High prevalence rate of digestive tract bacteria in duodenoscopes: a nationwide study

Rauwers, Arjan W.; Holt, Anne F. A.F. Voor In'T; Buijs, Jolanda G.; Groot, Woutrinus W. de; Hansen, Bettina B.E.; Bruno, Marco; Vos, Margreet

doi:10.1136/gutjnl-2017-315082

Cited by 112 publications

(132 citation statements)

References 28 publications

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“…Consistent with previous reports, the most common cause of scope contamination was found to be human factors [1,5,13,14]. Despite the complex design of the duodenal scope and recent concerns about duodenal scope contamination [3,5,15,16], duodenal scopes showed a lower scope contamination rate in our study compared with those in previous reports [7,17,18] and the frequency of microbiology surveillance should be the same regardless the type of endoscope. A monthly culture of all endoscopes in our unit helped to detect scope contamination and pinpoint the step in the endoscope reprocessing procedure in which contamination occurred.…”

Section: Discussionsupporting

confidence: 89%

“…Endoscopy-associated infection has become an important issue since the outbreak of carbapenem-resistant Enterobacteriaceae (CRE) infection after endoscopic retrograde cholangiopancreatography in the USA between 2012 and 2015 [4]. These outbreaks resulted in efforts to investigate the quality and e cacy of endoscope reprocessing, as well as factors that in uence transmission between endoscopes and patients [2,5,6].…”

Section: Introductionmentioning

confidence: 99%

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Monthly endoscopy surveillance culture facilitates detection of breaches in the scope reprocessing procedure: 5 year-experience in an endoscopy center

Yen

Chen

Lai

et al. 2019

Preprint

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AIM To review the clinical impact of monthly microbiology surveillance culture for monitoring endoscope contamination after high-level disinfection.METHODS Monthly surveillance culture of the endoscopes was conducted from January 2014 to December 2018 at our endoscopy center. A total of 1931 cultures were collected, including 765 cultures from 16 gastroscopes, 730 cultures from 18 colonoscopes, 379 cultures from 8 duodenalscopes, 46 cultures from 1 echoscopes, and 11 cultures from 1 enterscope. Cultures were obtained from ready-to-use endoscopes after a full reprocessing cycle and storage. Samples were cultured to test for aerobic and anaerobic bacteria.RESULTS The positive culture rates for the endoscope were 2% (15/765) for gastroscopes, 1.9% (14/730) for colonoscopes, 0.8% (3/379) for duodenscopes, 4.3% (2/46) for echoscopes, and 9.1% (1/11) for enterscopes. These findings were predominantly attributed to human factors (71.4%, 25/35) followed by storage cabinet failure (14.3%, 5/35), automatic endoscope reprocessing failure (11.4%, 4/35), and endoscope channel damage (2.8%, 1/35). Multivariate analysis showed that the years 2015 [odds ratio (OR) 0.19, 0.04 to 0.91], 2016 (OR 0.21, 0.05 to 0.80), and 2017 (OR 0.22, 0.06 to 0.83) were associated with decreased risk of endoscope contamination. The age, type, and number of times the scope was used were not related to contamination.CONCLUSIONS A low risk of endoscope contamination was found over a 5-year period in our endoscopy center. The most common cause of contamination was human factor. Duodenalscopes showed the lowest scope contamination rate. We suggested the implantation of a systematic endoscope culture regardless of the type of scope to facilitate early detection of breaches in the scope reprocessing procedure in clinical practice.

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Monthly endoscopy surveillance culture facilitates detection of breaches in the scope reprocessing procedure: 5 year-experience in an endoscopy center

Yen

Chen

Lai

et al. 2019

Preprint

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“…In 2015, the FDA letter stated that infectious outbreaks of multidrug-resistant bacterial contamination of duodenoscopes were reported in duodenoscopes with a fixed distal cap [25]. Another nationwide study by Rauwers et al evaluated the prevalence of bacterial contamination of 10 different duodenoscope types and designs, including the elevator channel and the distal cap, and found that the contamination was not associated with one particular duodenoscope type (P ≥ 0.20) [26]. This led manufacturers to design duodenoscopes with detachable caps in order to reduce the risk of contamination at the elevator site.…”

Section: Discussionmentioning

confidence: 99%

A newly designed duodenoscope with detachable distal cap significantly reduces organic residue contamination after reprocessing

et al. 2020

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Background A newly designed duodenoscope with detachable distal cap may reduce bacterial contamination by allowing better access to the elevator. We compared bacterial contamination and organic residue evaluated by rapid adenosine triphosphate (ATP) test and culture from duodenoscopes with detachable vs. fixed distal caps after high-level disinfection (HLD). Methods During December 2018–April 2019, 108 used newly designed duodenoscopes were enrolled. In group A (n = 54), the distal cap of the duodenoscope was detached before manual cleaning. In group B (n = 54), the distal cap was not detached. After HLD, samples were collected from the elevator, submitted for culture, and evaluated using the ATP test, using the cutoff value of 40 relative light units (RLUs). Results After HLD, the proportion of potential bacterial contamination and organic residue in group A was significantly lower than in group B (37.0 % vs. 75.9 %; P < 0.001; relative risk 0.49, 95 % confidence interval 0.33–0.71), and also confirmed by median ATP values (45.2 vs. 141.0 RLU; P < 0.001). In group B, one sample culture was positive for nonpathogenic bacteria. Pathogenic bacteria were not found in any culture from either group. Conclusions The detachable distal cap was more effective at eliminating bacterial contamination and reducing organic residue than a fixed cap. Nonpathogenic bacteria were detected in the fixed cap group after reprocessing. The ATP test with 40 RLU cutoff is a practical method to ensure the cleanliness of duodenoscope reprocessing without the need to wait for bacterial culture results.

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“…Recent cases of cross‐infection with carbapenem‐resistant organisms have been reported and, in some cases, despite apparently appropriate disinfection technique . A national audit in the Netherlands studied contamination in ready‐to‐use duodenoscopes and found 15% to be contaminated with enteric organisms . Guidelines aimed at minimizing this problem have been published but cross‐infection will remain a serious concern until endoscopic equipment can be sterilized.…”

Section: Cross‐infection the Achilles Heel Of Endoscopymentioning

confidence: 99%

Fifty years of digestive endoscopy: Successes, setbacks, solutions and the future

Axon

2020

Digestive Endoscopy

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Flexible endoscopes became generally available 50 years ago and created a revolution in the practice of gastroenterology. They improved diagnosis enormously, enabled quicker, less invasive, and more cost‐effective surgical treatment, while endoscopic screening has prevented many cancer deaths. The new technology stimulated research leading to a better understanding of gastrointestinal pathology, identifying new diseases and clarifying the etiology of others. Better‐controlled clinical trials accelerated the use of newer and more effective drugs. National and international endoscopy societies supported nursing input, encouraged research, stimulated specialist journals, and devised guidelines that encouraged audit and quality assurance. Advances in instrument design and the manufacture of new accessories enhanced endoscopic technique, diagnostic ability, patient comfort, and safety. The risk of cross‐infection inherent in the use of complex labile equipment that cannot be autoclaved remains a challenge. Endoscopy societies working closely with industry have established rigid protocols for high‐level disinfection that minimize the risks, but strict adherence to guidelines and continued vigilance is essential, especially with the increasing prevalence of antibiotic‐resistant commensals that can give rise to opportunistic infection. Government health departments have a responsibility to encourage and support research in this area by endoscopists, instrument manufacturers, and the pharmaceutical industry. Current trends suggest that in the future, artificial intelligence will greatly improve endoscopic diagnosis, and that therapeutic endoscopy will expand, encouraging endoscopists to subspecialize.

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High prevalence rate of digestive tract bacteria in duodenoscopes: a nationwide study

Cited by 112 publications

References 28 publications

Monthly endoscopy surveillance culture facilitates detection of breaches in the scope reprocessing procedure: 5 year-experience in an endoscopy center

Monthly endoscopy surveillance culture facilitates detection of breaches in the scope reprocessing procedure: 5 year-experience in an endoscopy center

A newly designed duodenoscope with detachable distal cap significantly reduces organic residue contamination after reprocessing

Fifty years of digestive endoscopy: Successes, setbacks, solutions and the future

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