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Gastroenterology

Mopping up

Machine developed by a small company cleans endoscopes more effectively

The simple mention of having an endoscopy, that examination in which a flexible tube with a microcamera inserted into the tip travels the digestive tract, usually makes people cringe. Despite now being a routine examination for many patients, few know that the endoscope, before being used, has to undergo rigorous cleaning and asepsis to avoid the risk of transmitting diseases like hepatitis, Aids and tuberculosis.  An automated piece of equipment called Endolav, developed by a small company from São Paulo called Ibasil Tecnologia, has done the job effectively and has now been installed in about 80 hospitals and clinics in Brazil. Using germicidal chemical products, the automatic reprocessor cleans endoscopes more quickly than the majority of similar products produced in the United States, Europe and Japan, making it possible for the doctor to carry out a greater number of examinations per day.

“The machine meets the standards of the Ministry of Health, and the disinfection system used prevents the transmission of diseases by bacteria and viruses”, says Professor Shinichi Ishioka, from the Gastroenterology Department of the School of Medicine of the University of São Paulo (FMUSP) and head of the Gastrointestinal Endoscopy Service of the Hospital and Clinics, one of the places where Endolav is used. At the moment, the reprocessor is manufactured by Lifemed, a Brazilian company that produces equipment for the health area. With a factory in the state of Rio Grande do Sul, 18 months ago the company bought the patent for the product and the brand, for R$ 1 million. “Lifemed, which is expecting sales of R$ 45 million this year, betted on a product developed in Brazil to enter a new market niche, endoscopy”, says Geraldo Stedile, the commercial director. “For its growth, this market is very attractive.”

Speed in the process
To arrive at the final product, Luís Iba, a director of Ibasil Tecnologia, took advantage of his experience as a manager of a company in the endoscopy area. “The idea arose from the need to automate the system used to disinfect endoscopes, which was basically manual”, says Iba, who studied mechanical engineering, but did not graduate. In those days, there was imported equipment on the Brazilian market for this purpose, but it was expensive and was not adapted to the needs of Brazilian doctors, who need speed in the process of disinfecting the endoscopes, on account of the large number of people attended to. Some 33 minutes are enough for Endolav to complete the four programmed stages, comprising enzymatic cleaning, high level disinfections, rinsing and drying the endoscopes. The whole procedure is carried out automatically. In all the stages of the process, the dirty water is discarded and gives way to flows of clean filtered water. This operation is important to guarantee the correct cleaning of the apparatus.

At the Hospital and Clinics, the first place sought by Iba to test Endolav’s effectiveness, five years ago, the device has been used specifically for cases in which it is already known that the patients are victims of hepatitis, Aids and tuberculosis, since another system has been installed for the routine demand. Before the automated disinfection is carried out, a detailed manual cleaning is carried out with a hose of water in a jet under pressure, detergent and scrubbing. “This is a cleaning to remove secretions and detritus”, says the head nurse of the HC’s Endoscopy Service, Maria da Graça Silva, who has been ten years in the job and three decades working at the hospital. After this stage, disinfection with chemical agents is carried out. The main disinfectant used is glutaraldehyde, a solution with a high bactericidal and fungicidal power. It is a powerful chemical substance that calls for care in its handling. That is why the nursing technicians who carry out the cleaning of the apparatuses use appropriate masks, glasses and gloves. And the endoscopes immersed in this solution, after the time for disinfection, need to be rinsed well. In the end, the apparatus is dried with compressed air and, once out of use, kept in cupboards with proper ventilation. As the examinations carried out at this teaching hospital come to as many as a hundred a day, a very high figure, the sequence of procedures has to be carried out to the letter. In clinics and hospitals, though, where fewer people are attended to, the basic manual cleaning of the apparatus and, next, the treatment done by Endolav are sufficient to achieve the same results.

Mechanisms modified
The original machine underwent modifications in the internal mechanisms and materials before reaching the final product. With this, the weight of the equipment was brought down from 50 to 22 kilos, and the productive capacity increased from three units a month to 15. These modifications were done with Ibasil installed in the Technology Companies Incubator Center (Cietec), which is in the building of the Institute of Nuclear Energy and Research (Ipen), in University City, in São Paulo, and currently brings together 70 technology based companies. The proximity with other innovative companies was providential. “Various technological solutions were discovered in informal conversations with colleagues from other companies, in the building’s corridor”, says Iba.

In April of this year, Ibasil completed its cycle in the incubator, which started in February 2002, and moved into new installations in the Butantã district, but it made a point of remaining the shortest distance possible from Ipen’s building. Not least because it still has a partnership with Electrocell, one of the incubated companies that helped to redesign Endolav. Now they are working on the development of a new disinfection system based on water and salt, intended to replace the glutaraldehyde in the chemical cleaning of the endoscopes, and also to be used in the hygienization of fruit and vegetables and in the asepsis of meat packing plants. Lifemed also continues as a partner. At the moment, besides working on the development of other projects, the two companies are dedicating themselves to making modifications to Endolav, to adapt it to the standards of the European Union, the next market to be conquered. “The product should be one of the main ones responsible for the increase in the company’s exports”, says Stedile, from the manufacturing company.

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