Reprocessing semicritical items: Outbreaks and current issues

Rutala, William A.; Weber, David J.

doi:10.1016/j.ajic.2019.01.015

Cited by 26 publications

(26 citation statements)

References 102 publications

(123 reference statements)

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“…For duodenoscopes contaminated with Pseudomonas aeruginosa , double cycles of HLD, peracetic acid high-level disinfection, and ethylene oxide sterilization[ 29 ] may not be effective; thus, endoscopists should return them to the manufacturer for replacement. With continuous use of the damaged endoscope and its accessories, organic debris may enter into different areas of the device, thereby interfering with reprocessing; this might increase the likelihood of biofilm development.…”

Section: Discussionmentioning

confidence: 99%

SpyGlass application for duodenoscope working channel inspection: Impact on the microbiological surveillance

Liu

Peng

Wang

et al. 2020

WJG

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BACKGROUND Patient-ready duodenoscopes were designed with an assumed contamination rate of less than 0.4%; however, it has been reported that 5.4% of clinically used duodenoscopes remain contaminated with viable high-concern organisms despite following the manufacturer’s instructions. Visual inspection of working channels has been proposed as a quality control measure for endoscope reprocessing. There are few studies related to this issue. AIM To investigate the types, severity rate, and locations of abnormal visual inspection findings inside patient-ready duodenoscopes and their microbiological significance. METHODS Visual inspections of channels were performed in 19 patient-ready duodenoscopes using the SpyGlass visualization system in two endoscopy units of tertiary care teaching hospitals (Tri-Service General Hospital and National Taiwan University Hospital) in Taiwan. Inspections were recorded and reviewed to evaluate the presence of channel scratches, buckling, stains, debris, and fluids. These findings were used to analyze the relevance of microbiological surveillance. RESULTS Seventy-two abnormal visual inspection findings in the 19 duodenoscopes were found, including scratches ( n = 10, 52.6%), buckling ( n = 15, 78.9%), stains ( n = 14, 73.7%), debris ( n = 14, 73.7%), and fluids ( n = 6, 31.6%). Duodenoscopes > 12 mo old had a significantly higher number of abnormal visual inspection findings than those ≤ 12 mo old (46 findings vs 26 findings, P < 0.001). Multivariable regression analyses demonstrated that the bending section had a significantly higher risk of being scratched, buckled, and stained, and accumulating debris than the insertion tube. Debris and fluids showed a significant positive correlation with microbiological contamination ( P < 0.05). There was no significant positive Spearman’s correlation coefficient between negative bacterial cultures and debris, between that and fluids, and the concomitance of debris and fluids. This result demonstrated that the presence of fluid and debris was associated with positive cultures, but not negative cultures. Further multivariate analysis demonstrated that fluids, but not debris, is an independent factor for bacterial culture positivity. CONCLUSION In patient-ready duodenoscopes, scratches, buckling, stains, debris, and fluids inside the working channel are common, which increase the microbiological contamination susceptibility. The SpyGlass visualization system may be recommended to identify suboptimal reprocessing.

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Section: Discussionmentioning

confidence: 99%

SpyGlass application for duodenoscope working channel inspection: Impact on the microbiological surveillance

Liu

Peng

Wang

et al. 2020

WJG

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“…This suggests the importance of developing protocols for the treatment of semi-critical devices or a new ADA classification for these instruments. Rutala & Weber (2019) affirmed that it is extremely important to adopt control measures to avoid exposure of patients to pathogens, and that it is precisely semi-critical equipment that has mostly been associated with reprocessing errors. Although most of the time the current recommendations suggest referring to the manufacturer's instructions to be able to reprocess IOCIs (Centers for Disease Control and Prevention, 2016), there are currently no established protocols for new equipment to ensure access to this information (according to the FDA, the device manufacturer must include at least one validated cleaning and disinfection and sterilization protocol in the labelling for their device) (Rutala & Weber, 2019), nor alternatives that allow adherence to these recommendations for many of the devices available in the market, nor mechanisms to train staff on the safe use and reprocessing of IOCIs (Blázquez-Garrido et al; Rutala & Weber, 2019).…”

Section: Discussionmentioning

confidence: 99%

“…The disinfection process necessary for reuse between patients is a high-level process that in many cases is complicated not only by the structural complexity of the devices but also because it is a laborious process with different stages very dependent on proper training of the health personnel in charge of carrying it out (Blázquez-Garrido et al). Although this problem has been given significant attention in medicine (Rutala & Weber, 2019), it does not seem to have the same considerations in dentistry.…”

Section: Introductionmentioning

confidence: 99%

“…Their undivided design features are a disadvantage with respect to their structure, given that using non-removable nozzles does not allow their sterilization by conventional methods (Condor Intra-Oral Scanner, 2018). Although the schemes proposed by Spaulding still remain valid, disinfection strategies for some semi-critical items are highly variable and, in many cases, an obvious challenge (Rutala & Weber, 2019).…”

Section: Introductionmentioning

confidence: 99%

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Infection Control in the Dental Practice with Emphasis on Intraoral Scanners and Semi-Critical Complex Instruments

Soto-Álvarez¹,

Fonseca²,

Aguilera³

et al. 2020

Int. J. Odontostomat.

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We present an integrative review of the literature conducted to find and analyse specific measures for disinfection and/or sterilization of intraoral complex instruments, applicable to intraoral scanners. We performed a two-stage search in the PubMed/MEDLINE, SciELO, REDALYCS, and LILACS databases, and the Google Scholar website, which included full articles in Spanish, Portuguese, and English. The strategy associated the terms 'disinfection', 'biosecurity', 'decontamination', and (a) 'intraoral scanners', and (b) other 'semi-critical' intraoral complex instruments, according to the American Dental Association definition (e.g., 'turbine', etc). Strategy (a) produced just one outcome, whereas (b) produced nine articles, which only suggested low-level disinfectants.The lack of empirically based protocols that allow effective microbiological control makes it necessary to create a new categorization for these instruments when trying to comply with American Dental Association recommendations for dental practice.

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“…Duodenoscopes require high-level disinfection (HLD) using chemical disinfectants. Glutaraldehyde, hydrogen peroxide, ortho-phthalaldehyde (OPA), peracetic acid, peracetic acid with hydrogen peroxide, and a chlorinebased system are cleared by the FDA and are dependable high-level disinfectants which provided the factors influencing that germicidal procedures are met [9].…”

Section: Introductionmentioning

confidence: 99%

Does double high-level disinfection for duodenoscopes add any value? A mini-systematic review and meta-analysis

Elbahr

Saleh

Aziz

et al. 2020

Egypt Liver Journal

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Background: Duodenoscope-emerging infection especially drug-resistant bacteria is considered a major concern nowadays. Different approaches were attempted to overcome this problem, like double high-level disinfection procedure. We performed a systematic review and meta-analysis to evaluate risk difference for positive cultures from duodenoscopes between double high-level disinfection (dHLD) and single (standard) high-level disinfection (sHLD). Main body: A thorough literature search (in October and November 2019) for studies comparing dHLD and sHLD for duodenoscopes was performed by 3 researchers in the Web of Science, Scopus, PubMed, and Cochran databases. The search terms were "duodenoscope," "ERCP endoscope," "disinfection," "sterilization," and "reprocessing," and only randomized clinical trials with the English language were accepted. Four trials were identified studying dHLD, and only 2 clinical trials comparing dHLD with standard sHLD were found reporting 6193 duodenoscope cultures. Overall sHLD cultures were 2972, and dHLD cultures were 3221; overall positive cultures were 140 in sHLD and 161 in dHLD. The results of a meta-analysis using the random-effect model showed no significant risk difference (RD) between the 2 procedures for duodenoscope positive cultures (p = 0.53, RD 0.003, 95% CI "− 0.007-0.013"). Conclusions: Double HLD offered no significant difference over single HLD for duodenoscope disinfection. An alternative strategy to overcome duodenoscope-transmitted infection is a big issue to be resolved.

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Reprocessing semicritical items: Outbreaks and current issues

Cited by 26 publications

References 102 publications

SpyGlass application for duodenoscope working channel inspection: Impact on the microbiological surveillance

SpyGlass application for duodenoscope working channel inspection: Impact on the microbiological surveillance

Infection Control in the Dental Practice with Emphasis on Intraoral Scanners and Semi-Critical Complex Instruments

Does double high-level disinfection for duodenoscopes add any value? A mini-systematic review and meta-analysis

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