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Gastrointestinal Endoscopy Clinics of... Oct 2020Elevator-based endoscope-related infections from patient cross-contamination is a multifactorial problem related to device design, maintenance, and function, with... (Review)
Review
Elevator-based endoscope-related infections from patient cross-contamination is a multifactorial problem related to device design, maintenance, and function, with additional risk incurred from a high-level disinfection process that lacks quality controls. This article reviews the historical context for these outbreaks, technical aspects of scope design contributing to this risk, and innovations in endoscope technology that have the potential to overcome these shortcomings. Also reviewed are interim solutions and the data that support use of some of these interventions. Still needed are a validated manufacturer-recommended schedule for routine duodenoscope and echoendoscope maintenance with reprocessing protocols that can be implemented in endoscopy units.
Topics: Biofilms; Cross Infection; Disinfection; Drug Resistance, Multiple, Bacterial; Duodenoscopes; Duodenoscopy; Endosonography; Equipment Contamination; Equipment Design; Fomites; Humans; Infection Control
PubMed: 32891223
DOI: 10.1016/j.giec.2020.05.002 -
European Journal of Clinical... Dec 2019Flexible digestive endoscopes are used for the management of various conditions with hundreds of thousands of therapeutic procedures performed worldwide each year.... (Review)
Review
Flexible digestive endoscopes are used for the management of various conditions with hundreds of thousands of therapeutic procedures performed worldwide each year. Duodenoscopes are indispensable tools for the delivery of minimally invasive vital care of numerous pancreaticobiliary disorders. Despite the fact that nosocomial infections after endoscopic retrograde cholangiopancreatography (ERCP) have always been among the most frequently cited postprocedural complications, recent emergence of duodenoscope-transmitted multiple drug-resistant bacterial infections has led to intense research and debate yet with no clearly delineated solution. Duodenoscope-transmitted nosocomial infections have become one of the most visible topics in the recent literature. Hundreds of high-impact articles have therefore been published in the last decade. This review article discusses how such infections were seen in the past and what is the current situation in both research and practice and thus tries to solve some of the unanswered questions for the future. With the persistence of nosocomial infections despite strict adherence to both manufacturer-issued reprocessing protocols and international guidelines and regulations, an urgent and proper microbiologically driven common action is needed for controlling such nosocomial worldwide threat.
Topics: Cholangiopancreatography, Endoscopic Retrograde; Cross Infection; Disinfection; Duodenoscopes; Equipment Contamination; Equipment Reuse; Humans; Infection Control; Risk Factors
PubMed: 31482418
DOI: 10.1007/s10096-019-03671-3 -
Endoscopy Feb 2022
Topics: Cross Infection; Duodenoscopes; Equipment Contamination; Humans
PubMed: 34412140
DOI: 10.1055/a-1507-5196 -
Digestive Diseases and Sciences Jun 2019The duodenoscope is among the most complex medical instruments that undergo disinfection between patients. Transmission of infection by contaminated scopes has remained... (Review)
Review
The duodenoscope is among the most complex medical instruments that undergo disinfection between patients. Transmission of infection by contaminated scopes has remained a challenge since its inception. Notable risk factors for pathogen transmission include non-adherence to disinfection guidelines, encouragement of biofilm deposition due to complex design and surface defects and contaminated automated endoscope reprocessors. The most common infections following endoscopy are endogenous infections involving the patient's own gut flora. Exogenous infections, on the other hand, are associated with contaminated scopes and can theoretically be prevented by effective reprocessing. Pseudomonas aeruginosa is currently the most common organism isolated from contaminated endoscopes. Of note, reports of multidrug-resistant duodenoscopy-associated outbreaks have surfaced recently, many of which occurred despite adequate reprocessing. The FDA and CDC currently recommend comprehensive cleaning followed with at least high-level disinfection for reprocessing of flexible GI endoscopes. Reports of duodenoscope-related outbreaks despite compliance with established guidelines have prompted professional and government bodies to revisit existing guidelines and offer supplementary recommendations for duodenoscope processing. For the purposes of this review, we identified reports of duodenoscope-associated infections from 2000 till date. For each outbreak, we noted the organisms isolated, the number of cases reported, any possible explanations of contamination, and the measures undertaken to end each outbreak. We have also attempted to present an overview of recent developments in this rapidly evolving field.
Topics: Anti-Bacterial Agents; Antibiotic Prophylaxis; Bacterial Infections; Decontamination; Disease Outbreaks; Duodenoscopes; Duodenoscopy; Equipment Contamination; Equipment Reuse; Gastrointestinal Microbiome; Humans; Risk Assessment; Risk Factors
PubMed: 30569333
DOI: 10.1007/s10620-018-5431-7 -
Clinical Endoscopy Mar 2022Unlike simple forward-viewing endoscopes such as gastroscope or colonoscope, duodenoscope houses much more complex design to fulfil its function. This design differences... (Review)
Review
Unlike simple forward-viewing endoscopes such as gastroscope or colonoscope, duodenoscope houses much more complex design to fulfil its function. This design differences leave duodenoscopes more prone to contamination from inadequate disinfection process and potential dissemination of pathogens. Recent reports on dissemination of infection through the duodenoscope mandated an overhaul of duodenoscope utilization including development of a disposable duodenoscope. This article reviews the current state of disposable duodenoscope development, including reported early efficacy as well as its future direction and utilization.
PubMed: 34154307
DOI: 10.5946/ce.2021.075 -
Endoscopy International Open Dec 2020Recent outbreaks of duodenoscope-associated multidrug-resistant organisms (MDROs) have brought attention to the infection risk from procedures performed with... (Review)
Review
Recent outbreaks of duodenoscope-associated multidrug-resistant organisms (MDROs) have brought attention to the infection risk from procedures performed with duodenoscopes. Prior to these MDRO outbreaks, procedures with duodenoscopes were considered safe and low risk for exogenous infection transmission, provided they were performed in strict accordance with manufacturer instructions for use and multisociety reprocessing guidelines. The attention and efforts of the scientific community, regulatory agencies, and the device industry have deepened our understanding of factors responsible for suboptimal outcomes. These include instrument design, reprocessing practices, and surveillance strategies for detecting patient and instrument colonization. Various investigations have made it clear that current reprocessing methods fail to consistently deliver a pathogen-free instrument. The magnitude of infection transmission has been underreported due to several factors. These include the types of organisms responsible for infection, clinical signs presenting in sites distant from ERCP inoculation, and long latency from the time of acquisition to infection. Healthcare providers remain hampered by the ill-defined infectious risk innate to the current instrument design, contradictory information and guidance, and limited evidence-based interventions or reprocessing modifications that reduce risk. Therefore, the objectives of this narrative review included identifying outbreaks described in the peer-reviewed literature and comparing the findings with infections reported elsewhere. Search strategies included accessing peer-reviewed articles, governmental databases, abstracts for scientific conferences, and media reports describing outbreaks. This review summarizes current knowledge, highlights gaps in traditional sources of evidence, and explores opportunities to improve our understanding of actual risk and evidence-based approaches to mitigate risk.
PubMed: 33269310
DOI: 10.1055/a-1264-7173 -
Endoscopy Nov 2022
Topics: Humans; Duodenoscopes; Decontamination; Equipment Contamination; Disinfection
PubMed: 35863342
DOI: 10.1055/a-1866-3886 -
Gastroenterology Nursing : the Official... 2020A rise in duodenoscope-associated infections, especially in regard to multidrug-resistant organisms, has led to an increase in scrutiny regarding duodenoscope... (Review)
Review
A rise in duodenoscope-associated infections, especially in regard to multidrug-resistant organisms, has led to an increase in scrutiny regarding duodenoscope reprocessing. Endoscopic retrograde cholangiopancreatography scopes have a specialized elevator wire channel, allowing more flexible duct cannulation; however, this channel can be difficult to reprocess with standard techniques. Although strict adherence to manufacturer reprocessing protocols remains the primary means of infection prevention, periodic microbiological surveillance is a Food and Drug Administration-recommended practice that the Medical University of South Carolina has implemented to further prevent duodenoscope-associated infections. The Medical University of South Carolina obtains 2 separate cultures from 2 duodenoscopes every 2 months, which undergo standard speciation and sensitivity and are returned to use once negative at 48 hours. The initial results of the Medical University of South Carolina's surveillance cultures are negative for any multidrug-resistant organisms; however, other centers should consider implementing surveillance cultures into their reprocessing practices and closely monitoring for future endoscope infection prevention modalities.
Topics: Cholangiopancreatography, Endoscopic Retrograde; Disinfection; Duodenoscopes; Equipment Contamination; Humans; Infection Control
PubMed: 33055545
DOI: 10.1097/SGA.0000000000000499 -
Current Gastroenterology Reports Oct 2016Numerous outbreaks of duodenoscope-associated transmission of multi-drug resistant bacteria have recently been reported. Unlike prior episodes of endoscope-transmitted... (Review)
Review
Numerous outbreaks of duodenoscope-associated transmission of multi-drug resistant bacteria have recently been reported. Unlike prior episodes of endoscope-transmitted infections, the latest outbreaks have occurred despite strict adherence to duodenoscope reprocessing guidelines. The current standard for all flexible endoscope reprocessing includes pre-cleaning, leak testing, an additional manual cleaning step, and high-level disinfection. When these steps are strictly followed, the risk of infection transmission during endoscopy is exceedingly rare. However, due to its complex design, the duodenoscope may not be able to be adequately disinfected using the current reprocessing standards. Supplemental measures to enhance scope reprocessing have subsequently been recommended to reduce the infection risk in patients undergoing endoscopic retrograde cholangiopancreatography. These methods are likely short-term solutions that have yet to be validated regarded their effectiveness. Additional approaches to monitor the quality of duodenoscope reprocessing may also be useful. Ultimately, a definitive, yet logistically feasible, method of duodenoscope reprocessing is required to ensure the safety of our patients.
Topics: Cholangiopancreatography, Endoscopic Retrograde; Cross Infection; Disinfection; Duodenoscopes; Equipment Contamination; Equipment Reuse; Humans; Infection Control
PubMed: 27595583
DOI: 10.1007/s11894-016-0528-7 -
Gastrointestinal Endoscopy Jan 2017
Review
Topics: Antibiotic Prophylaxis; Cholangiopancreatography, Endoscopic Retrograde; Cholangitis; Cholecystitis; Duodenoscopes; Embolism, Air; Hemorrhage; Humans; Intestinal Perforation; Pancreatitis; Risk Factors; Sphincterotomy, Endoscopic
PubMed: 27546389
DOI: 10.1016/j.gie.2016.06.051