Duodenoscope-Associated Infections: Update on an Emerging Problem

Rahman, M Rubayat; Perisetti, Abhilash; Coman, Roxana M.; Bansal, Pardeep; Chhabra, Rajiv; Goyal, Hemant

doi:10.1007/s10620-018-5431-7

Cited by 55 publications

(51 citation statements)

References 87 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…18 GASTROINTESTINAL ENDOSCOPY AND VIRAL TRANSMISSION C ONTAMINATED FLEXIBLE ENDOSCOPES have been reported as the vector for transmission of infections for many years. 31 The exact number of infections though unclear, are likely underreported, possibly due to asymptomatic infections, incomplete surveillance, and prolonged latency. Healthcare-associated infection outbreaks have been reported in the past, forcing the FDA and Centers for Disease Control (CDC) to recommend comprehensive endoscope cleaning strategies with high-level disinfection and reprocessing.…”

Section: Endoscopy Staff and Covid-19mentioning

confidence: 99%

“…As endoscopes are frequently affected by gut flora, this could pose a risk not only to the endoscopists, nurses, and other endoscopy staff but also could be a vector for potential transmission to other patients. 31 While no cases of endoscope-related COVID-19 transmission have been reported so far, this risk exists, especially with previous experiences with hepatitis B and C viruses. It is reassuring that post-cleaning samples of SARS-CoV-2 became negative, indicating that current endoscope disinfection techniques are sufficient.…”

Section: Endoscopy Staff and Covid-19mentioning

confidence: 99%

See 1 more Smart Citation

COVID‐19 and gastrointestinal endoscopies: Current insights and emergent strategies

Perisetti

Gajendran

Boregowda

et al. 2020

Digestive Endoscopy

Self Cite

View full text Add to dashboard Cite

A new coronavirus emerged in December 2019 in Wuhan city of China, named as the severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2), and the disease was called coronavirus disease‐2019 (COVID‐19). The infection due to this virus spread exponentially throughout China and then spread across >205 nations, including the United States (US). Gastrointestinal (GI) endoscopies are routinely performed in the US and globally. Previous reports of isolated infection outbreaks were reported with endoscopes acting as potential vectors. While multidrug‐resistant organisms have been reported to be spread by endoscopes, few cases of viruses such as hepatitis B and C are noted in the literature. COVID‐19 is predominately spread by droplet transmission, although recent evidence has showed that shedding in feces and feco‐oral transmission could also be possible. It is unclear if COVID‐19 could be transmitted by endoscopes, but it could theoretically happen due to contact with mucous membranes and body fluids. GI endoscopies involve close contact with oral and colonic contents exposing endoscopy staff to respiratory and oropharyngeal secretions. This can increase the risk of contamination and contribute to virus transmission. Given these risks, all major GI societies have called for rescheduling elective non‐urgent procedures and perform only emergent or urgent procedures based on the clinical need. Furthermore, pre‐screening of all individuals prior to endoscopy is recommended. This article focuses on the risk of COVID‐19 transmission by GI shedding, the potential role of endoscopes as a vector of this novel virus, including transmission during endoscopies, and prevention strategies including deferral of elective non‐urgent endoscopy procedures.

show abstract

Section: Endoscopy Staff and Covid-19mentioning

confidence: 99%

Section: Endoscopy Staff and Covid-19mentioning

confidence: 99%

COVID‐19 and gastrointestinal endoscopies: Current insights and emergent strategies

Perisetti

Gajendran

Boregowda

et al. 2020

Digestive Endoscopy

Self Cite

View full text Add to dashboard Cite

show abstract

“…9,17 Contaminated hands and gloves, the endoscope, and other equipment used can be sources of infection. 18 Keyboards of computers in the examination room may also be a source of infection.…”

Section: Precautions When Performing Endoscopymentioning

confidence: 99%

Clinical Questions and Answers on Gastrointestinal Endoscopy during the Novel Coronavirus Disease 2019 pandemic

Furuta

Irisawa

Matsumoto

et al. 2020

Digestive Endoscopy

View full text Add to dashboard Cite

Some situations may require endoscopy during the COVID‐19 (Coronavirus Disease 2019) pandemic. Here, we describe the necessary precautions in the form of clinical questions and answers (Q&A) regarding the safe deployment of gastrointestinal endoscopy in such situations while protecting endoscopy staff and patients from infection. Non‐urgent endoscopy should be postponed. The risk of infection in patients should be evaluated in advance by questionnaire and body temperature. The health of staff must be checked every day. Decisions to employ endoscopy should be based on the institutional conditions and aims of endoscopy. All endoscopic staff need to wear appropriate personal protective equipment (PPE). The endoscope and other devices should be cleaned and disinfected after procedures in accordance with the relevant guidelines. Optimal management of the endoscopy unit is required. Endoscopy for infected patients or those with suspected infection demands exceptional caution. When a patient who undergoes endoscopy is later found to have COVID‐19, the members of staff involved are considered exposed to the virus and must not work for at least 14 days if their PPE is considered insufficient. When PPE resources are limited, some equipment may be used continuously throughout a shift as long as it is not contaminated. Details of the aforementioned protective measures are described.

show abstract

“…Flexible endoscopes when contaminated have been considered as the vector for transmission of infections. 10 The exact burden of this problem is, however, unknown, possibly due to asymptomatic infections and incomplete surveillance. Health care-associated infection outbreaks have been reported and hence comprehensive endoscope cleaning strategies with high-level disinfection (HLD) and reprocessing has been recommended.…”

Section: Gastrointestinal Endoscopy and Viral Transmissionmentioning

confidence: 99%

“…Since the endoscopes are affected by gut flora, it poses a risk not only to the endoscopists, nurses, and other endoscopy staff but also could be a source of infection transmission to other patients. 10 Till date, there is no reported case of endoscope-related COVID-19 transmission; however, the risk remains, especially with prior experiences with hepatitis B and C viruses. It is reassuring that post cleaning samples of SARS-CoV-2 became negative, indicating that current endoscope disinfection techniques are sufficient.…”

Section: Gastrointestinal Endoscopy and Viral Transmissionmentioning

confidence: 99%

Disinfection of Endoscopy and Reusability of Accessories

Rai

2020

Journal of Digestive Endoscopy

View full text Add to dashboard Cite

Corona viruses are a group of medium-sized positive-sense single-stranded RNA viruses with crown-like structure due to projections noted over the surface of the virus. The infection has been declared as a pandemic by the world health organization (WHO) in March 2020. Health care professionals in endoscopy are at high risk of infection by novel corona virus disease 2019 (COVID-19) from inhalation of droplets, conjunctival contact, feces, and touch contamination. Upper gastrointestinal (GI) endoscopy is considered to be a high-risk aerosol-generating procedures (AGPs) and the live virus has been found in patient stool. Flexible endoscopes when contaminated have been considered as the vector for transmission of infections. Infections related to the side viewing endoscopes and endoscopic ultrasound scopes are more frequent than upper GI scope and colonoscopes. Stratifying patients needing endoscopy and deferral of elective procedures will help to decrease the virus spread. Planning and revision of workflows is necessary for safety of patient and staff and to successfully provide infection prevention and control measures, for this a “three zones and two passages” concept should be followed. Manual cleaning followed by high-level disinfection (HLD), effectively eliminates nearly all microorganisms from endoscopes during reprocessing. Transmission of viral infections during endoscopy is quite rare and, it is usually the result of noncompliance from the essential steps of reprocessing. Reuse of any disposable GI endoscopic device is strongly discouraged. Environmental decontamination is essential to reduce the risk of fomite transmission. Noncritical environmental surfaces frequently touched by hands (e.g., bedside tables and bed rails) and endoscopy furniture and floor should be considered heavily contaminated in patients with intermediate or high risk of COVID-19 and should be thoroughly disinfected at the end of each procedure. If available, negative pressure rooms are preferred for endoscopy, as has been advised by Centers for Disease Control and Prevention (CDC). Staff involved in reprocessing and the cleaning of endoscopy rooms should utilize personal protective equipment (PPE) including N95 mask. Reprocessing staff should undergo necessary training and ongoing annual assessment of competency.

show abstract

Duodenoscope-Associated Infections: Update on an Emerging Problem

Cited by 55 publications

References 87 publications

COVID‐19 and gastrointestinal endoscopies: Current insights and emergent strategies

COVID‐19 and gastrointestinal endoscopies: Current insights and emergent strategies

Clinical Questions and Answers on Gastrointestinal Endoscopy during the Novel Coronavirus Disease 2019 pandemic

Disinfection of Endoscopy and Reusability of Accessories

Contact Info

Product

Resources

About