Clin Endosc.  2015 Sep;48(5):361-363. 10.5946/ce.2015.48.5.361.

Current Issues in Duodenoscope-Associated Infections: Now Is the Time to Take Action

• Ha J
• Son BK

• KMID: 2148544
• DOI: http://doi.org/10.5946/ce.2015.48.5.361

Abstract

A duodenoscope has a very complex structure that contains many small parts which make reprocessing more challenging. The difficulty in cleaning duodenoscopes contributes to a higher risk of infection than that of conventional gastrointestinal endoscopes. However, a duodenoscope shares similar disinfection process with other gastrointestinal endoscopes. Recent outbreaks of carbapenem-resistant Enterobacteriaceae (CRE) infections associated with duodenoscopes used for endoscopic retrograde cholangiopancreatography procedures have raised many concerns worldwide. Duodenoscope-associated infections involving CRE or other multidrug-resistant bacteria pose a great threat to patients undergoing procedures using duodenoscopes and should be dealt with a great concern. Updated guidelines regarding cleaning and disinfection of duodenoscope needs to be developed urgently to prevent transmission of infection and ensure patient safety. Meanwhile, healthcare staff should pay special attention to thorough cleaning and disinfection of duodenoscopes.

Keyword

Duodenoscopes; Cholangiopancreatography, endoscopic retrograde; Endoscope reprocessing; Carbapenem-resistant Enterobacteriaceae

MeSH Terms

Bacteria
Cholangiopancreatography, Endoscopic Retrograde
Delivery of Health Care
Disease Outbreaks
Disinfection
Duodenoscopes
Endoscopes, Gastrointestinal
Enterobacteriaceae
Humans
Patient Safety

Reference

1. Dirlam Langlay AM, Ofstead CL, Mueller NJ, Tosh PK, Baron TH, Wetzler HP. Reported gastrointestinal endoscope reprocessing lapses: the tip of the iceberg. Am J Infect Control. 2013; 41:1188–1194. PMID: 24021660.

2. Epstein L, Hunter JC, Arwady MA, et al. New Delhi metallo-beta-lactamase-producing carbapenem-resistant Escherichia coli associated with exposure to duodenoscopes. JAMA. 2014; 312:1447–1455. PMID: 25291580.

3. Wendorf KA, Kay M, Baliga C, et al. Endoscopic retrograde cholangiopancreatography-associated AmpC Escherichia coli outbreak. Infect Control Hosp Epidemiol. 2015; 36:634–642. PMID: 25817743.

4. U.S. Food and Drug Administration. Design of endoscopic retrograde cholangiopancreatography (ERCP) duodenoscopes may impede effective cleaning: FDA safety communication [Internet]. Silver Spring: U.S. Food and Drug Administration;2015. updated 2015 Mar 4. cited 2015 Sep 7. Available from: http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm434871.htm.

5. Rutala WA, Weber DJ. Healthcare Infection Control Practices Advisory Committee. Guidelines for disinfection and sterilization in healthcare facilities, 2008 [Internet]. Atlanta: Centers for Disease Control and Prevention;2015. updated 2009 Dec 29. cited 2015 Sep 7. Available from: http://www.cdc.gov/hicpac/Disinfection_Sterilization/6_0disinfection.html.

6. Centers for Disease Control and Prevention (CDC). Notes from the field: New Delhi metallo-beta-lactamase-producing Escherichia coli associated with endoscopic retrograde cholangiopancreatography: Illinois, 2013. MMWR Morb Mortal Wkly Rep. 2014; 62:1051. PMID: 24381080.

7. Aumeran C, Poincloux L, Souweine B, et al. Multidrug-resistant Klebsiella pneumoniae outbreak after endoscopic retrograde cholangiopancreatography. Endoscopy. 2010; 42:895–899. PMID: 20725887.

8. Clorox Healthcare. Clorox Healthcare Bleach Germicidal Cleaners. Testing results [Internet]. Oakland: Clorox Healthcare;c2015. cited 2015 Sep 7. Available from: http://www.cloroxprofessional.com/products/clorox-healthcare-bleach-germicidal-cleaners/efficacyclaims/.

9. PURE Bioscience, Inc. Technical report and efficacy statement. PURE Hard Surface spray disinfectant [Internet]. Bolivar: Nilodor, Inc.;c2014. cited 2015 Sep 7. Available from: http://www.nilodor.com/Member/nilodor/Images/ImageGallery/flyers/pure_hard_surface_disinfectant.pdf.