An article in the February 2016 issue of Infection Control and Hospital Epidemiology discusses current duodenoscope reprocessing methods, as reported by physician members of The Infectious Diseases Society of America’s Emerging Infections Network. Current guidelines from the Centers for Disease Control and Prevention (CDC) for duodenoscope infection surveillance techniques are also reviewed.
The following is a summary of the data presented in this article. A full reference for the original article, from which all information below is gathered, can be found at the conclusion of this post.
Breaches in infection control procedures, device defects, and subpar reprocessing techniques have all been linked to bacterial transmission via duodenoscopy, though post-procedure infection outbreaks have also been known to occur in the absence of these factors. In March 2015, the Centers for Disease Control and Prevention (CDC) released a surveillance protocol for duodenoscopes that outlines guidelines for surveillance using both culture and nonculture techniques. Importantly, the CDC does not specifically advocate any of these methods. The CDC also recommends that institutions performing duodenoscopies conduct quarterly reviews of decontamination policies and procedures to ensure strict adherence to manufacturers’ instructions.
A few weeks following the publication of these CDC guidelines, physician members of the Infectious Diseases Society of America’s Emerging Infections Network were emailed a five-item survey to ascertain their current duodenoscope reprocessing practices. Respondents whose facilities did not use duodenoscopes were excluded from the study.
According to the 190 respondents included in the analysis, three primary decontamination methods were used for duodenoscope reprocessing: manual reprocessing using high-level disinfectant (HLD), ethylene oxide gas, and automated endoscope reprocessing using HLD. A total of 70% of the respondents reported using a single method, 20% reported using two methods, 3% reported using three methods, and 7% were “unsure.” Of the 70% who reported using a single method, automated reprocessing using HLD was the most common (57%). Of note, “adequate” reprocessing was defined as “manual reprocessing using HLD” either alone or in combination with another method. Recommended reprocessing includes manual pre-cleaning followed by HLD (either automated or manual), followed by rinsing and forced-air drying.
Although the CDC has outlined methods for obtaining bacterial cultures on reprocessed, dried endoscopes, there is no evidence that this practice actually reduces bacterial transmission. Therefore, the American Society of Microbiology (ASM) now recommends that routine duodenoscope cultures not be performed. Despite these ASM recommendations, 31% of respondents reported that surveillance cultures of duodenoscopes at their institutions had been performed in the previous year, while 17 respondents used the CDC guidelines when choosing culture methods.
Currently, there is no standardized method for detection or monitoring of bacterial transmission. When asked to explain whether their institutions were employing surveillance to identify possible bacterial transmission following duodenoscopy, 31% of respondents replied that they had not used any such methods (the most common answer). Other respondents cited the use of a range of one to five methods, including microbiologic patient screening, clinical cultures, and follow-up patient contact.
Due to lack of compliance with the many steps involved in typical duodenoscope reprocessing methods, current surveillance and culturing techniques are likely inadequate in their prevention of post-duodenoscopy infection. It is PENTAX Medical’s opinion that strict adherence to CDC duodenoscope reprocessing guidelines, if universally adopted, could prevent bacterial transmission post-duodenoscopy, resulting in a significant decrease in post-procedure infection rates. To ensure patient safety, further research is needed to establish a standardized method to track these infections.
Beekman, S.E. et al. 2016. Adequacy of duodenoscope reprocessing methods as reported by infectious disease physicians. Infection Control and Hospital Epidemiology. 37(2): 226-228.