Effect of a novel endoscope cleaning brush on duodenoscope contamination

Abstract

Background Current duodenoscope reprocessing protocols are insufficient to prevent contamination and require adaptations to prevent endoscopy-associated infections (EAIs). This study aimed to investigate the effect of a new endoscope cleaning brush on the contamination rate of ready-to-use duodenoscopes.

Methods This retrospective before-and-after intervention study collected duodenoscope surveillance culture results from March 2018 to June 2022. Contamination was defined as ≥1 colony-forming unit of a microorganism of gut or oral origin (MGO). In December 2020, an endoscope cleaning brush with a sweeper design was introduced as an intervention in the manual cleaning of duodenoscopes. A logistic mixed-effects model was used to study the effects of this intervention.

Results Data were collected from 176 culture sets before the new brush’s introduction and 81 culture sets afterwards. Pre-introduction, culture sets positive with an MGO comprised 45.5% (95%CI 38.3%–52.8%; 80/176), decreasing to 17.3% (95%CI 10.6%–26.9%; 14/81) after implementation of the new brush. Compared with the former brush, duodenoscopes cleaned with the new brush had lower odds of contamination with MGOs (adjusted odds ratio 0.25, 95%CI 0.11–0.58; P=0.001)

Conclusions Use of the new brush in manual cleaning reduced contamination with MGOs and is expected to prevent EAIs. These findings should be confirmed in future prospective randomized studies.

Publication History

Received: 25 May 2023

Accepted after revision: 17 October 2023

Accepted Manuscript online:
17 October 2023

Article published online:
05 December 2023

• References

• 1 Andriulli A, Loperfido S, Napolitano G. et al. Incidence rates of post-ERCP complications: a systematic survey of prospective studies. Am J Gastroenterol 2007; 102: 1781-1788
• 2 Hutfless S, Shiratori Y, Chu D. et al. Risk factors for infections after endoscopic retrograde cholangiopancreatography (ERCP): a retrospective cohort analysis of US Medicare Fee-For-Service claims, 2015–2021. BMJ Open 2022; 12: e065077
• 3 Balan GG, Sfarti CV, Chiriac SA. et al. Duodenoscope-associated infections: a review. Eur J Clin Microbiol Infect Dis 2019; 38: 2205-2213
• 4 Larsen S, Russell RV, Ockert LK. et al. Rate and impact of duodenoscope contamination: A systematic review and meta-analysis. EClinicalMedicine 2020; 25: 100451
• 5 Alfa MJ, Singh H. Impact of wet storage and other factors on biofilm formation and contamination of patient-ready endoscopes: a narrative review. Gastrointest Endosc 2020; 91: 236-247
• 6 Alfa M, Olson N, DeGagne P. et al. 270. Prevention of biofilm accumulation in duodenoscopes varies with the method of reprocessing. Gastrointest Endosc 2017; 85: AB67-AB68
• 7 Bridier A, Sanchez-Vizuete Mdel P, Le Coq D. et al. Biofilms of a Bacillus subtilis hospital isolate protect Staphylococcus aureus from biocide action. PLoS One 2012; 7: e44506
• 8 da Costa Luciano C, Olson N, DeGagne P. et al. A new buildup biofilm model that mimics accumulation of material in flexible endoscope channels. J Microbiol Methods 2016; 127: 224-229
• 9 US Food and Drug Administration (FDA), Center for Disease Control and Prevention (CDC), American Society for Microbiology (ASM). Duodenoscope Surveillance Sampling-and Culturing Protocols. 2018 Accessed September 02, 2023 at: https://www.fda.gov/media/111081/download
• 10 Colman S, Vanzieleghem T, Leroux-Roels I. In vitro comparison of 3 different brushes for manual cleaning of endoscopes. Infect Control Hosp Epidemiol 2022; 43: 1076-1078
• 11 Nederlandse Vereniging voor Medische Microbiologie. Richtlijn controle op microbiologische veiligheid van thermolabiele flexibele hoog-risico gastrointestinale endoscopen [Dutch]. 2018 Accessed September 03, 2023 at: https://www.vdsmh.nl/publicaties/flexibele-endoscopen/richtlijn-controle-op-microbiologische-veiligheid-van-thermolabiele-flexibele-hoog-risico-gastro-intestinale-endoscopen
• 12 Rauwers AW, Voor in 't Holt AF, Buijs JG. et al. High prevalence rate of digestive tract bacteria in duodenoscopes: A nationwide study. Gut 2018; 67: 1637-1645
• 13 Rauwers AW, Voor in ’t Holt AF, Buijs JG. et al. Nationwide risk analysis of duodenoscope and linear echoendoscope contamination. Gastrointest Endosc 2020; 92: 681-691.e681
• 14 R Core Team. R: A language and environment for statistical computing (2022). R Foundation for Statistical Computing, Vienna, Austria. Accessed September 06, 2023 at: https://www.r-project.org
• 15 Rizopoulos D. GLMMadaptive: Generalized Linear Mixed Models using Adaptive Gaussian Quadrature. R package version 0.8–5. Accessed September 06, 2023 at: https://www.CRAN.R-project.org/package=GLMMadaptive
• 16 Kwakman JA, Erler NS, Vos MC. et al. Risk evaluation of duodenoscope-associated infections in the Netherlands calls for a heightened awareness of device-related infections: A systematic review. Endoscopy 2022; 54: 148-155
• 17 Ofstead CL, Buro BL, Hopkins KM. et al. Duodenoscope-associated infection prevention: A call for evidence-based decision making. Endosc Int Open 2020; 8: E1769-E1781
• 18 Visrodia K, Petersen BT. Borescope examination: Is there value in visual assessment of endoscope channels?. Gastrointest Endosc 2018; 88: 620-623
• 19 Santos LCS, Parvin F, Huizer-Pajkos A. et al. Contribution of usage to endoscope working channel damage and bacterial contamination. J Hosp Infect 2020; 105: 176-182
• 20 Schweizer ML, Braun BI, Milstone AM. Research methods in healthcare epidemiology and antimicrobial stewardship-quasi-experimental designs. Infect Control Hosp Epidemiol 2016; 37: 1135-1140