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Prospective assessment of the effectiveness of standard high-level disinfection for echoendoscopes

  • Author Footnotes
    ∗ Drs Becq and Snyder contributed equally to this article.
    Aymeric Becq
    Footnotes
    ∗ Drs Becq and Snyder contributed equally to this article.
    Affiliations
    Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA

    Division of Infection Control/Hospital Epidemiology, Boston, Massachusetts, USA
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  • Author Footnotes
    ∗ Drs Becq and Snyder contributed equally to this article.
    Graham M. Snyder
    Footnotes
    ∗ Drs Becq and Snyder contributed equally to this article.
    Affiliations
    Division of Infection Control/Hospital Epidemiology, Boston, Massachusetts, USA

    Harvard Medical School, Boston, Massachusetts, USA
    Search for articles by this author
  • Riley Heroux
    Affiliations
    Division of Infection Control/Hospital Epidemiology, Boston, Massachusetts, USA
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  • Sharon B. Wright
    Affiliations
    Division of Infection Control/Hospital Epidemiology, Boston, Massachusetts, USA

    Harvard Medical School, Boston, Massachusetts, USA
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  • Shishira Bharadwaj
    Affiliations
    Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA

    Division of Infection Control/Hospital Epidemiology, Boston, Massachusetts, USA
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  • Jonah Cohen
    Affiliations
    Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA

    Division of Infection Control/Hospital Epidemiology, Boston, Massachusetts, USA
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  • Moamen Gabr
    Affiliations
    Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA

    Division of Infection Control/Hospital Epidemiology, Boston, Massachusetts, USA
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  • Tyler M. Berzin
    Affiliations
    Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA

    Division of Infection Control/Hospital Epidemiology, Boston, Massachusetts, USA
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  • Douglas K. Pleskow
    Affiliations
    Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA

    Division of Infection Control/Hospital Epidemiology, Boston, Massachusetts, USA
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  • Mandeep S. Sawhney
    Correspondence
    Reprint requests: Mandeep Sawhney, MD, MS, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Rabb-Rose 101, Boston, MA 02215.
    Affiliations
    Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA

    Division of Infection Control/Hospital Epidemiology, Boston, Massachusetts, USA
    Search for articles by this author
  • Author Footnotes
    ∗ Drs Becq and Snyder contributed equally to this article.
Published:January 14, 2019DOI:https://doi.org/10.1016/j.gie.2018.12.024

      Background and Aims

      Duodenoscopes have been implicated in the transmission of multidrug-resistant organisms (MDROs). Echoendoscopes could potentially transmit infection. The aim of this study was to assess the effectiveness of standard high-level disinfection (HLD) for radial and linear echoendoscopes and to compare it with that of duodenoscopes.

      Methods

      We performed a prospective single-center study sampling echoendoscopes immediately before use, from the working channel (radial and linear echoendoscopes) and the transducer (radial echoendoscope) or elevator mechanism and transducer (linear echoendoscope). The primary outcome was the proportion of echoendoscopes with any culture showing ≥1 MDRO; secondary outcomes included bacterial growth >0 colony forming units (CFUs) and ≥10 CFUs on either sampling location. We compared these findings with duodenoscope cultures from the previously published DISINFECTS trial.

      Results

      During the study period, 101 echoendoscopes were sampled (n = 50 radial echoendoscopes, n = 51 linear echoendoscopes). No MDROs were recovered. Bacterial growth >0 CFUs was noted in 6% and ≥10 CFUs in 3% of all echoendoscopes. There was no significant difference in growth between radial and linear echoendoscopes (P = .4 for >0 CFU growth; P = .6 for ≥10 CFUs growth). The proportion of transducer and/or elevator mechanism positive for bacterial growth was significantly higher in duodenoscopes as compared with echoendoscopes (P = .02).

      Conclusions

      After standard HLD, no echoendoscope showed MDRO growth, 6% showed >0 CFUs, and 3% showed ≥10 CFUs bacterial growth. Bacterial growth was higher in duodenoscopes at the level of the transducer and/or elevator mechanism when compared with echoendoscopes.

      Abbreviations:

      CFU (colony-forming unit), MDRO (multidrug-resistant organism), HLD (high-level disinfection)
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