High-quality endoscope reprocessing decreases endoscope contamination

Decristoforo, P.; Kaltseis, Josef; Fritz, Andreas; Edlinger, Michael; Posch, Wilfried; Wilflingseder, Doris; Lass‐Flörl, Cornelia; Orth‐Höller, Dorothea

doi:10.1016/j.cmi.2018.01.017

Cited by 20 publications

(12 citation statements)

References 16 publications

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“…When the contamination definition for high-concern organisms by the Centers for Disease Control and Prevention was used, the contamination prevalence for DLEs was 8% in this study, similar to the interim results of the postmarket surveillance studies ordered by the U.S. Food and Drug Administration. 53 Recent studies assessing surveillance, 9,13,17,53 culture and quarantine strategies, 8,9,54,55 double high-level disinfection, 14,56 and ethylene oxide sterilization 11 have reported promising lower contamination rates, showing that reduction of contamination is feasible. In addition to the assessed interventions, the lower rates may also be the result of continuous feedback and raised alertness by the culture results for these studies, 9,14,55,56 or less-sensitive sampling and culture methods.…”

Section: Discussionmentioning

confidence: 99%

“…Recent studies show that the incidence of duodenoscope contamination ranges from 0.3% to 30%. [8][9][10][11][12][13][14] The first nationwide PROCESS (Prevalence of contamination of complex endoscopes in the Netherlands) study showed that 15% of patient-ready duodenoscopes were contaminated with GI or oral microorganisms, that is, bacteria originating from previous patients. 15 Contamination of reprocessed duodenoscopes is attributed to their complex design, which includes a side viewing tip, forceps elevator, and elevator wire channel.…”

Section: Introductionmentioning

confidence: 99%

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Nationwide risk analysis of duodenoscope and linear echoendoscope contamination

Rauwers

holt

Buijs

et al. 2020

Gastrointestinal Endoscopy

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Background and Aims: Contaminated duodenoscopes and linear echoendoscopes (DLEs) pose a risk for infectious outbreaks. To identify DLEs and reprocessing risk factors, we combined the data from the previously published nationwide cross-sectional PROCESS 1 study (Prevalence of contamination of complex endoscopes in the Netherlands) with the follow-up PROCESS 2 study. Methods: We invited all 74 Dutch DLE centers to sample !2 duodenoscopes during PROCESS 1, and all duodenoscopes as well as linear echoendoscopes during PROCESS 2. The studies took place 1 year after another. Local staff sampled each DLE at 6 sites according to uniform methods explained by online videos. We used 2 contamination definitions: (1) any microorganism with !20 colony-forming units (CFU)/20 mL (AM20) and (2) presence of microorganisms with GI or oral origin, independent of CFU count (MGOs). We assessed the factors of age and usage by performing an analysis of pooled data of both PROCESS studies; additional factors including reprocessing characteristics were only recorded in PROCESS 2. Results: Ninety-seven percent of all Dutch centers (72 of 74; PROCESS 1, 66; PROCESS 2, 61) participated in one of the studies, sampling 309 duodenoscopes and 64 linear echoendoscopes. In total, 54 (17%) duodenoscopes and 8 (13%) linear echoendoscopes were contaminated according to the AM20 definition. MGOs were detected on 47 (15%) duodenoscopes and 9 (14%) linear echoendoscopes. Contamination was not age or usage dependent (all P values !.27) and was not shown to differ between the reprocessing characteristics (all P values !.01). Conclusions: In these nationwide studies, we found that DLE contamination was independent of age and usage. These results suggest that old and heavily used DLEs, if maintained correctly, have a similar risk for contamination as new DLEs. The prevalence of MGO contamination of w15% was similarly high for duodenoscopes as for linear echoendoscopes, rendering patients undergoing ERCP and EUS at risk for transmission of microorganisms. (Gastrointest Endosc 2020;92:681-91.) Abbreviations: AER, automated endoscope reprocessor; AM20, any microorganism with !20 CFU/20 mL; CFU, colony-forming units; DLE, duodenoscope and linear echoendoscope; IFU, instructions for use; IQR, interquartile range; MGO, presence of microorganisms with GI or oral origin, independent of CFU count; PROCESS study, Prevalence of contamination of complex endoscopes in the Netherlands; SFERD, Dutch Steering Group for Flexible Endoscope Cleaning and Disinfection. DISCLOSURE: Dr Bruno has had the following relevant financial activities outside the submitted work: consultant for 3M; grant from 3M for an investigator-initiated study; consultant and lecturer for Boston Scientific; grants from Boston Scientific for investigator-initiated studies and industryinitiated studies; consultant and lecturer for Cook Medical; grants from Cook Medical for investigator-initiated studies and industry-initiated studies; grants from Pentax Medical. Dr Vos has had the following relevant fina...

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Nationwide risk analysis of duodenoscope and linear echoendoscope contamination

Rauwers

holt

Buijs

et al. 2020

Gastrointestinal Endoscopy

View full text Add to dashboard Cite

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“…1,2 Studies show duodenoscope contamination incidences ranging from 1% to 35%. [9][10][11][12][13][14] A recent nationwide Dutch study by our group showed that 15% of the patient-ready duodenoscopes were contaminated with GI or oral flora, 15 indicating that patients undergoing ERCP have been exposed to contaminated equipment with risk of transmission.…”

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confidence: 99%

Independent root-cause analysis of contributing factors, including dismantling of 2 duodenoscopes, to investigate an outbreak of multidrug-resistant Klebsiella pneumoniae

Rauwers

Troelstra

Fluit

et al. 2019

Gastrointestinal Endoscopy

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Background and Aims: Worldwide, an increasing number of duodenoscope-associated outbreaks are reported. The high prevalence rate of contaminated duodenoscopes puts patients undergoing ERCP at risk of exogenous transmission of microorganisms. The contributing factors of the duodenoscope design to contamination are not well understood. This article reports on the investigation after the outbreak of a multidrugresistant Klebsiella pneumoniae (MRKP) related to 2 Olympus TJF-Q180V duodenoscopes. Methods: We conducted a contact patient screening and microbiologic laboratory database search. Reprocessing procedures were audited, and both duodenoscopes were fully dismantled to evaluate all potential contamination factors. Outcomes were reviewed by an experienced independent expert. Results: In total, 102 patients who had undergone an ERCP procedure from January to August 2015 were invited for screening. Cultures were available of 81 patients, yielding 27 MRKP-infected or-colonized patients. Ten patients developed an MRKP-related active infection. The 2 duodenoscopes had attack rates (the number of infected or colonized cases/number of exposed persons) of 35% (17/49) and 29% (7/24), respectively. Identical MRKP isolates were cultured from channel flushes of both duodenoscopes. The review revealed 4 major abnormalities: miscommunication about reprocessing, undetected damaged parts, inadequate repair of duodenoscope damage, and duodenoscope design abnormalities, including the forceps elevator, elevator lever, and instrumentation port sealing. Conclusions: Outbreaks are associated with a combination of factors, including duodenoscope design issues, repair issues, improper cleaning, and systemic monitoring of contamination. To eliminate future duodenoscopeassociated infections, a multipronged approach is required, including clear communication by all parties involved, a reliable servicing market, stringent surveillance measures, and eventually new duodenoscope designs and reprocessing procedures with a larger margin of safety. (Gastrointest Endosc 2019;90:793-804.

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“…Some studies have revealed a significantly lower degree of GI endoscope contamination. For instance, in a study performed by Decristoforo et al in Austria, the microbial contamination rate of GI endoscopes was 1.3% to 4.6% according to the national guideline, suggesting the high quality of endoscope reprocessing, drying, and storage in this country ( 19 ). Possible reasons for the different contamination rates in these studies could be due to the different guidelines applied for precleaning, cleaning, disinfection, drying, and storage in endoscopy centers.…”

Section: Discussionmentioning

confidence: 99%

High Prevalence Rate of Microbial Contamination in Patient-Ready Gastrointestinal Endoscopes in Tehran, Iran: an Alarming Sign for the Occurrence of Severe Outbreaks

et al. 2022

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In the light of severe outbreaks caused by multidrug-resistant microorganisms due to contaminated GI endoscopes, understanding to what extent GI endoscopes are inadequately reprocessed is crucial. Several studies assessed contamination of GI endoscopes with various outcomes across the world; however, the prevalence and risk factors of contaminated GI endoscopes and potential subsequent nosocomial spread are still unknown in Iran.

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High-quality endoscope reprocessing decreases endoscope contamination

Abstract: In the present study the contamination rate of endoscopes was low compared with results from other European countries, possibly due to the high quality of endoscope reprocessing, drying and storage.

Cited by 20 publications

References 16 publications

Nationwide risk analysis of duodenoscope and linear echoendoscope contamination

Nationwide risk analysis of duodenoscope and linear echoendoscope contamination

Independent root-cause analysis of contributing factors, including dismantling of 2 duodenoscopes, to investigate an outbreak of multidrug-resistant Klebsiella pneumoniae

High Prevalence Rate of Microbial Contamination in Patient-Ready Gastrointestinal Endoscopes in Tehran, Iran: an Alarming Sign for the Occurrence of Severe Outbreaks

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