Residual bioburden in reprocessed side-view endoscopes used for endoscopic retrograde cholangiopancreatography (ERCP)

Background and study aim: Worldwide some endoscopy units routinely continue to use manual reprocessing techniques for disinfection of side-view endoscopes. The aim of this study was to evaluate the outcome quality of manual reprocessing techniques for removal and inactivation of the bioburden from side-view endoscopes used for endoscopic retrograde cholangiopancreatography (ERCP) in a tertiary referral endotherapy unit in Sri Lanka.

Methods: 102 samples obtained from two different flexible side-view endoscopes (Olympus TJF Q 180V and Olympus TJF 160 R) were tested for microbial growth. Three samples were collected each time; one swab from the tip before and another after manual reprocessing. The third sample was collected by flushing the working channel with sterile normal saline after manual reprocessing. Microorganisms were identified by culturing the samples.

Result:: After reprocessing, culture-positive rates were 20 % and 9 % for the samples obtained from the tip and the working channel of the side-view endoscopes, respectively. Klebsiella spp. and Candida spp. were found to be the commonest microorganisms in the samples from the tips and from the working channels, respectively, of the reprocessed side-view endoscopes.

Conclusion: There is a high culture-positive rate after reprocessing of the side-view endoscopes using the manual reprocessing procedure, despite strict adherence to the protocol for reprocessing.

• References

• 1 Nelson DB, Muscarella LF. Current issues in endoscope reprocessing and infection control during gastrointestinal endoscopy. World J Gastroenterol 2006; 12: 3953-3964
• 2 Alfa MJ, Olson N, DeGagne P et al. A survey of reprocessing methods, residual viable bioburden, and soil levels in patient-ready endoscopic retrograde cholangiopancreatography duodenoscopes used in Canadian centers. Infect Control Hosp Epedimiol 2002; 23: 198-206
• 3 Pascu O, Tantau M eds. Therapeutic Gastrointestinal Endoscopy. Croatia: InTech; 2011
• 4 Chu NS, Favero M. The microbial flora of the gastrointestinal tract and the cleaning of flexible endoscopes. Gastrointest Endosc Clin N Am 2000; 10: 233-244
• 5 Alfa MJ, Sitter DL. In-hospital evaluation of orthophthalaldehyde as a high level disinfectant for flexible endoscopes. J Hosp Infect 1994; 26: 15-26
• 6 Vesley D, Melson J, Stanley P. Microbial bioburden in endoscope reprocessing and an in-use evaluation of the high-level disinfection capabilities of Cidex PA. Gastroenterol Nurs 1999; 22: 63-68
• 7 Chu NS, McAlister D, Antonoplos PA. Natural bioburden levels detected on flexible gastrointestinal endoscopes after clinical use and manual cleaning. Gastrointest Endosc 1998; 48: 137-142
• 8 Gastroenterological Nurses College of Australia (GENCA) and Gastroenterological SocietyAustralia (GESA). Infection Control in Endoscopy. 3rd ed. Australia: Gastroenterological SocietyAustralia; 2010
• 9 Petersen BT, Chennat J, Cohen J et al. Multisociety guideline on reprocessing flexible gastrointestinal endoscopes: 2011. Gastrointest Endosc 2011; 73: 1075-1084
• 10 Schembre DB. Infectious complications associated with gastrointestinal endoscopy. Gastrointest Endosc Clin N Am 2000; 10: 215-232
• 11 Gillespie EE, Kotsanas D, Stuart RL. Microbiological monitoring of endoscopes: 5-year review. J Gastroenterol Hepatol 2008; 23: 1069-1074
• 12 Nelson DB, Barkun AN, Block KP et al. Technology status evaluation report. Transmission of infection by gastrointestinal endoscopy. May 2001. . Gastrointest Endosc 2001; 54: 824-828
• 13 Ofstead CL, Dirlam LanglayAM, Mueller NJ et al. Re-evaluating endoscopy-associated infection risk estimates and their implications. Am J Infect Control 2013; 41: 734-736
• 14 Rutala WA, Weber DJ. Reprocessing endoscopes: United States perspective. J Hosp Infect PubMed 2004; 56 (Suppl. 02) S27-S39
• 15 Nelson DB. Infectious disease complications of GI endoscopy: part II, exogenous infections. Gastrointest Endosc 2003; 57: 695-711
• 16 Rutala WA, Weber DJ Healthcare Infection Control Practices Advisory Committee (HICPAC). CDC guideline for disinfection and sterilization in healthcare facilities, 2008. Epub 11/2008;
• 17 Beilenhoff U, Neumann CS, Rey JF et al. ESGE-ESGENA guideline for quality assurance in reprocessing: microbiological surveillance testing in endoscopy. Endoscopy 2007; 39: 175-181
• 18 Catalone B. Microbiological surveillance of flexible endoscopes. Managing Infect Control 2006; 56-60
• 19 Muscarella LF. Investigation and prevention of infectious outbreaks during endoscopic retrograde cholangiopancreatography. Endoscopy 2010; 42: 957-959
• 20 Kim JB, Han DS, Lee HL et al. The value of peracetic Acid (SCOTELIN) for endoscope disinfection. Korean J Gastrointest Endosc 2004; 28: 284-290
• 21 Rerknimitr R, Eakthunyasakul S, Nunthapisud P et al. Results of gastroscope bacterial decontamination by enzymatic detergent compared to chlorhexidine. World J Gastroenterol 2006; 12: 4199-4202
• 22 Moses FM, Lee J. Surveillance cultures to monitor quality of gastrointestinal endoscope reprocessing. Am J Gastroenterol 2003; 98: 77-81
• 23 Aumeran C, Poincloux L, Souweine B et al. Multidrug-resistant Klebsiella pneumoniae outbreak after endoscopic retrograde cholangiopancreatography. Endoscopy 2010; 42: 895-899
• 24 Kim SY, Lee HS, Hyun JJ et al. Comparison on the efficacy of disinfectants used in automated endoscope reprosessors: PHMB-DBAC versus Orthopthalaldehyde. Clin Endosc 2011; 44: 109-115
• 25 Desilets D, Kaul V, Tierney WM et al. Automated endoscope reprocessors. Gastrointest Endosc 2010; 72: 675-680
• 26 Classen M, Tytgat G, Lightdale C. Gastroenterological Endoscopy. Hong Kong: Leo Paper Ltd; 2010
• 27 Beilenhoff U, Neumann CS, Rey JF et al. ESGE-ESGENA guideline: cleaning and disinfection in gastrointestinal endoscopy. Endoscopy 2008; 40: 939-957
• 28 Nelson DB. Recent advances in epidemiology and prevention of gastrointestinal endoscopy related infections. Curr Opin Infect Dis 2005; 18: 326-330
• 29 Bisset L, Cossart YE, Selby W et al. A prospective study of the efficacy of routine decontamination for gastrointestinal endoscopes and the risk factors for failure. Am J Infect Control 2006; 34: 274-280