A narrative review on current duodenoscope reprocessing techniques and novel developments

Abstract

Duodenoscopy-associated infections occur worldwide despite strict adherence to reprocessing standards. The exact scope of the problem remains unknown because a standardized sampling protocol and uniform sampling techniques are lacking. The currently available multi-society protocol for microbial culturing by the Centers for Disease Control and Prevention, the United States Food and Drug Administration (FDA) and the American Society for Microbiology, published in 2018 is too laborious for broad clinical implementation. A more practical sampling protocol would result in increased accessibility and widespread implementation. This will aid to reduce the prevalence of duodenoscope contamination. To reduce the risk of duodenoscopy-associated pathogen transmission the FDA advised four supplemental reprocessing measures. These measures include double high-level disinfection, microbiological culturing and quarantine, ethylene oxide gas sterilization and liquid chemical sterilization. When the supplemental measures were advised in 2015 data evaluating their efficacy were sparse. Over the past five years data regarding the supplemental measures have become available that place the efficacy of the supplemental measures into context. As expected the advised supplemental measures have resulted in increased costs and reprocessing time. Unfortunately, it has also become clear that the efficacy of the supplemental measures falls short and that duodenoscope contamination remains a problem. There is a lot of research into new reprocessing methods and technical applications trying to solve the problem of duodenoscope contamination. Several promising developments such as single-use duodenoscopes, electrolyzed acidic water, and vaporized hydrogen peroxide plasma are already applied in a clinical setting.

Endoscope reprocessing: Retrospective analysis of 90,311 samples

“…Taking into account all factors that may have an impact on the efficacy of an endoscope sampling method [6,15], it is highly probable that some studies may have underestimated the real contamination level of endoscopes and, therefore, they should be considered with caution in any comparison or attempt to define the threshold limit for endoscope contamination level. As stated by Heuvelmans et al [34] and Kenters et al [35], there is a real need to develop a standardized sampling protocol for endoscopes, including common interpretation criteria to allow any healthcare facility to evaluate the real risk associated with use of their endoscopes and facilitate evaluation of the impact of any new reprocessing method or process.…”

Single‐use accessories and endoscopes in the era of sustainability and climate change—A balancing act

“…Reusable devices can be prone to failure in sterilization or cleaning processes, posing a risk to subsequent patients. While enhanced surveillance and reprocessing methods were proposed, their superiority over standard HLD could not be consistently demonstrated 4,29,30 . Moreover, the adoption of enhanced surveillance and reprocessing methods raises the operational expenses with significant negative financial impact on the organizations 31 .…”

“…Some of the outbreaks were associated with deviation from standard disinfection protocols highlighting the importance of strict adherence to high‐level disinfection (HLD) protocols 2,3 . The fact that adequate reprocessing and adherence to protocols could not entirely eliminate bacterial contamination was explained by the complex design of the reusable duodenoscopes (especially the distal end) and endoscopic accessories 4 . As such, eliminating the reuse of the devices and accessories seemed to be the picture‐perfect remedy for cross‐infection associated with reusable devices.…”

Alginate-Coated Calcium Peroxide Nanoparticles as a Disinfectant for Duodenoscope Reprocessing

“…The nosocomial infection incidence caused by multidrug-resistant organisms (MDROs) following endoscopic retrograde cholangiopancreatography (ERCP) investigations has been one of the most alarming developments in recent years . A cutting-edge medical procedure called ERCP, which was first used in 1968, is intended to make a noninvasive examination for diagnosis and treatment of pancreaticobiliary illnesses. , Duodenoscopes are difficult to properly be sterilized due to their complex structure. − Duodenoscope contamination rates after reprocessing range from 0.4 to 35.8%. − The most nosocomial infections are related to microbial adhesion to duodenoscopes. The most common pathogens known for their capacity to form an MDRO and attach to surfaces and areas that are challenging to access for reprocessing are Salmonella faecalis, Pseudomonas aeruginosa, Escherichia coli, and Klebsiella pneumoniae. − Our previous research studies showed how sterilization cycles affected the duodenoscope, highlighting usage-related alterations to the coatings and working channel polymers and proving that the external coating is harmed gradually from the distal to the proximal part, ending with the elevator. , The stated rates of contamination on the duodenoscope show that the present reprocessing techniques are insufficient.…”