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)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Gastrointestinal EndoscopyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Control of a multi-hospital outbreak of KPC-producing Klebsiella pneumoniae type 2 in France, September to October 2009.Euro Surveill. 2010; 15: 19734
- Multidrug-resistant Klebsiella pneumoniae outbreak after endoscopic retrograde cholangiopancreatography.Endoscopy. 2010; 42: 895-899
- New Delhi metallo-β-lactamase-producing carbapenem-resistant Escherichia coli associated with exposure to duodenoscopes.JAMA. 2014; 312: 1447-1455
- Endoscopic retrograde cholangiopancreatography-associated AmpC Escherichia coli outbreak.Infect Control Hosp Epidemiol. 2015; 36: 634-642
- Early identification and control of carbapenemase-producing Klebsiella pneumoniae, originating from contaminated endoscopic equipment.Am J Infect Control. 2013; 41: 562-564
- Withdrawal of a novel-design duodenoscope ends outbreak of a VIM-2-producing Pseudomonas aeruginosa.Endoscopy. 2015; 47: 493-502
- Transmission of infection by flexible gastrointestinal endoscopy and bronchoscopy.Clin Microbiol Rev. 2013; 26: 231-254
- A quarantine process for the resolution of duodenoscope-associated transmission of multidrug-resistant Escherichia coli.Gastrointest Endosc. 2015; 82: 477-483
- Risk of infection transmission in curvilinear array echoendoscopes: results of a prospective reprocessing and culture registry.Gastrointest Endosc. 2017; 85: 390-397.e1
- Delayed processing of simulated duodenoscope and patient cultures yields viable bacteria.Society for Healthcare Epidemiology of America Spring 2016 Conference, Atlanta2016
- Interim duodenoscope culture method.(Available at:) (Accessed January 30, 2019)
- Randomized comparison of 3 high-level disinfection and sterilization procedures for duodenoscopes.Gastroenterology. 2017; 153: 1018-1025
U.S. Food and Drug Administration. Supplemental measures to enhance duodenoscope reprocessing: FDA safety communication 2015. Available at: https://wayback.archiveit.org/7993/20170111065959/http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm454766.htmAccessed January 30, 2019
- A randomized trial of single versus double high-level disinfection of duodenoscopes and linear echoendoscopes using standard automated reprocessing.Gastrointest Endosc. 2018; 88: 306-313
- Surveillance of guideline practices for duodenoscope and linear echoendoscope reprocessing in a large healthcare system.Gastrointest Endosc. 2016; 84: 392-399.e3
- A novel protocol obviates endoscope sampling for carbapenem-resistant Enterobacteriaceae: experience of a center with a prior outbreak.Dig Dis Sci. 2017; 62: 3100-3109
- Reply. Gastroenterology. 2018; 154: 1206-1207
Article Info
Publication History
Published online: January 14, 2019
Accepted:
December 29,
2018
Received:
September 24,
2018
Footnotes
DISCLOSURE: This study was supported in part by a grant from the American Society for Gastrointestinal Endoscopy. All other authors disclosed no financial relationships relevant to this publication.
Identification
Copyright
© 2019 by the American Society for Gastrointestinal Endoscopy
