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Chang WK, Peng CL, Chen YW, Sun CK, Chen CC, Liu TC, Chu YY, Tsai IF, Chung CS, Lin HF, Hsu FY, Tai WC, Lee HC, Yen HH, Wang EM, Chen SH, Chu CH, Chen MJ, Lu CL, Chiu CT. Recommendations and guidelines for endoscope reprocessing: Current position statement of digestive endoscopic society of Taiwan. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2024; 57:211-224. [PMID: 38135645 DOI: 10.1016/j.jmii.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 10/23/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023]
Abstract
Reprocessing of gastrointestinal (GI) endoscopes and accessories is an essential part of patient safety and quality control in GI endoscopy centers. However, current endoscopic reprocessing guidelines or procedures are not adequate to ensure patient-safe endoscopy. Approximately 5.4 % of the clinically used duodenoscopes remain contaminated with high-concern microorganisms. Thus, the Digestive Endoscopy Society of Taiwan (DEST) sets standards for the reprocessing of GI endoscopes and accessories in endoscopy centers. DEST organized a task force working group using the guideline-revision process. These guidelines contain principles and instructions of step-by-step for endoscope reprocessing. The updated guidelines were established after a thorough review of the existing global and local guidelines, systematic reviews, and health technology assessments of clinical effectiveness. This guideline aims to provide detailed recommendations for endoscope reprocessing to ensure adequate quality control in endoscopy centers.
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Affiliation(s)
- Wei-Kuo Chang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taiwan
| | - Chen-Ling Peng
- Department of Integrated Diagnostics & Therapeutics, National Taiwan University Hospital, National Taiwan University College of Medicine, Taiwan
| | - Yen-Wei Chen
- Endoscopy Center for Diagnosis and Treatment, Taipei Veterans General Hospital, Taiwan
| | - Cheuk-Kay Sun
- Division of Hepatology and Gastroenterology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei 11101, Taiwan
| | - Chieh-Chang Chen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taiwan
| | - Tao-Chieh Liu
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taiwan
| | - Yin-Yi Chu
- Department of Gastroenterology and Hepatology, New Taipei Municipal Tucheng Hospital, Chang Gung University, Taoyuan, Taiwan
| | - I-Fang Tsai
- Ultrasonography and Endoscopy Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Chen-Shuan Chung
- Ultrasonography and Endoscopy Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Hsiao-Fen Lin
- Division of Gastroenterology and Hepatology, Renai Branch, Taipei City Hospital, Taiwan
| | - Fang-Yu Hsu
- Therapeutic Endoscopic Center, Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Taiwan
| | - Wei-Chen Tai
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Hsi-Chang Lee
- Division of Gastroenterology and Hepatology, Renai Branch, Taipei City Hospital, Taiwan
| | - Hsu-Heng Yen
- Division of Gastroenterology, Changhua Christian Hospital, Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taiwan
| | - E-Ming Wang
- Department of Internal Medicine Division of Gastroenterology and Hepatology, Kaohsiung Veterans General Hospital, Taiwan
| | - Shu-Hui Chen
- Division of Gastroenterology, Changhua Christian Hospital, Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taiwan
| | - Cheng-Hsin Chu
- Division of Gastroenterology, Internal Medicine, MacKay Memorial Hospital, Taiwan
| | - Ming-Jen Chen
- Division of Gastroenterology, Internal Medicine, MacKay Memorial Hospital, Taiwan
| | - Ching-Liang Lu
- Endoscopy Center for Diagnosis and Treatment, Taipei Veterans General Hospital, Taiwan
| | - Cheng-Tang Chiu
- Department of Gastroenterology & Hepatology, Linkou Chang Gung Memorial Hospital, Chang Gung Medical Foundation, Taiwan.
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Li XH, Huang ZY, Zhang YY, Cheng LJ, Zhen J, Zhang Y, Tian X, Huang X, Ma JH. Bacterial bioburden of duodenoscope elevator mechanism in different reprocessing stages. Am J Infect Control 2024; 52:488-490. [PMID: 37838249 DOI: 10.1016/j.ajic.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 10/05/2023] [Accepted: 10/06/2023] [Indexed: 10/16/2023]
Abstract
Over the past decade, infections linked to duodenoscopes have become a significant concern, primarily due to the intricate design of the elevator mechanism. Currently, there is limited evidence regarding the bacterial contamination level of the elevator mechanism after clinical use and throughout its various reprocessing stages. This study utilized the swab culture technique to examine the bacterial contamination on the duodenoscope elevator mechanism after clinical use and after 3 reprocessing stages at a Center of tertiary hospital. Our findings revealed severe bacterial contamination after clinical usage, emphasizing that the effectiveness of manual cleaning greatly influences the subsequent high-level disinfection quality.
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Affiliation(s)
- Xian-Huang Li
- Endoscopy Center, Department of Gastroenterology, the First Affiliated Hospital of Nanchang University, Jiangxi, China
| | - Zi-Yi Huang
- Endoscopy Center, Department of Gastroenterology, the First Affiliated Hospital of Nanchang University, Jiangxi, China; School of Nursing, Nanchang University, Jiangxi, China
| | - Yang-Yang Zhang
- Endoscopy Center, Department of Gastroenterology, the First Affiliated Hospital of Nanchang University, Jiangxi, China; School of Nursing, Nanchang University, Jiangxi, China
| | - Liu-Ji Cheng
- Endoscopy Center, Department of Gastroenterology, the First Affiliated Hospital of Nanchang University, Jiangxi, China; School of Nursing, Nanchang University, Jiangxi, China
| | - Jing Zhen
- Endoscopy Center, Department of Gastroenterology, the First Affiliated Hospital of Nanchang University, Jiangxi, China; School of Nursing, Nanchang University, Jiangxi, China
| | - Yun Zhang
- Endoscopy Center, Department of Gastroenterology, the First Affiliated Hospital of Nanchang University, Jiangxi, China
| | - Xin Tian
- JiangXi College Of Traditional Chinese Medicine, Jiangxi, China
| | - Xi Huang
- Endoscopy Center, Department of Gastroenterology, the First Affiliated Hospital of Nanchang University, Jiangxi, China.
| | - Jiu-Hong Ma
- Endoscopy Center, Department of Gastroenterology, the First Affiliated Hospital of Nanchang University, Jiangxi, China.
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Chan ASF, Chan HLY, Yan BKL, Lai MKC. Effectiveness of adenosine triphosphate to monitor manual cleaning and disinfection efficacy of flexible endoscopes in Hong Kong. JGH Open 2023; 7:141-147. [PMID: 36852145 PMCID: PMC9958339 DOI: 10.1002/jgh3.12863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 12/18/2022] [Accepted: 01/01/2023] [Indexed: 01/20/2023]
Abstract
Background and Aim Adenosine triphosphate (ATP) bioluminescence assay is widely adopted in the West to allow rapid evaluation of endoscopes for bacteriologic/biologic residue, but this practice is rarely adopted in Asia. In this continuous quality improvement program, we evaluated the utility of ATP in bacteriologic surveillance on endoscope reprocessing. Methods A total of 456 samples (304 ATP samples and 152 culture samples) of 38 flexible endoscopes were assessed after routine clinical use in a private hospital in Hong Kong. Endoscopes were assessed with an ATP system and bacterial cultures at different time points during the reprocessing. Results After pre-cleaning, the ATP values ranged from 228 to 65 163 relative light units (RLU) through all endoscope types. After manual cleaning, ATP values were decreased to 7-81 RLU (median, 19 RLU) for endoscope surface and 3-671 RLU (median, 12 RLU) for channel rinsate. There was a significant reduction in ATP levels between pre-cleaning and after manual cleaning. One of the 38 (2.6%) endoscopes (a duodenoscope) had an ATP value of 671 RLU from channel rinsate, which exceeded the benchmark for cleanliness of >200 RLU, and was sent back for re-cleaning. All endoscopes cultured no bacteria after high-level disinfection (HLD) by automated endoscope reprocessor (AER) and storage up to 24 h. ATP values were <200 RLU for all endoscopes after HLD and storage. Conclusions Adenosine triphosphate bioluminescence assay offers a rapid, practical, and cost-effective alternative for detection of endoscope microbial residue as well as a routine monitoring tool for endoscope cleanliness in the clinical setting.
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Affiliation(s)
- Ada S F Chan
- Department of Nursing AdministrationUnion HospitalHong Kong SARChina
| | - Henry L Y Chan
- Faculty of MedicineThe Chinese University of Hong KongHong Kong SARChina,Department of Internal MedicineUnion HospitalHong Kong SARChina
| | - Bruno K L Yan
- Department of Emergency MedicineUnion HospitalHong Kong SARChina
| | - Mooris K C Lai
- Department of Nursing AdministrationUnion HospitalHong Kong SARChina
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Kwakman JA, Rauwers AW, Buijs JG, de Groot W, Vos MC, Bruno MJ. No relation between adenosine triphosphate after manual cleaning and presence of microorganisms on endoscopes after automated high-level disinfection. Endosc Int Open 2022; 10:E1275-E1281. [PMID: 36118629 PMCID: PMC9473803 DOI: 10.1055/a-1897-5000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 07/08/2022] [Indexed: 12/02/2022] Open
Abstract
Background and study aims Adenosine triphosphate (ATP) tests are increasingly used to detect biological material; however, their reliability to detect bacterial contamination in endoscopes is not proven. We investigated the predictive value of ATP tests after manual cleaning for presence or absence of microorganisms as shown by culture after automated high-level disinfection (HLD) in duodenoscopes and linear echoendoscopes (DLEs). Patients and methods After manual cleaning, ATP tests were performed on swab samples taken from the detachable cap and forceps elevator, and on flush samples of the DLE working channels. These results were compared to the growth of any microorganisms in cultures acquired after automated HLD. ATP tests with > 200 relative light units (RLU) were considered positive. Receiver operator characteristic (ROC) curves were used to compare the RLU levels with microbial presence in cultures. Results In total, 903 procedures were performed involving 26 distinct DLEs. Depending on sample site, 20.8 % (cap) to 63.8 % (channel brush) of the ATP negative samples were accompanied by positive post-HLD cultures. 54.4 % of the cap samples with a positive culture (growth of any kind of microorganism) and 91.8 % of the channel samples with a positive culture had a negative ATP test after manual cleaning. ROC curves per sample site, DLE type and microorganism type all had area under the curves below 0.6. Conclusions In our study, ATP tests performed after manual cleaning could not predict presence or absence of microorganisms after automated HLD as shown by culture. More than half of the positive cultures were preceded by a negative ATP test.
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Affiliation(s)
- Judith A. Kwakman
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands,Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Arjan W. Rauwers
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands,Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Jolanda G. Buijs
- Qualtity Assurance and Regulatory Affairs Office Medical Devices, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Woutrinus de Groot
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Margreet C. Vos
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Marco J. Bruno
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
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Rauwers AW, Voor In 't Holt AF, Buijs JG, Groot WD, Erler NS, Vos MC, Bruno MJ. Assessment of postmanual cleaning adenosine triphosphate tests to prevent the use of contaminated duodenoscopes and linear echoendoscopes: the DETECT study. Gastrointest Endosc 2022; 96:282-290.e5. [PMID: 35341715 DOI: 10.1016/j.gie.2022.03.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 03/17/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS We investigated whether the use of postmanual cleaning adenosine triphosphate (ATP) tests lowers the number of duodenoscopes and linear echoendoscopes (DLEs) contaminated with gut flora. METHODS In this single-center before-and-after study, DLEs were ATP tested after cleaning. During the control period, participants were blinded to ATP results: ATP-positive DLEs were not recleaned. During the intervention period, ATP-positive DLEs were recleaned. DLEs underwent microbiologic sampling after high-level disinfection (HLD) with participants blinded to culture results. RESULTS Using 15 endoscopes of 5 different DLE types, we included 909 procedures (52% duodenoscopes, 48% linear echoendoscopes). During the intervention period, the absolute rate of contamination with gut flora was higher (16% vs 21%). The main analysis showed that contamination was less likely to occur in the intervention period (odds ratio, .32; 95% credible interval [CI], .12-.85). A secondary analysis showed that this effect was based on 1 particular duodenoscope type (estimated probability, 39% [95% CI, 18%-64%] vs 9% [95% CI, 2%-21%]), whereas no effect was seen in the other 4 DLE types. In detail, of the 4 duodenoscopes of this type, 2 had lower contamination rates (69% vs 39% and 36% vs 10%). During the control period, both these duodenoscopes had multiple episodes with ongoing contamination with the same microorganism that ended weeks before the start of the intervention period (ie, they were not terminated by ATP testing). CONCLUSIONS Postmanual cleaning ATP tests do not reduce post-HLD gut flora contamination rates of DLEs. Hence, postcleaning ATP tests are not suited as a means for quality control of endoscope reprocessing.
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Affiliation(s)
- Arjan W Rauwers
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands; Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Anne F Voor In 't Holt
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Jolanda G Buijs
- Staff Office Medical Devices, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Woutrinus de Groot
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Nicole S Erler
- Department of Biostatistics, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Margreet C Vos
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Marco J Bruno
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
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Gromski MA, Sherman S. Technological review: developments in innovative duodenoscopes. Gastrointest Endosc 2022; 95:42-50. [PMID: 34487777 DOI: 10.1016/j.gie.2021.08.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 08/23/2021] [Indexed: 12/11/2022]
Affiliation(s)
- Mark A Gromski
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Stuart Sherman
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Peng CL, Liu TC, Wang HP, Chang WK. Two novel protocols for cleaning residual simethicone and fluid in patient-ready duodenoscopes. J Gastroenterol Hepatol 2021; 36:1843-1850. [PMID: 33274470 DOI: 10.1111/jgh.15365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 11/01/2020] [Accepted: 11/29/2020] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIM Approximately 42-95% of working channels have been reported to show the presence of residual fluid despite endoscope reprocessing. The aim of this study was to design two novel protocols for cleaning residual simethicone and demonstrate its efficiency by evaluating the residual fluid and cleanliness in the working channels of patient-ready duodenoscopes. METHODS The designed protocol for cleaning residual simethicone was implemented in manual cleaning and/or high-level disinfection (HLD). The residual fluid inside the working channels was estimated by visual inspection. Adenosine triphosphate (ATP) values were evaluated to determine cleanliness after manual cleaning. RESULTS Manual cleaning with novel simethicone cleaning protocol demonstrated a significant decrease in fluid droplets (14.6 ± 29.9 vs 0 ± 0, P < 0.001) and ATP values (157 ± 196 relative light units [RLUs] vs 52 ± 41 RLUs, P = 0.031). HLD with simethicone cleaning protocol, using either enzymatic detergent with effective for cleaning simethicone or cleaning time set in the automatic endoscope reprocessor program for 8 min, demonstrated significant decrease in the number of fluid droplets. Follow-up after the implementation of the simethicone cleaning protocol showed a significant decrease in fluid droplets (37.4 ± 41.0 vs 2.1 ± 5.5, P = 0.003) and ATP values (271 ± 268 RLUs vs 82 ± 136 RLUs, P = 0.021). CONCLUSIONS Simethicone cleaning protocol is advantageous for significantly decreasing fluid droplets and ATP values within endoscope working channels. After manual cleaning with the simethicone cleaning protocol, in particular, no retained fluid droplet was observed in patient-ready duodenoscopes.
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Affiliation(s)
- Chen-Ling Peng
- Department of Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Tao-Chieh Liu
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Hsiu-Po Wang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wei-Kuo Chang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Chen S, Liu T, Lai H, Chang H, Yen H. Monthly endoscopy surveillance culture facilitates detection of breaches in the scope reprocessing procedure: 5‐year experience in an endoscopy center. ADVANCES IN DIGESTIVE MEDICINE 2021. [DOI: 10.1002/aid2.13251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Shu‐Hui Chen
- Endoscopy Center, Division of Gastroenterology Changhua Christian Hospital Changhua Taiwan
| | - Theophile Liu
- Center for Infection Prevention and Control Changhua Christian Healthcare System Changhua Taiwan
| | - Huei‐Wen Lai
- Center for Infection Prevention and Control Changhua Christian Healthcare System Changhua Taiwan
| | - Hui‐Lan Chang
- General Education Center Chienkuo Technology University Changhua Taiwan
| | - Hsu‐Heng Yen
- Endoscopy Center, Division of Gastroenterology Changhua Christian Hospital Changhua Taiwan
- General Education Center Chienkuo Technology University Changhua Taiwan
- College of Medicine Chung Shan Medical University Taichung Taiwan
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Elbahr O, Saleh A, Aziz AA, Awad SM, Khalil FO, Afiffy S, Kamal A, Alsebaey A, Badra G. Does double high-level disinfection for duodenoscopes add any value? A mini-systematic review and meta-analysis. EGYPTIAN LIVER JOURNAL 2020. [DOI: 10.1186/s43066-020-00040-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Abstract
Background
Duodenoscope-emerging infection especially drug-resistant bacteria is considered a major concern nowadays. Different approaches were attempted to overcome this problem, like double high-level disinfection procedure. We performed a systematic review and meta-analysis to evaluate risk difference for positive cultures from duodenoscopes between double high-level disinfection (dHLD) and single (standard) high-level disinfection (sHLD).
Main body
A thorough literature search (in October and November 2019) for studies comparing dHLD and sHLD for duodenoscopes was performed by 3 researchers in the Web of Science, Scopus, PubMed, and Cochran databases. The search terms were “duodenoscope,” “ERCP endoscope,” “disinfection,” “sterilization,” and “reprocessing,” and only randomized clinical trials with the English language were accepted.
Four trials were identified studying dHLD, and only 2 clinical trials comparing dHLD with standard sHLD were found reporting 6193 duodenoscope cultures. Overall sHLD cultures were 2972, and dHLD cultures were 3221; overall positive cultures were 140 in sHLD and 161 in dHLD.
The results of a meta-analysis using the random-effect model showed no significant risk difference (RD) between the 2 procedures for duodenoscope positive cultures (p = 0.53, RD 0.003, 95% CI “− 0.007–0.013”).
Conclusions
Double HLD offered no significant difference over single HLD for duodenoscope disinfection. An alternative strategy to overcome duodenoscope-transmitted infection is a big issue to be resolved.
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Liu TC, Peng CL, Wang HP, Huang HH, Chang WK. SpyGlass application for duodenoscope working channel inspection: Impact on the microbiological surveillance. World J Gastroenterol 2020; 26:3767-3779. [PMID: 32774056 PMCID: PMC7383844 DOI: 10.3748/wjg.v26.i26.3767] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 05/28/2020] [Accepted: 06/23/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Patient-ready duodenoscopes were designed with an assumed contamination rate of less than 0.4%; however, it has been reported that 5.4% of clinically used duodenoscopes remain contaminated with viable high-concern organisms despite following the manufacturer’s instructions. Visual inspection of working channels has been proposed as a quality control measure for endoscope reprocessing. There are few studies related to this issue.
AIM To investigate the types, severity rate, and locations of abnormal visual inspection findings inside patient-ready duodenoscopes and their microbiological significance.
METHODS Visual inspections of channels were performed in 19 patient-ready duodenoscopes using the SpyGlass visualization system in two endoscopy units of tertiary care teaching hospitals (Tri-Service General Hospital and National Taiwan University Hospital) in Taiwan. Inspections were recorded and reviewed to evaluate the presence of channel scratches, buckling, stains, debris, and fluids. These findings were used to analyze the relevance of microbiological surveillance.
RESULTS Seventy-two abnormal visual inspection findings in the 19 duodenoscopes were found, including scratches (n = 10, 52.6%), buckling (n = 15, 78.9%), stains (n = 14, 73.7%), debris (n = 14, 73.7%), and fluids (n = 6, 31.6%). Duodenoscopes > 12 mo old had a significantly higher number of abnormal visual inspection findings than those ≤ 12 mo old (46 findings vs 26 findings, P < 0.001). Multivariable regression analyses demonstrated that the bending section had a significantly higher risk of being scratched, buckled, and stained, and accumulating debris than the insertion tube. Debris and fluids showed a significant positive correlation with microbiological contamination (P < 0.05). There was no significant positive Spearman’s correlation coefficient between negative bacterial cultures and debris, between that and fluids, and the concomitance of debris and fluids. This result demonstrated that the presence of fluid and debris was associated with positive cultures, but not negative cultures. Further multivariate analysis demonstrated that fluids, but not debris, is an independent factor for bacterial culture positivity.
CONCLUSION In patient-ready duodenoscopes, scratches, buckling, stains, debris, and fluids inside the working channel are common, which increase the microbiological contamination susceptibility. The SpyGlass visualization system may be recommended to identify suboptimal reprocessing.
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Affiliation(s)
- Tao-Chieh Liu
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
| | - Chen-Ling Peng
- Department of Integrated Diagnostics & Therapeutics, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei 10002, Taiwan
| | - Hsiu-Po Wang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei 114, Taiwan
| | - Hsin-Hung Huang
- Division of Gastroenterology, Cheng Hsin General Hospital, National Defense Medical Center, Taipei 114, Taiwan
| | - Wei-Kuo Chang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
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