Is bacteriologic surveillance in endoscope reprocessing stringent enough?

 

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Endoscopes, including duodenoscopes, are medical devices that are frequently associated with outbreaks of nosocomial infections. We investigated an outbreak of multidrug-resistant Pseudomonas aeruginosa sepsis affecting three patients after endoscopic retrograde cholangiopancreaticography (ERCP). Epidemiologic investigation supplemented by molecular typing revealed that one ERCP scope was the source of infection with P. aeruginosa. No contamination with this microorganism was found after screening of washer-disinfectors, connecting tubes, and environmental surfaces in the endoscopy center. Pseudomonas isolates from blood and endoscope channels before gas sterilization with ethylene oxide (ETO) were characterized by molecular typing as ”linked isolates”. Though the current surveillance system did not prevent the infections in three patients, our microbiological surveillance protocol with routine culturing of endoscopes was helpful in detecting the source of contamination and probably avoided numerous cross-contaminations in other patients who underwent ERCP procedures with endoscopes.

References

• 1 Kimmey M B, Burnett D A, Carr-Locke D L. et al . Transmission of infection by gastrointestinal endoscopy.  Gastrointest Endosc. 1993;  36 885-888
  PubMedGoogle Scholar
• 2 Srinivasan A. Epidemiology and prevention of infections related to endoscopy.  Curr Inf Dis Rep. 2003;  5 467-472
  PubMedGoogle Scholar
• 3 Gastroenterological Nurses College of Australia, Gastroenterological Society of Australia .Infection control in endoscopy. 2nd edition. 2003. Digestive Health Foundation. Available at: http://www.gesa.org.au/pdf/booklets/I_Control_2nd_Edition.pdf; Publication date: March 2006
  PubMedGoogle Scholar
• 4 Banerjee S, Shen B, Baron T H. et al . ASGE Standards of Practice Committee. Antibiotic prophylaxis for gastrointestinal endoscopy.  Gastrointest Endosc. 2008;  67 791-798
  CrossrefPubMedGoogle Scholar
• 5 Buss A J, Been M H, Borgers R P. et al . Endoscope disinfection and its pitfalls – requirement for retrograde surveillance cultures.  Endoscopy. 2008;  40 327-332
  Article in Thieme ConnectPubMedGoogle Scholar
• 6 Pajkos A, Vickery K, Cossart Y. Is biofilm accumulation on endoscope tubing a contributor to the failure of cleaning and decontamination?.  J Hosp Infect. 2004;  58 224-229
  CrossrefPubMedGoogle Scholar
• 7 Guideline of the Dutch Infection Prevention Working Party (WIP) for cleaning and disinfection of endoscopes. Revision: April 2009. Available from: http://www.wip.nl/UK/disclaim.asp?url=http://www.wip.nl/UK/free_content/Richtlijnen/Cleaning%20and%20disinfection%20endoscopes070731.pdf; Publication date: April 2004
  Google Scholar
• 8 Beilenhoff U, Neumann C S, Rey J F. et al . ESGE-ESGENA guideline: cleaning and disinfection in gastrointestinal endoscopy.  Endoscopy. 2008;  40 939-957
  Article in Thieme ConnectPubMedGoogle Scholar
• 9 Doléans-Jordheim A, Cournoyer B, Bergeron E. et al . Reliability of Pseudomonas aeruginosa semi-automated rep-PCR genotyping in various epidemiological situations.  Eur J Clin Microbiol Infect Dis. DOI: DOI 10.1007/s10096-009-0755-z Available from: http://www.springerlink.com/content/r5p87673273j4021/fulltext.pdf; Publication date: 16 May 2009
  PubMedGoogle Scholar
• 10 Nelson D B, Muscarella L F. Current issues in endoscope reprocessing and infection control during gastrointestinal endoscopy.  World J Gastroenterol. 2006;  12 3953-3964
  CrossrefPubMedGoogle Scholar
• 11 Srinivasan A, Wolfenden L L, Song X. et al . An outbreak of Pseudomonas aeruginosa infections associated with flexible bronchoscopes.  N Engl J Med. 2003;  348 221-227
  CrossrefPubMedGoogle Scholar
• 12 Kirschke D L, Jones T F, Craig A S. et al . Pseudomonas aeruginosa and Serratia marcescens contamination associated with a manufacturing defect in bronchoscopes.  N Engl J Med. 2003;  348 214-220
  CrossrefPubMedGoogle Scholar
• 13 Corne P, Godreuil S, Jean-Pierre H. et al . Unusual implication of biopsy forceps in outbreaks of Pseudomonas aeruginosa infections and pseudo-infections related to bronchoscopy.  J Hosp Infect. 2005;  61 20-26
  CrossrefPubMedGoogle Scholar
• 14 Alfa M J, DeGagne P, Olson N. et al . Comparison of ion plasma, vaporized hydrogen peroxide, and 100 % ethylene oxide sterilizers to the 12 / 88 ethylene oxide gas sterilizer.  Infect Cont Hosp Epidemiol. 1996;  17 92-100
  CrossrefPubMedGoogle Scholar
• 15 Marion K, Freney J, Bergeron E. et al . Using an efficient biofilm detaching agent: an essential step for the improvement of endoscope reprocessing protocols.  J Hosp Infect. 2006;  64 136-142
  CrossrefPubMedGoogle Scholar
• 16 Rutala W A, Weber D J. New disinfection and sterilization methods.  Emerg Infect Dis. 2001;  7 348-353
  CrossrefPubMedGoogle Scholar
• 17 Colt H G, Beamis J J, Harrell J H. et al . Novel flexible bronchoscope and single-use disposable-sheath endoscope system. A preliminary technology evaluation.  Chest. 2000;  1181 183-187
  PubMedGoogle Scholar
• 18 Systchenko R, Marchetti B, Canard J N. et al . Guidelines of the French Society of Digestive Endoscopy: recommendations for setting up cleaning and disinfection procedures in gastrointestinal endoscopy.  Endoscopy. 2000;  32 807-818
  Article in Thieme ConnectPubMedGoogle Scholar
• 19 Beilenhoff U, Neumann C S, Rey J F. et al . ESGE-ESGENA guideline for quality assurance in reprocessing: microbiological surveillance testing in endoscopy.  Endoscopy. 2007;  39 175-181
  Article in Thieme ConnectPubMedGoogle Scholar
• 20 Gillespie E E, Kotsanas D, Stuart R L. Microbiological monitoring of endoscopes: 5-year review.  J Gastroenterol Hepatol. 2008;  23 1069-1074
  CrossrefPubMedGoogle Scholar

J. KovalevaMD 

Department of Medical Microbiology
University Medical Centre Groningen

PO Box 300019700 RB Groningen
The Netherlands

Fax: +31-50-3619105

Email: j.kovaleva@mmb.umcg.nl