How clean is your scope? A completed audit cycle of the disinfection of nasendoscopes.

INTRODUCTION: Correct disinfection of nasendoscopes is essential to address both the potential iatrogenic transmission of infection and to avoid injury from the chemicals used. MATERIALS AND METHODS: Standards-based audit of the disinfection of nasendoscopes against the ENT UK guidelines. INTERVENTION: instructional poster and staff training session. The disinfection process was re-audited one month later. RESULTS: A total of 10 sessions and 31 cleaning episodes were audited in the first cycle (C1). A total of 12 sessions and 36 cleaning episodes were re-audited in the second cycle (C2). Clinic set-up results: there was a marked improvement in the checking of the expiry date (C1=5/10; C2=10/12; P≤0.001) and recording the date for the solution to be discarded (C1=0/10; C2=10/12; P≤0.048). Each cleaning episode results: an improvement in transportation in a 'dirty bag' (C1=0/31; C2=19/36; P≤0.001), washing of the scope (C1=0/31; C2=36/36; P≤0.001), adequate disinfection time (C1=16/31; C2=33/36; P≤0.001), rinsing and drying with alcohol swab (C1=0/31; C2=35/36; P≤0.001) and placing of the scope in a 'clean bag' for storage (C1=0/31; C2=35/36; P≤0.001) was seen after the intervention. CONCLUSIONS: The introduction of a poster and training in the disinfection of nasendoscopes proved successful in improving compliance with the published guidelines. These simple measures were simple, cheap and effective to institute. The benefit of improving the disinfection of nasendoscopes to patients, doctors and the organisations that they work in is clear.

Cerebrotendinous xanthomatosis presenting with bilateral Achilles tendon xanthomata.

We report on a case of a 36-year-old lady who presented with large, painful soft-tissue swellings of both Achilles tendons. MRI demonstrated fusiform enlargement involving the Achilles tendons bilaterally. The tendons returned heterogeneous signal intensity characterised by a diffuse reticulated appearance. The right tendon mass was treated with a wide marginal excision and Achilles tendon reconstruction. The histology confirmed Achilles tendon xanthoma. Further metabolic investigation revealed the patient to have a rare autosomal recessive condition called cerebrotendinous xanthomatosis (CTX). Her brother was also affected. CTX is easily treatable if diagnosed early, and should be suspected in patients presenting with bilateral Achilles tendon xanthomas and normal plasma lipid levels.