinfection step.
Since only two different types of washer-disinfectors (BeliMed International and
Olympus washer-disinfectors EDT 2 and 3-similar in design) are used, I’m still
not convinced whether the conclusion of the authors that the electronic
documentation system ‘can be used in any washer-disinfector that documents
the procedures involved in the automatic cleaning process..’ is justified and
whether the concept discussed on page 7 that technological innovations and
‘additional systems are likely to be added’ is correct for new endoscopes but not
for new types of washer-disinfectors with single channel perfusion.
From a quality management point of view I have mentioned (see 6 of my review)
that a more careful discussion of the question whether we should focus on
process quality or outcome quality of reprocessing flexible endoscopes would be
helpful. Although standardized reprocessing is possible in special
washer-disinfectors using automatic single channel cleaning with enzymatic
cleaners and programmed disinfection with glutaraldehyde at higher temperature
(1), only microbiological controls of reprocessing quality are able to detect
equipment defects of flexible endoscopes (such as perforation of internal
channels) which affect the outcome of the reprocessing process and which would
be without surveillance cultures only recognized in working ups of nosocomial
infection outbreaks (2). In contrast to the US multi-society guideline (3) the
German (4) and recent European guideline for endoscope reprocessing (4) both
recommends regular surveillance cultures of endoscope reprocessing. Thus, the
presented computer-aided recording of automatic endoscope washing and
disinfection is a helpful tool to document process quality, but not a substitute for
outcome quality.
In summary, because of only minimal corrections I think that the improvement of
the revised manuscript is rather limited.
Nevertheless, I agree with publication in the present form.
Reviewer's report
Title:Computer-aided recording of automatic endoscope washing and
disinfection processes as an integral part of medical documentation for quality
assurance purposes
Version: 2Date:4 June 2010
Reviewer: Ottmar Leiss
Reviewer's report:
Although the authors comments on all major compulsory revisions, minor
essential revisions or discretionary revisions of the reviewers, they have done
this in a very minimalistic way.
The importance of the manual cleaning is underlined and stressed that the
computer program only documents the automatic cleaning and disinfection step.
Since only two different types of washer-disinfectors (BeliMed International and
Olympus washer-disinfectors EDT 2 and 3-similar in design) are used, I’m still
not convinced whether the conclusion of the authors that the electronic
documentation system ‘can be used in any washer-disinfector that documents
the procedures involved in the automatic cleaning process..’ is justified and
whether the concept discussed on page 7 that technological innovations and
‘additional systems are likely to be added’ is correct for new endoscopes but not
for new types of washer-disinfectors with single channel perfusion.
From a quality management point of view I have mentioned (see 6 of my review)
that a more careful discussion of the question whether we should focus on
process quality or outcome quality of reprocessing flexible endoscopes would be
helpful. Although standardized reprocessing is possible in special
washer-disinfectors using automatic single channel cleaning with enzymatic
cleaners and programmed disinfection with glutaraldehyde at higher temperature
(1), only microbiological controls of reprocessing quality are able to detect
equipment defects of flexible endoscopes (such as perforation of internal
channels) which affect the outcome of the reprocessing process and which would
be without surveillance cultures only recognized in working ups of nosocomial
infection outbreaks (2). In contrast to the US multi-society guideline (3) the
German (4) and recent European guideline for endoscope reprocessing (4) both
recommends regular surveillance cultures of endoscope reprocessing. Thus, the
presented computer-aided recording of automatic endoscope washing and
disinfection is a helpful tool to document process quality, but not a substitute for
outcome quality.
In summary, because of only minimal corrections I think that the improvement of
the revised manuscript is rather limited.
Nevertheless, I agree with publication in the present form.
Please review this paper.
user
Reviewer's report
Title:Computer-aided recording of automatic endoscope washing and
disinfection processes as an integral part of medical documentation for quality
assurance purposes
Version: 2Date:4 June 2010
Reviewer: Ottmar Leiss
Reviewer's report:
Although the authors comments on all major compulsory revisions, minor
essential revisions or discretionary revisions of the reviewers, they have done
this in a very minimalistic way.
The importance of the manual cleaning is underlined and stressed that the
computer program only documents the automatic cleaning and disinfection step.
Since only two different types of washer-disinfectors (BeliMed International and
Olympus washer-disinfectors EDT 2 and 3-similar in design) are used, I’m still
not convinced whether the conclusion of the authors that the electronic
documentation system ‘can be used in any washer-disinfector that documents
the procedures involved in the automatic cleaning process..’ is justified and
whether the concept discussed on page 7 that technological innovations and
‘additional systems are likely to be added’ is correct for new endoscopes but not
for new types of washer-disinfectors with single channel perfusion.
From a quality management point of view I have mentioned (see 6 of my review)
that a more careful discussion of the question whether we should focus on
process quality or outcome quality of reprocessing flexible endoscopes would be
helpful. Although standardized reprocessing is possible in special
washer-disinfectors using automatic single channel cleaning with enzymatic
cleaners and programmed disinfection with glutaraldehyde at higher temperature
(1), only microbiological controls of reprocessing quality are able to detect
equipment defects of flexible endoscopes (such as perforation of internal
channels) which affect the outcome of the reprocessing process and which would
be without surveillance cultures only recognized in working ups of nosocomial
infection outbreaks (2). In contrast to the US multi-society guideline (3) the
German (4) and recent European guideline for endoscope reprocessing (4) both
recommends regular surveillance cultures of endoscope reprocessing. Thus, the
presented computer-aided recording of automatic endoscope washing and
disinfection is a helpful tool to document process quality, but not a substitute for
outcome quality.
In summary, because of only minimal corrections I think that the improvement of
the revised manuscript is rather limited.
Nevertheless, I agree with publication in the present form.
assistant