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Zeitschrift Fur Gastroenterologie Feb 2016
Topics: Cross Infection; Drug Resistance, Multiple, Bacterial; Duodenoscopes; Equipment Contamination; Equipment Failure Analysis; Humans; Sterilization
PubMed: 27280257
DOI: 10.1055/s-0041-110815 -
Infection Control and Hospital... Dec 2022Several clinical procedures utilize duodenoscopes, which are processed for reuse after the procedures are completed. However, infection outbreaks due to improper...
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.
DESIGN AND SETTING
Prospective study in 16 clinical sites in the United States.
METHODS
We sampled and cultured reprocessed duodenoscopes following the FDA/CDC/ASM guideline; "Duodenoscope Surveillance Sampling and Culturing - Reducing the Risks of Infection." High-concern (HC) organisms were those highly associated with disease, including gram-negative rods, , β-hemolytic , spp, and yeasts. We evaluated duodenoscopes with ≥1 CFU of organisms after reprocessing. The reprocessing environments were also sampled and cultured.
RESULTS
We assessed 859 newer-model (NM) duodenoscopes (TJF-Q180V) and 850 older-model (OM) duodenoscopes (TJF-160F/VF); of these, 35 NM samples (4.1%) and 56 OM samples (6.6%) were contaminated with HC organisms. We detected and classified the HC organisms as gastrointestinal (45.4%), human origin (16.7%), environmental (24.1%), waterborne (13.0%), and unidentified (0.9%).
CONCLUSIONS
We detected an overall HC contamination rate of 5.3% in nonoutbreak settings. Although the relationship between endoscopic contamination and the occurrence of infections remains unclear, attempts should continue to be made to further reduce contamination rates. Additional improvements to the manufacturer's instructions for use, human factors during the reprocessing procedure, ongoing training programs, cleanliness of reprocessing environments, and the design of the distal end of the duodenoscope should be considered.
Topics: Humans; Duodenoscopes; Prospective Studies; Equipment Contamination; Disease Outbreaks; Gram-Negative Bacteria; Disinfection
PubMed: 35300743
DOI: 10.1017/ice.2021.525 -
Gastroenterology Nursing : the Official... 2016Pathogen transmissions via flexible endoscopes have been documented in the literature and have been historically related to human error or omission of steps in the... (Review)
Review
Pathogen transmissions via flexible endoscopes have been documented in the literature and have been historically related to human error or omission of steps in the reprocessing cycle. The 2008 Centers for Disease Control and Prevention report challenged manufacturers of automated endoscope reprocessors to improve and advance technology to automate more of the reprocessing steps. A review and synthesis of the literature following the 2008 Centers for Disease Control and Prevention report was performed to evaluate whether advances in reprocessing technology have occurred and whether these have had an impact on pathogen transmission via flexible endoscopes. The Iowa Model of Evidence-Based Practice to Promote Quality Care was used to guide the project. The literature search regarding pathogen transmission related to flexible endoscopes yielded 10 documents citing infections from 2008 to 2015. A total of 353 patients were identified as having been infected with a contaminated gastroscope, bronchoscope, or duodenoscope. An evaluation of reprocessing technology identified 3 automated endoscope reprocessors with enhanced capabilities and flushing devices intended to automate portions of the manual cleaning step.
Topics: Biomedical Technology; Centers for Disease Control and Prevention, U.S.; Cross Infection; Endoscopes, Gastrointestinal; Endoscopy, Gastrointestinal; Equipment Contamination; Equipment Reuse; Evidence-Based Medicine; Female; Humans; Male; Practice Guidelines as Topic; Quality Control; United States
PubMed: 27922516
DOI: 10.1097/SGA.0000000000000267 -
Gut Mar 2024Contaminated duodenoscopes caused several hospital outbreaks. Despite efforts to reduce contamination rates, 15% of patient-ready duodenoscopes are still contaminated... (Review)
Review
OBJECTIVE
Contaminated duodenoscopes caused several hospital outbreaks. Despite efforts to reduce contamination rates, 15% of patient-ready duodenoscopes are still contaminated with gastrointestinal microorganisms. This study aimed to provide an overview of duodenoscope contamination over time, identify risk factors and study the effects of implemented interventions.
DESIGN
Duodenoscope culture sets between March 2015 and June 2022 at a Dutch tertiary care centre were analysed. Contamination was defined as (1) the presence of microorganisms of oral or gastrointestinal origin (MGO) or (2) any other microorganism with ≥20 colony-forming units/20 mL (AM20). A logistic mixed effects model was used to identify risk factors and assess the effect of interventions, such as using duodenoscopes with disposable caps, replacing automated endoscope reprocessors (AER) and conducting audits in the endoscopy department.
RESULTS
A total of 404 culture sets were analysed. The yearly contamination rate with MGO showed great variation, ranging from 14.3% to 47.5%. Contamination with AM20 increased up to 94.7% by 2022. For both MGO and AM20, the biopsy and suction channels were the most frequently contaminated duodenoscope components. The studied interventions, including audits, AER replacement and implementation of duodenoscopes with disposable caps, did not show a clear association with contamination rates.
CONCLUSION
Duodenoscope contamination remains a significant problem, with high contamination rates despite several interventions. Reprocessing the biopsy and suction channels is especially challenging. Changes in the design of reusable duodenoscopes, such as enabling sterilisation or easily replaceable channels, are necessary to facilitate effective duodenoscope reprocessing and to eliminate the risk of duodenoscope-associated infections.
Topics: Humans; Cholangiopancreatography, Endoscopic Retrograde; Cross Infection; Duodenoscopes; Magnesium Oxide; Retrospective Studies; Tertiary Care Centers
PubMed: 38182137
DOI: 10.1136/gutjnl-2023-330355 -
American Journal of Infection Control May 2016Recent outbreaks with carbapenem-resistant Enterobacteriaceae (CRE) in patients who have undergone endoscopic retrograde cholangiopancreatography (ERCP) have raised... (Review)
Review
Recent outbreaks with carbapenem-resistant Enterobacteriaceae (CRE) in patients who have undergone endoscopic retrograde cholangiopancreatography (ERCP) have raised concerns of whether current endoscope reprocessing guidelines are adequate to ensure a patient-safe endoscope. Unlike previous outbreaks, these CRE outbreaks occurred even though manufacturer's instructions and professional guidelines were followed correctly. This article reviews why outbreaks associated with endoscopes continue to occur; what alternatives exist that might improve the margin of safety associated with duodenoscope reprocessing; and how to prevent future outbreaks associated with ERCP procedures. The advantages and disadvantages for the proposed enhancements for reprocessing duodenoscopes are reviewed as well as future strategies to prevent GI endoscope-related outbreaks.
Topics: Anti-Bacterial Agents; Carbapenems; Disease Outbreaks; Duodenoscopes; Duodenoscopy; Enterobacteriaceae; Enterobacteriaceae Infections; Humans; Infection Control; Patient Safety; beta-Lactam Resistance
PubMed: 27131135
DOI: 10.1016/j.ajic.2015.10.037 -
Endoscopy International Open Mar 2023The contamination level of ready-to-use endoscopes published in the literature varies from 0.4 % to 49.0 %. Unfortunately, the comparison and the interpretation of...
The contamination level of ready-to-use endoscopes published in the literature varies from 0.4 % to 49.0 %. Unfortunately, the comparison and the interpretation of these results are quite impossible, given the limited number of samples and sites included and the differences observed between sampling, culturing methods, and interpretation criteria. The objective of this retrospective study was to analyze the results of 90,311 endoscope samples collected between 2004 and 2021 in 490 private or public hospitals in France. Through the full test period, the mean ratio of endoscopes at the action level was 12.6 % (19.5 % including alert level). Of the endoscopy units, 23.0 % had a ratio of compliant endoscopes ≤ 70.0 %. The overall microbial quality of gastroscopes, duodenoscopes, and colonoscopes is improving year by year, whereas an opposite trend is observed for ultrasound endoscopes and bronchoscopes. In 2021, following French guidelines, 13.0 % of the endoscopes should have been quarantined and 8.1 % were at the alert level, meaning that the contamination level of 21.1 % of the endoscopes exceeded what was defined as a maximum acceptable value. This study demonstrates that additional efforts, including implementation of microbial surveillance strategies using a standardized sampling method and periodic observational audits, must be made to improve the overall microbiological quality of endoscopes and reduce the risk associated with their use.
PubMed: 36937825
DOI: 10.1055/a-1991-1391 -
The Lancet. Gastroenterology &... Jul 2018
Topics: Duodenoscopes; Endoscopy; Humans
PubMed: 29893228
DOI: 10.1016/S2468-1253(18)30168-7 -
Canadian Journal of Gastroenterology &... 2019Duodenoscope use in healthcare facilities has been associated with transmission of multidrug resistant pathogens between patients. To assist healthcare facilities in... (Comparative Study)
Comparative Study Randomized Controlled Trial
Duodenoscope use in healthcare facilities has been associated with transmission of multidrug resistant pathogens between patients. To assist healthcare facilities in monitoring the quality of their duodenoscope reprocessing procedures and limit patient risk of infection, the Centers for Disease Control and Prevention (CDC) deployed voluntary interim duodenoscope sampling and culturing surveillance protocols in 2015. Though the interim methods were widely adopted, alternative surveillance protocols were developed and implemented at individual institutions. Here, we compared two sampling methods-the 2015 CDC interim protocol and an alternative protocol developed by the University of Wisconsin Hospitals and Clinics (UWHC). We hypothesized that the UWHC protocol would detect a higher incidence of bacterial contamination from reprocessed duodenoscopes. A total of 248 sampling events were performed at UWHC. The CDC protocol ( = 129 sampling events) required culturing samples collected from each duodenoscope after brushing its terminal end and flushing its lumen with sterile water. The UWHC protocol ( = 119 sampling events) required culturing samples collected from each duodenoscope after swabbing its elevator, immersing its terminal end into broth and flushing its lumen with saline. With the CDC method, 8.53% ( = 11) of the duodenoscopes sampled were positive for bacterial growth with 15 isolates recovered. Using the UWHC method, 15.13% ( = 18) of cultures were positive for bacterial growth with 20 isolates recovered. The relative risk of identifying a contaminated duodenoscope using the CDC interim method, however, was not different than when using the UWHC protocol. Mean processing time (27.35 and 5.11 minutes, < 0.001) and total cost per sample event ($17.87 and $15.04) were lower using the UWHC method. As the UWHC protocol provides similar detection rates as the CDC protocol, the UWHC method is useful, provided the shorter processing time and lower cost to perform.
Topics: Disinfection; Duodenoscopes; Equipment Contamination; Equipment Reuse; Humans; Microbiological Techniques; Prospective Studies; Time Factors
PubMed: 31828050
DOI: 10.1155/2019/1959141 -
Gastrointestinal Endoscopy Dec 2022
Topics: Humans; Duodenoscopes
PubMed: 36007585
DOI: 10.1016/j.gie.2022.08.025 -
Clinical Endoscopy Jan 2015Biliopancreatic malignancies such as cholangiocarcinoma (CCA) has notoriously been diagnosed late. As such most therapy have been palliative in nature. Cholangioscopy... (Review)
Review
Biliopancreatic malignancies such as cholangiocarcinoma (CCA) has notoriously been diagnosed late. As such most therapy have been palliative in nature. Cholangioscopy allows for an earlier diagnosis to be made. Brachytherapy with the insertion of catheter with iridium-132 seeds, percutaneously or through endoscopic retrograde cholangiopancreatography (ERCP) was the earliest ablative techniques used. It has been shown to have a beneficial effect only in prolonging survival. Photodynamic therapy (PDT) has also been used for several years. stenting with PDT versus stenting alone for unresectable CCA showed a marked survival benefit with the addition of PDT. However the most exciting endoscopic ablative modality appears to be intraductal radiofrequency ablation using the Habib catheter and device. Several case series have shown the effectiveness of this technique in ablating tumors. This technique is evolving and coupled with early diagnosis of CCA through cholangioscopy will allow for a curative therapy. The crux to the effective treatment of early cancerous lesions in the bile or pancreatic duct is the early diagnosis of such lesions. Effective endoscopic ablative therapy is now available with the advent of radiofrequency ablation probes that can be passed through the duodenoscope via ERCP.
PubMed: 25674521
DOI: 10.5946/ce.2015.48.1.15