Multisocieties position paper: Microbiological surveillance on flexible endoscopes

Casini, Beatrice; Pan, Angelo; Guarini, Alessandra; Rivara, Cinzia; Zullo, Angelo; Monica, Fabio; Cimbro, Monica; Casarano, Salvatore; Inglese, Agostino; Vaghi, Adriano; Schiffino, L; Capezzuto, E.; Carrara, Paola; Pasquale, Luigi; Bertoni, C; Curti, Cesarina; Giacomini, Maurizio; Meledandri, Marcello; Palmieri, Dalia; Privitera, Gaetano Pierpaolo; Raglio, Alfredo; Tuvo, Benedetta; Colombo, Benedetta; Iannone, Teresa; Iori, Giorgio; Giaquinto, Antonella; Minenna, Angela; Petrocelli, Giulio; Valdinoci, Monia; Bortoluzzi, Francesco; Galeazzi, Francesca; Manta, Raffaele; Montalto, Paolo; Segato, Sergio; Soncini, Marco; Satta, P. Usai; Vassallo, Roberto; Ferraiolo, Fabio; Roseto, Fabio; Bezziccheri, Milena; Fighera, Michele Rechia; Giampà, Ada; Mancini, Antonio; Marino, Caterina; Cerone, Marina Pisegna; Risitano, Tommaso; Sergio, Emmanuele; Sinopoli, Raffaele; Caprio, Maria Teresa De; Failla, Giuseppe; Agli, Luigi Lazzari; Majori, Maria; Toccaceli, Andrea; Marciano, Emanuele; Maurano, Attilio; Rodella, Luca; Cengia, Gianpaolo; Ciliberto, Enrico; Conigliaro, Rita; Germanà, B.; Lamazza, Antonietta; Pisani, Antonio; Zagari, Rocco Maurizio; Spinzi, Giancarlo

doi:10.1016/j.dld.2021.06.016

Cited by 5 publications

(6 citation statements)

References 22 publications

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“…As far as microbiological surveillance is concerned, the data found that it was performed in only 59% of endoscopic units. Moreover, the sampling of duodenoscopes and echoendoscopes was performed only every 3-6 months in more than half of the centres, rather than monthly or earlier when more than 60 procedures were performed with the same instrument, as recommended [8,12]. It was relevant to note that only 21% of centres reported performing an additional microbiological sampling when the endoscope was used in patients with known MDR strain infection.…”

Section: Discussionmentioning

confidence: 99%

“…In Europe, the explicit recommendation to perform microbiological investigation on all endoscopes, not only duodenoscopes, is supported by major scientific societies, such as the European Society of Gastrointestinal Endoscopy (ESGE) and the European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA) [7]. According to the practices reported by the cited recommendations, in 2021, an Italian Consensus document on microbiological surveillance after the reprocessing of flexible endoscopes was delivered by different societies of operators involved in the use of endoscopes, in the reprocessing process, and the prevention of healthcare-associated infections [12]. In particular, this document defines the non-conformities in the reprocessing process based on the results of the microbiological surveillance and indicates the corrective actions to be implemented to improve the quality of the process.…”

Section: Introductionmentioning

confidence: 99%

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Good Practices on Endoscope Reprocessing in Italy: Findings of a Nationwide Survey

Scarpaci

Cosci

Tuvo

et al. 2022

IJERPH

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Background: Correct reprocessing and microbiological surveillance on endoscopes are fundamental for preventing the transmission of multi-drug resistant strains and device-related infections. Methods: A questionnaire with three domains was created: (1) centre characteristics; (2) endoscope reprocessing procedures; and (3) application of microbiological surveillance. Nurses working in endoscopic units across Italy were invited to anonymously fill out the questionnaire on the SurveyMonkey platform between November 2021 and February 2022. Results: A total of 82 out of 132 endoscopic centres participated in the survey, with at least one centre from each Italian region. Data found different concerns regarding the current practice of both reprocessing and microbiological surveillance. According to respondents, the training on reprocessing was performed through theoretical training and only in 10% of centres; the microbiological surveillance was regularly performed in 59% of centres; and sampled endoscopes were not excluded for use in 31% of centres performing the surveillance until the outcome was pending, and when positive, 72% maintained them in quarantine until a successive negative result. Conclusions: Reprocessing and microbiological surveillance currently present several criticisms along the endoscopic centres in Italy. Our survey highlights the need for the correct application of the national recommendations in each endoscopic centre to prevent the potential transmission of endoscope-related infections.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Good Practices on Endoscope Reprocessing in Italy: Findings of a Nationwide Survey

Scarpaci

Cosci

Tuvo

et al. 2022

IJERPH

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“…For this reason, it is essential to perform a regular microbiological surveillance through which the presence of breaches in the manual cleaning and/or in the disinfection process, as well as in handling of bronchoscope, can be verified and so corrected through focused training. This is recommended in several guidelines, included the Australian Guidelines and is well underlined in the Italian multisocieties position paper [ 22 , 25 ].…”

Section: Discussionmentioning

confidence: 99%

“…The rationale in performing a regular microbiological surveillance is highlighted by different guidelines, which recommend it with different periodicity. A quarterly frequency for the analyses of endoscopes and washer–disinfectors is proposed by Dutch [ 32 ] and German [ 33 ] guidelines, while the Australian [ 15 ] studies recommend a yearly frequency and the Italian position paper every 3–6 months [ 25 ]. Moreover, there is no uniformity among the guidelines regarding the quarantine of endoscope until the availability of negative microbiological results.…”

Section: Discussionmentioning

confidence: 99%

Adoption of Improved Reprocessing Decreased Microbiological Non-Compliance for Bronchoscopes

Tuvo

Scarpaci

Cosci

et al. 2022

IJERPH

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Background: In the past few decades, the inadequate reprocessing of bronchoscopes has been associated with several serious outbreaks caused by multidrug-resistant microorganisms. In this study we evaluated the improvement in the quality of reprocessing in a Bronchoscopy Unit (BU), after the introduction of a new procedure. Methods: In 2019, observational and clinical audits were conducted in the BU. After the introduction of an improved procedure in 2020, a microbiological surveillance plan was implemented in 2021. Results: In 2019, 13 of 22 bronchoscopes (59%) resulted as non-compliant, 18% as high concern organisms (HCO) and 36.4% as high microbial count (≥100 CFU/all channels) and HCO. The most frequent microorganisms were Staphylococcus aureus (38.5%) and NDM-producing Klebsiella pneumoniae (15.4%). The bronchoscopes were stored inside their transport cases, which in some cases were found to be contaminated by the same strains isolated on the bronchoscopes (Enterobacter gergoviae and Vibrio alginolyticus). In 2021, all 31 bronchoscopes were sampled at least three times and 13/99 (13.1%) resulted as non-compliant, mostly K. pneumoniae (4.04%). Contamination level increases weakly in bronchoscopes in use for more than 14 years (R = 0.32). Conclusions: The adoption of an improved reprocessing procedure decreased the non-compliance of bronchoscopes, increasing the quality of the process and patient safety.

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“…Recommendations on single-use GI endoscopy reprocessing are beyond the scope of this document. Yet, current clinical guidelines fail to consider sustainability [70,71,132]. ESGE-ESGENA recommend that future guidelines and legislation on GI endoscopy reprocessing/disinfection should take this domain into account.…”

Section: Position Statementmentioning

confidence: 99%

Reducing the environmental footprint of gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA) Position Statement

Dinis‐Ribeiro²,

et al. 2022

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Climate change and the destruction of ecosystems by human activities are among the greatest challenges of the 21st century and require urgent action. Health care activities significantly contribute to the emission of greenhouse gases and waste production, with gastrointestinal (GI) endoscopy being one of the largest contributors. This Position Statement aims to raise awareness of the ecological footprint of GI endoscopy and provides guidance to reduce its environmental impact. The European Society of Gastrointestinal Endoscopy (ESGE) and the European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA) outline suggestions and recommendations for health care providers, patients, governments, and industry. Main statements 1 GI endoscopy is a resource-intensive activity with a significant yet poorly assessed environmental impact. 2 ESGE-ESGENA recommend adopting immediate actions to reduce the environmental impact of GI endoscopy. 3 ESGE-ESGENA recommend adherence to guidelines and implementation of audit strategies on the appropriateness of GI endoscopy to avoid the environmental impact of unnecessary procedures. 4 ESGE-ESGENA recommend the embedding of reduce, reuse, and recycle programs in the GI endoscopy unit. 5 ESGE-ESGENA suggest that there is an urgent need to reassess and reduce the environmental and economic impact of single-use GI endoscopic devices. 6 ESGE-ESGENA suggest against routine use of single-use GI endoscopes. However, their use could be considered in highly selected patients on a case-by-case basis. 7 ESGE-ESGENA recommend inclusion of sustainability in the training curricula of GI endoscopy and as a quality domain. 8 ESGE-ESGENA recommend conducting high quality research to quantify and minimize the environmental impact of GI endoscopy. 9 ESGE-ESGENA recommend that GI endoscopy companies assess, disclose, and audit the environmental impact of their value chain. 10 ESGE-ESGENA recommend that GI endoscopy should become a net-zero greenhouse gas emissions practice by 2050.

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Multisocieties position paper: Microbiological surveillance on flexible endoscopes

Cited by 5 publications

References 22 publications

Good Practices on Endoscope Reprocessing in Italy: Findings of a Nationwide Survey

Good Practices on Endoscope Reprocessing in Italy: Findings of a Nationwide Survey

Adoption of Improved Reprocessing Decreased Microbiological Non-Compliance for Bronchoscopes

Reducing the environmental footprint of gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA) Position Statement

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