Contribution of usage to endoscope working channel damage and bacterial contamination

Santos, Luana Almeida dos; Parvin, Farhana; Huizer-Pajkos, Aniko; Wang, Jessica; Inglis, David W.; Andrade, Denise de; Hu, Honghua; Vickery, Karen

doi:10.1016/j.jhin.2020.03.007

Cited by 11 publications

(13 citation statements)

References 31 publications

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“…These results are in line with what has been previously observed in dental unit waterlines and flexible endoscopes [19,[60][61][62][63][64], where waterborne bacteria persisting in waterline effluent water, despite previous disinfection, can efficiently recolonize the water circuits of these devices. Given the well-established tolerance of biofilm to disinfectants, it is tempting to speculate that Legionella recolonization may be due to biofilm formation and persistence in these devices.…”

Section: Discussionsupporting

confidence: 91%

Persistence of Legionella in Routinely Disinfected Heater-Cooler Units and Heater Units assessed by Propidium Monoazide qPCR

et al. 2020

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Background: Evidence to date indicates that heater–cooler units (HCUs) and heater units (HUs) can generate potentially infectious aerosols containing a range of opportunistic pathogens such as Mycobacterium chimaera, other non-tuberculous mycobacterial (NTM) species, Pseudomonas aeruginosa and Legionella spp. Our purpose was to determine the extent of Legionella contamination and total viable count (TVC) in HCUs and HUs and to analyze the relationship by water system design of devices of two different brands (LivaNova vs. Maquet). Methods: Legionella spp. were detected and quantified by our optimized PMA-qPCR protocol; TVCs were assessed according to ISO protocol 6222. Analyses were performed in the first sampling round and after six months of surveillance. Results: Overall, Legionella spp. was detected in 65.7% of devices. In the second sampling round, Legionella positivity rates were significantly lower in water samples from the Maquet devices compared to the LivaNova ones (27.3% vs. 61.5%). LivaNova HCUs also yielded more Legionella, and aquatic bacteria counts than Maquet in both first and second-round samples. Conclusions: We recommend that all surgical patients and staff exposed to aerosols from thermoregulatory devices should be followed up for Legionella infection and that microbiological surveillance on such devices should be conducted regularly as precautionary principle.

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Section: Discussionsupporting

confidence: 91%

Persistence of Legionella in Routinely Disinfected Heater-Cooler Units and Heater Units assessed by Propidium Monoazide qPCR

et al. 2020

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“…This could be due to the frequent WCP. A previous report demonstrated that bacterial contamination is associated with damaged regions of working channels 17 . During the COVID‐19 pandemic, Kikuchi et al.…”

Section: Discussionmentioning

confidence: 98%

“…A previous report demonstrated that bacterial contamination is associated with damaged regions of working channels. 17 During the COVID-19 pandemic, Kikuchi et al reported a new shielding method for endoscopic procedures, including working channels. 18 The risk of bacterial exposure from working channels might decrease by using new infection control devices.…”

Section: Discussionmentioning

confidence: 99%

Bacterial exposure risk to the endoscopist's face while performing endoscopy

et al. 2023

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Objectives Gastrointestinal endoscopy increases the risk of bacterial exposure to endoscopists. However, before 2019, most endoscopists did not pay attention to microorganism transmission from patients. This study aimed to investigate the incidence of bacterial exposure to endoscopists’ faces during gastrointestinal endoscopic procedures using the bacterial culture method. Methods This was a single‐centered, retrospective study including endoscopists who performed various gastrointestinal endoscopy procedures at the Division of Endoscopy, Hirosaki University Hospital between August 31 and October 6, 2020. Endoscopists wore surgical masks and affixed pre‐sterilized films over them. Following the gastrointestinal endoscopic procedures, attached microbes were collected from the endoscopists’ surface films using sterilized swabs. Collected microorganisms were cultured on tryptic soy agar and 5% sheep blood agar, and the incidence of bacterial exposure was determined by bacterial culture positivity. Cultured bacteria were identified by gram staining and 16S rRNA gene sequencing. Results Bacterial culture positivity was 12.6%, and it was significantly higher in therapeutic than in diagnostic endoscopy. Notably, therapeutic endoscopy increased bacterial culture positivity in colonoscopy, but not in esophagogastroduodenoscopy. Staphylococci, including Staphylococcus epidermidis and Staphylococcus capitis, were the most commonly found bacteria in samples identified through 16S rRNA gene sequencing. Conclusions The risk of bacterial exposure to the endoscopist's face was increased in colonoscopy treatment procedures. Therefore, endoscopists should be aware of the significant risk of microbial infection from scattering fluid that comes from the endoscopy's working channel.

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“…There is evidence that some tools, such as bronchoscopes (Ofstead et al, 2020) and duodenoscopes (Rauwers et al, 2018;Balan et al, 2019), might still be contaminated with bacteria after routine sterilization. Recurrent passing of instruments down the working channel of the scope leads to damage, that damage leads to accumulation of biofilm which can become infected (Alfa and Singh, 2020;Bouiller et al, 2020;Santos et al, 2020).…”

Section: Challenges For Robotic Flexible Gi Endoscopy To Overcome Durmentioning

confidence: 99%

Guidelines for Robotic Flexible Endoscopy at the Time of COVID-19

et al. 2021

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Flexible endoscopy involves the insertion of a long narrow flexible tube into the body for diagnostic and therapeutic procedures. In the gastrointestinal (GI) tract, flexible endoscopy plays a major role in cancer screening, surveillance, and treatment programs. As a result of gas insufflation during the procedure, both upper and lower GI endoscopy procedures have been classified as aerosol generating by the guidelines issued by the respective societies during the COVID-19 pandemic—although no quantifiable data on aerosol generation currently exists. Due to the risk of COVID-19 transmission to healthcare workers, most societies halted non-emergency and diagnostic procedures during the lockdown. The long-term implications of stoppage in cancer diagnoses and treatment is predicted to lead to a large increase in preventable deaths. Robotics may play a major role in this field by allowing healthcare operators to control the flexible endoscope from a safe distance and pave a path for protecting healthcare workers through minimizing the risk of virus transmission without reducing diagnostic and therapeutic capacities. This review focuses on the needs and challenges associated with the design of robotic flexible endoscopes for use during a pandemic. The authors propose that a few minor changes to existing platforms or considerations for platforms in development could lead to significant benefits for use during infection control scenarios.

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Contribution of usage to endoscope working channel damage and bacterial contamination

Cited by 11 publications

References 31 publications

Persistence of Legionella in Routinely Disinfected Heater-Cooler Units and Heater Units assessed by Propidium Monoazide qPCR

Persistence of Legionella in Routinely Disinfected Heater-Cooler Units and Heater Units assessed by Propidium Monoazide qPCR

Bacterial exposure risk to the endoscopist's face while performing endoscopy

Guidelines for Robotic Flexible Endoscopy at the Time of COVID-19

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