Remote video auditing in the endoscopy unit for evaluation of duodenoscope reprocessing in a tertiary care center

Abstract

Background A significant proportion of duodenoscope-transmitted infections have resulted from errors related to reprocessing. Remote video auditing (RVA) is a tool that can monitor reprocessing compliance but it has not been previously evaluated in a tertiary care setting. The aims of this study were to evaluate: 1) RVA feasibility in a tertiary care setting (defined as the ability to audit every step of duodenoscope reprocessing without delaying the next procedure due to unavailability of duodenoscopes); and 2) the use of RVA as a compliance monitoring tool.

Methods This was a prospective study at a tertiary care center. A video camera with offsite monitoring was installed in March 2018. Auditors delivered a compliance score after each procedure. The duodenoscope was not used until it passed the audit. Feasibility and compliance data were collected from April 2018 to August 2019 after a 1-month run-in phase. Both per-step compliance and overall 100 % compliance rates were measured.

Results Of 743 duodenoscope reprocessing procedures, 32 666 individual steps were audited and 99.9 % of the steps were fully viewable. The mean time per audit was 38.3 minutes, the mean duodenoscope turnover time was 76.1 minutes, and there were no delays to the next procedure due to unavailability of duodenoscopes. The per-step compliance rate was 99.5 % but the overall 100 % compliance rate was 90.3 %.

Conclusions The use of RVA in duodenoscope reprocessing was feasible and promoted sustained high-level compliance in a tertiary care center.

Publication History

Received: 22 January 2020

Accepted: 30 March 2020

Article published online:
14 May 2020

• References

• 1 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
• 2 Gastmeier P, Vonberg RP. Klebsiella spp. in endoscopy-associated infections: we may only be seeing the tip of the iceberg. Infection 2014; 42: 15-21
• 3 Kola A, Piening B, Pape UF. et al. An outbreak of carbapenem-resistant OXA-48-producing Klebsiella pneumonia associated to duodenoscopy. Antimicrob Resist Infect Control 2015; 4: 8
• 4 Verfaillie CJ, Bruno MJ, Voor in ’t Holt AF. et al. Withdrawal of a novel-design duodenoscope ends outbreak of a VIM-2-producing Pseudomonas aeruginosa. Endoscopy 2015; 47: 493-502
• 5 Rahman MR, Perisetti A, Coman R. et al. Duodenoscope-associated infections: update on an emerging problem. Dig Dis Sci 2019; 64: 1409-1418
• 6 Rubin ZA, Kim S, Thaker AM. et al. Safely reprocessing duodenoscopes: current evidence and future directions. Lancet Gastroenterol Hepatol 2018; 3: 499-508
• 7 Kim S, Russell D, Mohamadnejad M. et al. Risk factors associated with the transmission of carbapenem-resistant Enterobacteriaceae via contaminated duodenoscopes. Gastrointest Endosc 2016; 83: 1121-1129
• 8 Schaefer MK, Jhung M, Dahl M. et al. Infection control assessment of ambulatory surgical centers. JAMA 2010; 303: 2273-2279
• 9 Dirlam Langlay AM, Ofstead CL, Mueller NJ. et al. Reported gastrointestinal endoscope reprocessing lapses: the tip of the iceberg. Am J Infect Control 2013; 41: 1188-1194
• 10 Petersen BT, Chennat J, Cohen J. et al. Multisociety guideline on reprocessing flexible GI endoscopes: 2011. Infect Control Hosp Epidemiol 2011; 32: 527-537
• 11 Petersen BT, Cohen J. Reprocessing Guideline Task Force. et al. Multisociety guideline on reprocessing flexible GI endoscopes: 2016 update. Gastrointest Endosc 2017; 85: 282-294 e1
• 12 Department of Health and Human Services. Brief summary of the Gastroenterology and Urology Devices Panel meeting. 26.02.2016 Available from (Accessed 30 January 2020): fda.gov/media/96201/download
• 13 Beilenhoff U, Biering H, Blum R. et al. Reprocessing of flexible endoscopes and endoscopic accessories used in gastrointestinal endoscopy: Position Statement of the European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastroenterology Nurses and Associates (ESGENA) – update 2018. Endoscopy 2018; 50: 1205-1234
• 14 522 Postmarket Surveillance Studies: Human Factors Study. PS150003/PSS001. 04.10.2018 Available from (Accessed 30 January 2020): https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfPMA/pss.cfm?t_id=354&c_id=3692
• 15 Lupo L. Remote video auditing: a big wrench in the quality and safety tool box. 06.04.2011 Available from (Accessed 30 January 2020): https://www.qualityassurancemag.com/article/qa-0311-video-auditing-safety/
• 16 Murphy SE. Tyson Foods adopts video audits to monitor animal welfare. 28.06.2017 Available from (Accessed 30 January 2020): https://www.greenbiz.com/article/tyson-foods-adopts-video-audits-monitor-animal-welfare
• 17 Sims B. Advancements in auditing. 07.07.2018 Available from (Accessed 30 January 2020): https://www.meatpoultry.com/articles/19824-advancements-in-auditing
• 18 Pellegrini M. Video auditing has become a powerful tool for slaughter operations across the industry. Available from (Accessed 30 January 2020): http://digital.bnpmedia.com/publication/?i=92385&article_id=915341&view=articleBrowser
• 19 Tomson B. Meat firms use video to curb contamination. 04.11.2011 Available from (Accessed 30 January 2020): https://www.wsj.com/articles/SB10001424052970204621904577018262490665468
• 20 Pedersen A, Getty Ritter E, Beaton M. et al. Remote video auditing in the surgical setting. AORN J 2017; 105: 159-169
• 21 Overdyk FJ, Dowling O, Newman S. et al. Remote video auditing with real-time feedback in an academic surgical suite improves safety and efficiency metrics: a cluster randomised study. BMJ Qual Saf 2016; 25: 947-953
• 22 Raphael K, Cerrone S, Sceppa E. et al. Improving patient safety in the endoscopy unit: utilization of remote video auditing to improve time-out compliance. Gastrointest Endosc 2019; 90: 424-429
• 23 Armellino D, Cifu K, Wallace M. et al. Implementation of remote video auditing with feedback and compliance for manual-cleaning protocols of endoscopic retrograde cholangiopancreatography endoscopes. Am J Infect Control 2018; 46: 594-596
• 24 Lan G, Tsistrakis S, Bernstein BB. 268 Remote video auditing with feedback in an ambulatory endoscopy suite: impact on compliance with endoscope cleaning protocols. Gastrointest Endosc 2017; 85: AB66-AB67
• 25 Olympus America, Inc. TJF-Q180V cleaning and disinfection checklist. 03/2015 Available from (Accessed 30 January 2020): https://medical.olympusamerica.com/sites/default/files/pdf/TJF-Q180V_ReprocessingEvaluationChecklist1.2.pdf
• 26 Kovaleva J, Peters FTM, Van Der Mei HC. et al. Transmission of infection by flexible gastrointestinal endoscopy and bronchoscopy. Clin Microbiol Rev 2013; 26: 231-254
• 27 McCafferty CE, Aghajani MJ, Abi-Hanna D. et al. An update on gastrointestinal endoscopy-associated infections and their contributing factors. Ann Clin Microbiol Antimicrob 2018; 17: 36
• 28 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
• 29 Moses FM, Lee J. Surveillance cultures to monitor quality of gastrointestinal endoscope reprocessing. Am J Gastroenterol 2003; 98: 3-5
• 30 Tunuguntla A, Sullivan MJ. Monitoring quality of flexible endoscope disinfection by microbiologic surveillance cultures. Tenn Med 2004; 97: 453-456
• 31 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
• 32 Fraser TG, Reiner S, Malczynski M. et al. Multidrug-resistant Pseudomonas aeruginosa cholangitis after endoscopic retrograde cholangiopancreatography: failure of routine endoscope cultures to prevent an outbreak. Infect Control Hosp Epidemiol 2004; 25: 856-859
• 33 Berzin TM, Feuerstein JD. Duodenoscope-related and echoendoscope-related infections: is “never” possible?. Gastrointest Endosc 2018; 88: 314-315
• 34 Sethi S, Huang RJ, Barakat MT. et al. Adenosine triphosphate bioluminescence for bacteriologic surveillance and reprocessing strategies for minimizing risk of infection transmission by duodenoscopes. Gastrointest Endosc 2017; 85: 1180-1187 e1
• 35 Olafsdottir LB, Whelan J, Snyder GM. A systematic review of adenosine triphosphate as a surrogate for bacterial contamination of duodenoscopes used for endoscopic retrograde cholangiopancreatography. Am J Infect Control 2019; 46: 697-705
• 36 Bartles RL, Leggett JE, Hove S. et al. 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.e.2
• 37 Muscarella LF. Use of ethylene-oxide gas sterilisation to terminate multidrug-resistant bacterial outbreaks linked to duodenoscopes. BMJ Open Gastroenterol 2019; 6: e000282
• 38 Ross AS. Enhanced methods for duodenoscope reprocessing: answers or just more questions. Gastrointest Endosc 2016; 84: 263-265
• 39 Butcher A. Endoscopy presentation for the investment community at DDW. 2018 Available from (Accessed 30 January 2020): http://investors.bostonscientific.com/~/media/Files/B/Boston-Scientific-IR/documents/events/endoscopy-investor-webcast-june-2018.pdf
• 40 Muthusamy VR, Bruno MJ, Kozarek RA. et al. Clinical evaluation of a single-use duodenoscope for endoscopic retrograde cholangiopancreatography. Clin Gastroenterol Hepatol 2019;
• 41 Ross AS, Bruno MJ, Kozarek RA. et al. Novel single-use duodenoscope compared with 3 models of reusable duodenoscopes for ERCP: a randomized bench-model comparison. Gastrointest Endosc 2020; 91: 396-403
• 42 US Food and Drug Administration. The FDA is recommending transition to duodenoscopes with innovative designs to enhance safety: FDA Safety Communication. 2020 Available from (Accessed 30 January 2020): https://www.fda.gov/medical-devices/safety-communications/fda-recommending-transition-duodenoscopes-innovative-designs-enhance-safety-fda-safety-communication
• 43 ESGE and ESGENA comment: Duodenoscope design. Available from (Accessed 30 January 2020): https://endopromag.com/esge-and-esgena-comment-duodenoscope-design/
• 44 GI societies advise FDA on duodenoscope reprocessing. 2020 Available from (Accessed 30 January 2020): https://www.mdedge.com/gihepnews/article/214911/society-news/gi-societies-advise-fda-duodenoscope-reprocessing