Investigating the failure of repeated standard cleaning and disinfection of a Pseudomonas aeruginosa–infected pancreatic and biliary endoscope

Abstract

Digestive endoscopy is an important technique for the diagnosis and treatment of digestive system disease. To assure medical safety, a digestive endoscope must be cleaned and disinfected before its use in an operation on the next patient. The most common treatment procedure on a digestive endoscope is high-level disinfection. The potential risk associated with digestive endoscopes is always the focus of endoscopic management in clinical practice. In this study, a polluted pancreatic and biliary endoscope after surgery was cleaned and disinfected multiple times with the standard procedure but still tested positive for Pseudomonas aeruginosa culture, which is very rare and has not been reported in China or abroad.

A pilot study on using chlorine dioxide gas for disinfection of gastrointestinal endoscopes

“…More seriously, some pathogens including Pseudomonas aeruginosae (Qiu et al, 2015) and M. abscessus (de Groote et al, 2014) show resistance to GA and OPA. Recently, outbreaks of superbugs in the United States and other countries associated with GI endoscopes ignited concerns about shifting endoscope reprocessing from HLD to sterilization or improving the margin of safety (Edmiston and Spencer, 2014;Rutala and Weber, 2014).…”

ASGE guideline for infection control during GI endoscopy

“…19,20 A lack of cleaning and drying of the airwater and/or the elevator channels of duodenoscopes also was implicated in some cases of transmission of Pseudomonas infection. [21][22][23][24] Failure of automated endoscope washer-dryers has been implicated in several cases. 22,25,26 Recently, a strain of Pseudomonas with reduced susceptibility to glutaraldehyde was reported.…”

O impacto da fricção, solução de limpeza e subsequente desinfecção de alto nível na remoção de biofilme buildup-5 e de biofilme tradicional-5 em canais endoscópicos gastrointestinais flexíveis

“…A remoção desta forma de vida microbiana nestes produtos para saúde pode ser difícil ou impossível (Quiu et al, 2015;Marion et al, 2006).…”

“…Consequentes surtos de infecção em pacientes que se submeteram a exames de endoscopia gastrointestinal encontram-se documentados (Kovaleva et al, 2013). A dificuldade ou impossibilidade de limpeza destes equipamentos devido ao complexo design, com consequente falha do processo de desinfecção de alto nível) tem sido descrita também como uma das principais causas de infecção em pacientes que submeteram à endoscopia gastrointestinal (Aumeran et al, 2010;Carbonne et al, 2010;Bajolet et al, 2012;Alrabaa et al, 2013;Quiu et al, 2015).…”

“…A remoção de BBF dos canais endoscópicos gastrointestinais pode ser impossível mesmo após vários procedimentos de limpeza e DAN, sendo necessário a troca do canal endoscópico para a resolução do problema (Quiu et al, 2015). Enquanto o biofilme tradicional desenvolve durante uma hidratação contínua, o BBF forma após vários ciclos de exposição a secreções do paciente, limpeza, desinfecção de alto nível, enxágue e secagem.…”