infection control & hospital epidemiology october 2015, vol. 36, no. 10 concise communication
Microbiologic Surveillance of Duodenoscope Reprocessing at the Vienna University Hospital From November 2004 Through March 2015
Helga Paula, MD;1 Elisabeth Presterl, MD;1 Barbara Tribl, MD;2 Magda Diab-Elschahawi, MD1
Bacterial contamination of duodenoscopes is attributed to difficulties with reprocessing the Albarran lever. Routine microbiologic surveillance data of endoscopes with Albarran lever retrospectively collected from November 2004 through March 2015 revealed no growth of microorganism at this specific site. Transmission of endoscope-associated infection is avoidable by following validated reprocessing procedures.
Infect. Control Hosp. Epidemiol. 2015;36(10):1233–1235
Gastroenterology and Hepatology approximately 8,000 endoscopic procedures are performed yearly, 700 of themwith duodenoscopes harboring an Albarran lever. At the Vienna University Hospital, reprocessing of endo-
scopes as well as their accessories follows quality-controlled standard operating procedures. These consist of (1) pretreat- ment of the endoscope after patient examination, (2) manual cleaning of the endoscope, (3) high-level disinfection in an automated endoscope washer disinfector (AEWD), (4) drying, and (5) proper storage. Additional requirements for endoscopeswith Albarran lever include the manual cleaning of the Albarran lever with a single-use soft brush as well as bringing the Albarran lever into midposition before loading the AEWD. For older models the Albarran tube adapter has to be fitted to the allocated cleaning channel. Regular biannual training of healthcare personnel involved in reprocessing is required. Flexible endoscopes at our institution are reprocessed in
A safety alert issued by the US Food and Drug Administration in February 2015 raised concerns of an association between multidrug-resistant (MDR) bacterial infections in patients who had undergone an endoscopic retrograde cholangiopan- creatography procedure with reprocessed duodenoscopes.1 The association between exposure to duodenoscopes and acquisition ofMDREnterobacteriaceae was reported earlier.2,3 A physical feature of duodenoscopes called Albarran lever is considered a likely source for bacterial contamination.3 It is a movable “elevator” situated at the tip of the duodenoscope necessary to change the angle of auxiliary instruments. Cleaning followed by high-level disinfection of endoscopic equipment is an elaborate process requiring specific training and adherence to well-defined protocols.4,5 Current recom- mendations include periodic microbiologic monitoring of endoscopes in order to assess the quality of endoscope repro- cessing procedures.6,7 According to guidelines of the Viennese District Health Authorities, microbiologic monitoring of endoscope reprocessing consists of microbiologic sampling of all endoscopes at least once a year. Following the Food and Drug Administration safety alert, microbiologic surveillance data from all reprocessed endoscopes with Albarran lever used in our hospital, available from 2004 to date, were reviewed. The aim of our study was to evaluate the efficacy of current reprocessing procedures of duodenoscopes in our hospital.
methods
The Vienna University Hospital is a tertiary care university teaching hospital with 2,137 beds. In our Division of
AEWDs (Olympus) according to manufacturer’s instructions. All reprocessing steps are documented, traceable, and stored for 10 years. Performance criteria of our AEWDs are validated according to the European standard EN ISO 15883-48 before initial use and revalidated once a year and additionally after any repair work or modification in programming or chemistry. At the Vienna University Hospital microbiologic sampling
of all endoscopes and last rinse water of the AEWD is performed once a year. Sampling sites include each channel (air, water, suction, and biopsy), endoscope surface samples, and if applicable the Albarran lever. Additionally, a sample of the last rinse water is taken (data not included). The endoscope surface is sampled using contact agar plates (Envirocheck Rodac GKZ; Merck). Endoscope channels are flushed with 20mL buffered peptone water (Merck) and the fluid is collected in a sterile container. The Albarran lever is separately sampled with a sterile swab. Specimens are labeled and immediately transferred to the microbiology laboratory for further analysis. The samples are inoculated onto both Columbia blood agar with 5% sheep blood (Becton Dickinson) and MacConkey agar plates. Culture plates were
table 1. Endoscope Device Models Tested From 2004 to 2015 Type of endoscope Duodenoscope
Model
Duodenoscope Duodenoscope Choledoscope Baby endoscope
Endoscopic ultrasound (EUS) Endoscopic ultrasound (EUS)
NOTE. All endoscopes were manufactured by Olympus.
TJF-180 V TJF-160 VR JF-130
CHF-P 20 CHF-BP 30 GF-UE 160
GF-UMQ 130
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