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Gastrointestinal Endoscopy Clinics of... Oct 2020Flexible endoscopes require cleaning, high-level disinfection, and sterilization between each patient use to reduce risk of transmitting pathogens. Public health... (Review)
Review
Flexible endoscopes require cleaning, high-level disinfection, and sterilization between each patient use to reduce risk of transmitting pathogens. Public health investigations have identified concerns, including endoscope damage, mishandling, and reprocessing deficiencies, placing patients at risk for transmission of bacterial, viral, and other pathogens. Findings from outbreak investigations and other studies have led to innovations in endoscope design, use, and reprocessing, yet infection risks related to contaminated or damaged endoscopes remain. Strict adherence to infection control guidelines and manufacturer instructions for use, utilization of supplemental guidance, and training and oversight of reprocessing personnel, reduce risk of pathogen transmission by flexible endoscopes.
Topics: Centers for Disease Control and Prevention, U.S.; Cross Infection; Disease Outbreaks; Endoscopes, Gastrointestinal; Guideline Adherence; Guidelines as Topic; Humans; Infection Control; United States
PubMed: 32891228
DOI: 10.1016/j.giec.2020.06.009 -
Digestive Diseases and Sciences Mar 2022The challenging disinfection process for the elevator mechanism on duodenoscopes and linear echoendoscopes has been identified as a source of clinically significant... (Comparative Study)
Comparative Study
BACKGROUND
The challenging disinfection process for the elevator mechanism on duodenoscopes and linear echoendoscopes has been identified as a source of clinically significant bacterial transmission. Despite increased awareness, there continues to be a lack of definitive guidelines for bacterial culturing protocols for elevator-containing endoscopes.
AIMS
To compare two different prospective bacterial surveillance protocols for duodenoscopes and linear echoendoscopes with regard to accuracy, efficiency, and cost.
METHODS
Consecutive duodenoscopes and linear echoendoscopes used at a single tertiary care center were reprocessed following hospital and manufacturer guidelines, dried using an automatic endoscope-drying machine, and hung overnight in an upright position. Following reprocessing, culture samples were sequentially obtained from each endoscope using two methods, first, the brush protocol followed immediately by the swab protocol.
RESULTS
A total of 532 primary cultures were collected from 17 duodenoscopes and eight linear echoendoscopes. Of these, 266 cultures gathered using the brush protocol were negative, while 266 cultures gathered using the swab protocol resulted in three positive cultures (1.1%). Positive cultures showed Enterobacter cloacae and Klebsiella pneumoniae from one duodenoscope and two linear echoendoscopes. Yearly, the brush protocol amounts to approximately 520 nursing hours, and the swab protocol takes an estimated 42 nursing hours. Annually, the swab protocol could save over $26,500 and 478 nursing hours.
CONCLUSIONS
The proposed swab protocol was superior to the brush protocol when evaluating the presence of residual bacteria on elevator-containing endoscopes following reprocessing and saves cost and nursing hours.
Topics: Bacteria; Disinfection; Duodenoscopes; Endoscopes; Enterobacter cloacae; Equipment Contamination; Humans; Klebsiella pneumoniae; Prospective Studies
PubMed: 33712967
DOI: 10.1007/s10620-021-06930-6 -
The Journal of Hospital Infection Feb 2023Microbiological cultures are the gold standard in the monitoring of duodenoscope reprocessing. However, many different sampling and culturing techniques are used, making...
AIM
Microbiological cultures are the gold standard in the monitoring of duodenoscope reprocessing. However, many different sampling and culturing techniques are used, making it difficult to compare results. The latest Centers for Disease Control and Prevention protocol advises the use of a neutralizer to deactivate any remaining disinfectants in the samples. This study compared culturing results of duodenoscope samples collected with and without addition of a neutralizer.
METHODS
Six duodenoscopes were soiled with gut bacteria in a non-clinical experimental setting and reprocessed afterwards. Samples of the tip and working channel were collected immediately after decontamination or after drying. Dey-Engley (DE) broth was added as a neutralizer to the samples of four duodenoscopes; samples for the other two duodenoscopes were collected without the addition of DE broth.
RESULTS
Post-decontamination cultures were significantly more likely to be positive for growth of the applied micro-organisms in the group of samples with DE broth (88.1% vs 20.2%; P<0.0001). Post-drying samples were significantly more likely to be positive in the group of samples without DE broth (75.7% vs 33.4%; P<0.001).
CONCLUSION
The addition of DE broth to samples collected from wet duodenoscopes increases the yield of those cultures. Remaining disinfectants in wet duodenoscopes can lead to false-negative results. This can be overcome by adding a neutralizer, such as DE broth, to the samples. The higher yield after drying in the group without neutralizer could be due to biofilm formation in these two duodenoscopes, but this was not investigated. Standardization of the sampling method can help to compare both clinical and study results regarding duodenoscope contamination.
Topics: Humans; Duodenoscopes; Equipment Contamination; Disinfectants; Bacteria; Disinfection
PubMed: 36414167
DOI: 10.1016/j.jhin.2022.11.008 -
Current Gastroenterology Reports Jul 2021Hepatobiliary complications are common in Roux-en-Y gastric bypass (RYGB) patients. Despite development of multiple surgical and endoscopic access techniques over the... (Review)
Review
PURPOSE OF REVIEW
Hepatobiliary complications are common in Roux-en-Y gastric bypass (RYGB) patients. Despite development of multiple surgical and endoscopic access techniques over the years, ERCP using standard duodenoscope remains challenging in these patients due to the altered anatomy.
RECENT FINDINGS
Limited success with enteroscope-assisted and laparoscope-assisted ERCP led to the evolution of the novel EUS-directed transgastric ERCP (EDGE) procedure, with variations of this technique termed as Gastric Access Temporary for Endoscopy (GATE), EUS-guided TransGastric ERCP (EUS-TG-ERCP), EUS-guided GastroGastrostomy-assisted ERCP (EUS-GG-ERCP), and EUS-directed transgastric intervention (EDGI). EDGE has high technical (100%) and clinical success rates (60-100%), lower adverse event rate (1.5-7.6%), and up to 20% access stent migration rate; without any significant weight changes. EDGE has significantly shorter procedure time (73vs184min), post-procedural hospital stays (0.8vs2.65 days) and is more cost effective compared to other modalities. EDGE technique addresses the challenges of RYGB anatomy as a minimally invasive, clinically successful, fully endoscopic, and cost-effective option. We present a literature review of the EDGE technique from its inception to current, in addition to reviewing other access techniques, their advantages, disadvantages and outcomes.
Topics: Cholangiopancreatography, Endoscopic Retrograde; Endosonography; Gastric Bypass; Humans; Stomach
PubMed: 34212281
DOI: 10.1007/s11894-021-00808-3 -
The Journal of Hospital Infection Jan 2023Microbiological surveillance of endoscopes is a safety measure for verifying the quality of reprocessing procedures and identifying contaminated devices, but...
INTRODUCTION
Microbiological surveillance of endoscopes is a safety measure for verifying the quality of reprocessing procedures and identifying contaminated devices, but duodenoscope-related outbreaks are still reported.
AIM
To assess the effectiveness of duodenoscope reprocessing procedures in Italy.
METHODS
Between December 2019 and April 2020, data obtained from microbiological surveillance post-reprocessing in 15 Italian endoscopy units were collected. Sampling was carried out after reprocessing or during storage in a cabinet. In keeping with international guidelines and the Italian position paper, the micro-organisms were classified as high-concern organisms (HCOs) and low-concern organisms (LCOs).
FINDINGS
In total, 144 samples were collected from 51 duodenoscopes. Of these, 36.81% were contaminated: 22.92% were contaminated with HCOs and 13.89% were contaminated with LCOs [2.08% with an LCO load of 11-100 colony-forming units (CFU)/device and 0.69% with an LCO load of >100 CFU/device]. The contamination rate was 27.5% in samples collected after reprocessing, 40% in samples collected during storage in a cabinet that was compliant with EN 16442:2015 (C-I), and 100% in samples collected during storage in a cabinet that was not compliant with EN 16442:2015 (NC-I). The respective HCO rates were 15.00%, 27.27% and 66.67%. Correlation between LCO contamination and storage time was demonstrated (Spearman's rho=0.3701; P=0.0026). The Olympus duodenoscope TJFQ180V demonstrated the lowest rate of contamination (29.82%), although the contamination rate was 100% for duodenoscopes stored in an NC-I cabinet.
CONCLUSION
Microbiological surveillance, along with strict adherence to reprocessing protocols, may help to detect endoscope contamination at an early stage, and reduce the risk of duodenoscope-associated infections.
Topics: Humans; Equipment Contamination; Disinfection; Endoscopes; Duodenoscopes; Endoscopy, Gastrointestinal
PubMed: 36244520
DOI: 10.1016/j.jhin.2022.09.024 -
Revista Latino-americana de Enfermagem 2022to analyze the cleaning process of gastroscopes, colonoscopes and duodenoscopes in eight in-hospital health services.
OBJECTIVE
to analyze the cleaning process of gastroscopes, colonoscopes and duodenoscopes in eight in-hospital health services.
METHOD
a cross-sectional study conducted with 22 endoscopes (eight gastroscopes, eight colonoscopes and six duodenoscopes), and microbiological analysis of 60 samples of air/water channels (all endoscopes) and elevator (duodenoscopes), in addition to protein testing. Descriptive statistics with calculation of frequencies and central tendency measures was used in data analysis.
RESULTS
the processing of 22 endoscopes was monitored with microbiological analysis for 60 channels. In the pre-cleaning procedure, in 82.3% (14/17) of the devices, gauze was used in cleaning the insertion tube. Incomplete immersion of the endoscope in detergent solution occurred in 72.3% (17/22) of the cases, and in 63.6% (14/22) there was no standardization of filling-in of the channels. Friction of the biopsy channel was not performed in 13.6% (3/22) of the devices. In the microbiological analysis, 25% (7/32) of the samples from the stored endoscopes were positive for microbial growth (from 2x101 to 9.5x104 CFU/mL), while after processing, contamination was 32% (9/28). Protein residues in the elevator channel were detected in 33% of duodenoscopes.
CONCLUSION
the results indicate important gaps in the stages of pre-cleaning and cleaning of endoscopes that, associated with presence of protein residues and growth of microorganisms of epidemiological importance, indicate limitations in safety of the processing procedures, which can compromise the disinfection processes and, consequently, their safe use among patients subjected to such tests.
Topics: Humans; Equipment Contamination; Cross-Sectional Studies; Detergents; Endoscopes; Disinfection; Hospitals
PubMed: 36287399
DOI: 10.1590/1518-8345.5969.3684 -
Journal of Clinical Microbiology Feb 2016Recent outbreaks of carbapenem-resistant Enterobacteriaceae infections associated with duodenoscopes used for endoscopic retrograde cholangiopancreatography have...
Recent outbreaks of carbapenem-resistant Enterobacteriaceae infections associated with duodenoscopes used for endoscopic retrograde cholangiopancreatography have highlighted the challenge of cleaning and high-level disinfection of these instruments. The Food and Drug Administration has suggested that duodenoscope surveillance by microbiological culturing, along with strict adherence to reprocessing protocols, may help reduce the risk of duodenoscope-associated infection transmission. We developed and validated an effective, user-friendly duodenoscope sampling and culture protocol and compared its performance to the interim Centers for Disease Control and Prevention-recommended guidelines. Our protocol resulted in a 65% recovery rate for Gram-negative organisms, demonstrating a 2-fold increased recovery rate compared to the CDC method. The implementation of this protocol may increase the feasibility of duodenoscope surveillance for microbiology laboratories and endoscopy departments.
Topics: Bacteriological Techniques; Cholangiopancreatography, Endoscopic Retrograde; Cross Infection; Duodenoscopes; Humans
PubMed: 26582839
DOI: 10.1128/JCM.02754-15 -
Antimicrobial Agents and Chemotherapy Aug 2018With the dissemination of carbapenemase-producing (CPE) strains worldwide, carbapenem-hydrolyzing enzymes are increasingly reported among isolates of , the first...
With the dissemination of carbapenemase-producing (CPE) strains worldwide, carbapenem-hydrolyzing enzymes are increasingly reported among isolates of , the first hospital and community-acquired opportunistic pathogen. Here, we have performed an epidemiological survey of carbapenemase-producing (CP-) isolates received at the French National Reference Centre (F-NRC) in 2012 and 2013. Antimicrobial susceptibilities for last-resort antibiotics and antimicrobial compounds commonly used to treat urinary tract infections were determined by broth microdilution. Clonal relationship was assessed using repetitive sequence-based PCR (rep-PCR) and multilocus sequence typing (MLST). From this collection of 140 carbapenemase-producing isolates, 74% produced an OXA-48-like carbapenemase and 21% produced an NDM carbapenemase. A link with a foreign country was suspected for 37% of infected/colonized patients. Most of the isolates were from screening (56%) and from urine samples (26%). Colistin, fosfomycin, and nitrofurantoin possessed the most consistent activity, with 100%, 95%, and 96% isolates susceptible, respectively. A wide diversity of carbapenemase-producing isolates has been found (50 different sequence types [STs]). The most prevalent clones were (i) sequence type 38 (ST38) producing OXA-48 ( = 21), a clone linked to Turkey and North African countries, (ii) ST-90 producing OXA-204 ( = 9), which was responsible for an outbreak related to a contaminated duodenoscope, and (iii) ST-410 producing OXA-181 ( = 5), which was recovered from patients of different geographical origins. These specific clones might be considered high-risk clones for the dissemination of carbapenemases in The wide diversity of STs, combined with the increasing number of CP- isolates received by the F-NRC, suggests a likely dissemination of CP- isolates in the community.
Topics: Africa, Northern; Anti-Bacterial Agents; Bacterial Proteins; Carbapenems; Colistin; Epidemiological Monitoring; Escherichia coli; Escherichia coli Infections; Fosfomycin; France; Gene Expression; Genetic Variation; Humans; Incidence; Multilocus Sequence Typing; Nitrofurantoin; Phylogeny; Turkey; Urinary Tract Infections; beta-Lactamases
PubMed: 29866863
DOI: 10.1128/AAC.00266-18 -
Infection Control and Hospital... Sep 2023To evaluate variables that affect risk of contamination for endoscopic retrograde cholangiopancreatography and endoscopic ultrasound endoscopes. (Observational Study)
Observational Study
OBJECTIVE
To evaluate variables that affect risk of contamination for endoscopic retrograde cholangiopancreatography and endoscopic ultrasound endoscopes.
DESIGN
Observational, quality improvement study.
SETTING
University medical center with a gastrointestinal endoscopy service performing ∼1,000 endoscopic retrograde cholangiopancreatography and ∼1,000 endoscopic ultrasound endoscope procedures annually.
METHODS
Duodenoscope and linear echoendoscope sampling (from the elevator mechanism and instrument channel) was performed from June 2020 through September 2021. Operational changes during this period included standard reprocessing with high-level disinfection with ethylene oxide gas sterilization (HLD-ETO) was switched to double high-level disinfection (dHLD) (June 16, 2020-July 15, 2020), and duodenoscopes changed to disposable tip model (March 2021). The frequency of contamination for the co-primary outcomes were characterized by calculated risk ratios.
RESULTS
The overall pathogenic contamination rate was 4.72% (6 of 127). Compared to duodenoscopes, linear echoendoscopes had a contamination risk ratio of 3.64 (95% confidence interval [CI], 0.69-19.1). Reprocessing using HLD-ETO was associated with a contamination risk ratio of 0.29 (95% CI, 0.06-1.54). Linear echoendoscopes undergoing dHLD had the highest risk of contamination (2 of 18, 11.1%), and duodenoscopes undergoing HLD-ETO and the lowest risk of contamination (0 of 53, 0%). Duodenoscopes with a disposable tip had a 0% contamination rate (0 of 27).
CONCLUSIONS
We did not detect a significant reduction in endoscope contamination using HLD-ETO versus dHLD reprocessing. Linear echoendoscopes have a risk of contamination similar to that of duodenoscopes. Disposable tips may reduce the risk of duodenoscope contamination.
Topics: Humans; Cholangiopancreatography, Endoscopic Retrograde; Disinfection; Duodenoscopes; Endosonography; Equipment Contamination
PubMed: 36645014
DOI: 10.1017/ice.2022.319 -
The Journal of Hospital Infection Apr 2021At present, the most frequent method for processing flexible gastrointestinal (GI) endoscopes is cleaning followed by high-level disinfection as terminal sterilization...
BACKGROUND
At present, the most frequent method for processing flexible gastrointestinal (GI) endoscopes is cleaning followed by high-level disinfection as terminal sterilization is often not practicable. Post-processing monitoring studies consistently show high levels of positive cultures remaining on endoscopes, which can lead to patient infection and even fatality. The processing deficiency is attributed to the complex design of endoscopes, incomplete cleaning, formation of biofilms and lack of margin of safety with high-level disinfection.
OBJECTIVE
To demonstrate that flexible GI endoscopes can be practicably terminally sterilized.
METHODS
An endoscope sterilization cycle was developed in a vaporized hydrogen peroxide sterilization system. The cycle was used to study the sterilization of flexible GI endoscopes which included colonoscopes and duodenoscope and material compatibility for both original flexible GI endoscopes and those experimentally modified endoscopes using compatible materials.
RESULTS
Testing demonstrated that the vaporized hydrogen peroxide can sterilize flexible GI endoscopes (colonoscopes, duodenoscope) with a sterility assurance level of 10. Additionally, no recoverable survivors were detected when devices were artificially soiled with hard water and serum. Material compatibility test results demonstrated that replacing molybdenum disulphide lubricant with a graphite-based inert lubricant can make them compatible with vaporized hydrogen peroxide sterilizers.
CONCLUSION
Flexible GI endoscopes can be practicably terminally sterilized using vaporized hydrogen peroxide sterilization technologies if their materials are revised to become compatible.
Topics: Disinfection; Duodenoscopes; Endoscopes, Gastrointestinal; Equipment Contamination; Hydrogen Peroxide; Sterilization
PubMed: 33549767
DOI: 10.1016/j.jhin.2021.01.021