Background and Aims
We aimed to determine whether monitoring of duodenoscope cleaning by rapid adenosine
triphosphate (ATP) combined with channel-purge storage could eliminate high-concern
microorganisms.
Methods
In a simulated-use study, suction channels, as well as lever recesses, from 2 duodenoscopes
models and the unsealed elevator guidewire (EGW) channel from 1 of these 2 duodenoscopes
(the other model has a sealed EGW) were perfused with ATS2015 containing approximately
8 Log10 colony-forming units (CFU)/mL of both Enterococcus faecalis and Escherichia coli. Pump-assisted cleaning was monitored by rapid ATP testing. Duodenoscopes exceeding
200 relative light units (RLUs) were recleaned. Clean duodenoscopes were processed
through an automated endoscope reprocessor and then stored in a channel-purge storage
cabinet for 1 to 3 days. Cultures of EGW channel and instrument channel combined with
the lever recess (IC-LR) were taken after storage. The impacts of extended cleaning
and alcohol flush were evaluated.
Results
E coli was reliably eliminated in IC-LR and EGW channels of 119 duodenoscope tests (59 with
sealed EGW and 60 with nonsealed EGW). However, actionable levels of E faecalis and environmental bacteria persisted. Neither alcohol flush nor extended cleaning
resulted in a reduction of actionable levels for these organisms. Identification of
isolates indicated that residual organisms in duodenoscope channels were hardy Gram-positive
bacteria (often spore formers) that likely originated from environmental sources.
Conclusions
These data indicate that high-concern Gram-negative bacteria but not E faecalis or environmental bacteria can be reliably eliminated by use of the manufacturer’s
instructions for reprocessing with ATP monitoring of cleaning and channel-purge storage
conditions.
Abbreviations:
AER (automated endoscope reprocessor), ATP (adenosine triphosphate), CDC (Centers for Disease Control), CFU (colony-forming unit), CP cabinet (channel-purge storage cabinet), EGW (elevator guidewire), IC-LR (instrument channel–lever recess), MALDI-TOF (matrix-assisted laser desorption/ionization-time of flight), MIFU (manufacturer’s instructions for use), RLU (relative light unit), sRO (sterile reverse osmosis), SS1E (Steris System 1E)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: February 21, 2018
Accepted:
February 7,
2018
Received:
October 23,
2017
Footnotes
DISCLOSURE: Funding for this study was provided by a research grant from the American Society for Gastrointestinal Endoscopy (ASGE). The Olympus 160 and 180 duodenoscopes, and the EFP-500 flushing pump, were lent and the channel and cavity brushes were donated by Olympus America. Healthmark Industries donated the ATS2015. Torvan Medical donated the channel purge endoscope storage cabinet. We acknowledge the expertise and technical support of the National Microbiology Laboratory staff, including Deborah Wiebe, Ana Luisa Pacheco, and Tina Zimmerman, and the managers of the NML’s Proteomic and Genomic Core Facilities. Dr Singh is on the advisory board of Pendopharm and Ferring Canada and the recipient of research funds from Merck Canada. Dr Alfa is a consultant for and participant in research projects for Olympus, Karl Storz, 3M, Novaflux, and Steris; the recipient of royalties from HealthMark Industries; and an invited conference speaker for Olympus, 3M, and Sealed Air. Dr Duerksen is on the advisory board of Ferring Canada. All other authors disclosed no financial relationships relevant to this publication.
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© 2018 by the American Society for Gastrointestinal Endoscopy
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