Implementation of a systematic culturing program to monitor the efficacy of endoscope reprocessing: outcomes and costs

Gene, K.; Pegues, David A.; Kochman, Michael L.; Alby, Kevin; Fishman, Neil O.; Saunders, Marianne; Grous, Carolyn; Dempsey, Daniel T.; Ginsberg, Gregory G.

doi:10.1016/j.gie.2017.05.001

Cited by 26 publications

(20 citation statements)

References 12 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%

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%

Nationwide risk analysis of duodenoscope and linear echoendoscope contamination

Rauwers

holt

Buijs

et al. 2020

Gastrointestinal Endoscopy

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“…As noted in multiple previous studies, the overall incidence of CRE is extremely low (0.5-1.1%) [11]. In the study by Smith et al [4], no CRE infections were noted throughout the institution during the study period.…”

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confidence: 60%

“…The American Gastroenterological Association (AGA) has recommended periodic culture of all elevator channel endoscopes [6]. In a 16-month study of 285 linear-array echoendoscopes and duodenoscopes, Ma et al [11] performed weekly culture of 25% of all elevator-containing endoscopes. They noted that only 1.1% of the cultures displayed bacterial growth from oral and skin contaminants.…”

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confidence: 99%

Eliminating Duodenoscope-Associated Transmission of Carbapenem-Resistant Enterobacteriaceae (CRE): In Search of an Optimal Strategy

2017

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“…Despite concerted preventative efforts, the incidence of CDI continues to rise. 19 Successfully tackling this complex problem requires a multipronged solution that relies on both the appropriate identification and treatment of patients with CDI and on mechanisms for managing risk and preventing the spread of disease. This approach could include reducing exposure to high-risk antibiotics 20 and acid-suppressive medications, 21 testing for C. difficile carriage and selectively isolating carriers, 22 or even deploying currently experimental preventative treatments such as probiotics 23 and gut-specific β-lactamases.…”

Section: Discussionmentioning

confidence: 99%

A Generalizable, Data-Driven Approach to Predict Daily Risk ofClostridium difficileInfection at Two Large Academic Health Centers

Makar

Fusco

et al. 2018

Infect. Control Hosp. Epidemiol.

111

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OBJECTIVE An estimated 293,300 healthcare-associated cases of Clostridium difficile infection (CDI) occur annually in the United States. To date, research has focused on developing risk prediction models for CDI that work well across institutions. However, this one-size-fits-all approach ignores important hospital-specific factors. We focus on a generalizable method for building facility-specific models. We demonstrate the applicability of the approach using electronic health records (EHR) from the University of Michigan Hospitals (UM) and the Massachusetts General Hospital (MGH). METHODS We utilized EHR data from 191,014 adult admissions to UM and 65,718 adult admissions to MGH. We extracted patient demographics, admission details, patient history, and daily hospitalization details, resulting in 4,836 features from patients at UM and 1,837 from patients at MGH. We used L2 regularized logistic regression to learn the models, and we measured the discriminative performance of the models on held-out data from each hospital. RESULTS Using the UM and MGH test data, the models achieved area under the receiver operating characteristic curve (AUROC) values of 0.82 (95% confidence interval [CI], 0.80-0.84) and 0.75 ( 95% CI, 0.73-0.78), respectively. Some predictive factors were shared between the 2 models, but many of the top predictive factors differed between facilities. CONCLUSION A data-driven approach to building models for estimating daily patient risk for CDI was used to build institution-specific models at 2 large hospitals with different patient populations and EHR systems. In contrast to traditional approaches that focus on developing models that apply across hospitals, our generalizable approach yields risk-stratification models tailored to an institution. These hospital-specific models allow for earlier and more accurate identification of high-risk patients and better targeting of infection prevention strategies. Infect Control Hosp Epidemiol 2018;39:425-433.

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Implementation of a systematic culturing program to monitor the efficacy of endoscope reprocessing: outcomes and costs

Cited by 26 publications

References 12 publications

Nationwide risk analysis of duodenoscope and linear echoendoscope contamination

Nationwide risk analysis of duodenoscope and linear echoendoscope contamination

Eliminating Duodenoscope-Associated Transmission of Carbapenem-Resistant Enterobacteriaceae (CRE): In Search of an Optimal Strategy

A Generalizable, Data-Driven Approach to Predict Daily Risk ofClostridium difficileInfection at Two Large Academic Health Centers

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