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Pineau L, Alfa M, Radix C. Endoscope sampling and culturing methods. J Hosp Infect 2024; 149:36-45. [PMID: 38649121 DOI: 10.1016/j.jhin.2024.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 03/27/2024] [Accepted: 03/27/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Contamination rates reported in the literature for patient-ready flexible endoscopes vary from 0.4% to 49%. Unfortunately, the comparison and interpretation of these results is almost impossible since several factors including sampling and culturing methods, target levels for contamination, or definition of indicator micro-organisms vary widely from one study to the other. AIM To compare the efficacy of six duodenoscope sampling and culturing methods by means of extraction efficacy comparison, while at the same time identifying key parameters that provide optimal microbial recovery. METHODS The duodenoscope sample extraction efficacy of each method was assessed using the repetitive recovery method described in ISO 11737-1: 2018. FINDINGS Mean overall bioburden extraction efficacy varied from 1% for the Australian method to 39% for the French one. The lowest endoscope sample extraction efficacy was associated with the absence of any neutralizer, friction, or tensioactive agent, and when only a small portion of the sampling solution collected was inoculated on to culture media. The efficacy of the sampling and culturing methods also varied according to the nature of micro-organisms present in the endoscope, and the time between sampling and culturing. CONCLUSION This study supports the need for a harmonized and standardized sampling and culturing method for flexible endoscopes.
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Affiliation(s)
- L Pineau
- Medical Device Testing, Eurofins Biotech Germande, Aix-en-Provence, France.
| | - M Alfa
- AlfaMed Consulting Inc., Winnipeg, Manitoba, Canada
| | - C Radix
- Medical Device Testing, Eurofins Biotech Germande, Aix-en-Provence, France
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Masciangelo G, Cecinato P, Bacchilega I, Masetti M, Ferrari R, Zagari RM, Napoleon B, Sassatelli R, Fusaroli P, Lisotti A. Urgent ERCP performed with single-use duodenoscope (SUD) in patients with moderate-to-severe cholangitis: Single-center prospective study. Endosc Int Open 2024; 12:E116-E122. [PMID: 38250162 PMCID: PMC10798844 DOI: 10.1055/a-2219-0826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 11/10/2023] [Indexed: 01/23/2024] Open
Abstract
Background and study aims To assess the outcomes of urgent endoscopic retrograde cholangiopancreatography (ERCP) performed with a single-use duodenoscope (SUD) in patients with moderate-to-severe cholangitis. Patients and methods Between 2021 and 2022 consecutive patients with moderate-to-severe cholangitis were prospectively enrolled to undergo urgent ERCP with SUD. Technical success was defined as the completion of the planned procedure with SUD. Multivariate analysis was used to identify factors related to incidence of adverse events (AEs) and mortality. Results Thirty-five consecutive patients (15 female, age 81.4±6.7 years) were enrolled. Twelve (34.3%) had severe cholangitis; 26 (74.3%) had an American Society of Anesthesiologists (ASA) score ≥3. Twenty-eight patients (80.0%) had a naïve papilla. Biliary sphincterotomy and complete stone clearance were performed in 29 (82.9%) and 30 patients (85.7%), respectively; in three cases (8.6%), concomitant endoscopic ultrasound-gallbladder drainage was performed. Technical and clinical success rates were 100%. Thirty-day and 3-month mortality were 2.9% and 14.3%, respectively. One patient had mild post-ERCP pancreatitis and two had delayed bleeding. No patient or procedural variables were related to AEs. ASA score 4 and leucopenia were related to 3-month mortality; on multivariate analysis, leukopenia was the only variable independently related to 3-month mortality (odds ratio 12.8; 95% confidence interval 1.03-157.2; P =0.03). Conclusions The results of this "proof of concept" study suggest that SUD use could be considered safe and effective for urgent ERCP for acute cholangitis. This approach abolishes duodenoscope contamination from infected patients without impairing clinical outcomes.
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Affiliation(s)
| | - Paolo Cecinato
- Gastroenterology and Endoscopy Unit, Arcispedale Santa Maria Nuova di Reggio Emilia, Reggio Emilia, Italy
| | - Igor Bacchilega
- Gastroenterology Unit, Hospital of Imola, University of Bologna, Imola, Italy
| | - Michele Masetti
- Gastroenterology Unit, Hospital of Imola, University of Bologna, Imola, Italy
| | - Rodolfo Ferrari
- Gastroenterology Unit, Hospital of Imola, University of Bologna, Imola, Italy
| | | | | | - Romano Sassatelli
- Gastroenterology and Endoscopy Unit, Arcispedale Santa Maria Nuova di Reggio Emilia, Reggio Emilia, Italy
| | - Pietro Fusaroli
- Gastroenterology Unit, Hospital of Imola, University of Bologna, Imola, Italy
| | - Andrea Lisotti
- Gastroenterology Unit, Hospital of Imola, University of Bologna, Imola, Italy
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Pineau L. Endoscope reprocessing: Retrospective analysis of 90,311 samples. Endosc Int Open 2023; 11:E247-E257. [PMID: 36937825 PMCID: PMC10023244 DOI: 10.1055/a-1991-1391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 11/16/2022] [Indexed: 03/19/2023] Open
Abstract
Background and study aims The contamination level of ready-to-use endoscopes published in the literature varies from 0.4 % to 49.0 %. Unfortunately, the comparison and the interpretation of these results are quite impossible, given the limited number of samples and sites included and the differences observed between sampling, culturing methods, and interpretation criteria. Methods The objective of this retrospective study was to analyze the results of 90,311 endoscope samples collected between 2004 and 2021 in 490 private or public hospitals in France. Results Through the full test period, the mean ratio of endoscopes at the action level was 12.6 % (19.5 % including alert level). Of the endoscopy units, 23.0 % had a ratio of compliant endoscopes ≤ 70.0 %. The overall microbial quality of gastroscopes, duodenoscopes, and colonoscopes is improving year by year, whereas an opposite trend is observed for ultrasound endoscopes and bronchoscopes. In 2021, following French guidelines, 13.0 % of the endoscopes should have been quarantined and 8.1 % were at the alert level, meaning that the contamination level of 21.1 % of the endoscopes exceeded what was defined as a maximum acceptable value. Conclusions This study demonstrates that additional efforts, including implementation of microbial surveillance strategies using a standardized sampling method and periodic observational audits, must be made to improve the overall microbiological quality of endoscopes and reduce the risk associated with their use.
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Affiliation(s)
- Lionel Pineau
- Eurofins Biotech Germande, Medical Device Testing, Aix-en-Provence, France
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Allescher HD, Voigt F, Mangold M, Haddadin S. Integration of robotic in the reprocessing and transfer of endoscopes. Endosc Int Open 2022; 10:E1022-E1028. [PMID: 35979027 PMCID: PMC9377825 DOI: 10.1055/a-1789-0532] [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: 06/01/2021] [Accepted: 11/26/2021] [Indexed: 11/18/2022] Open
Abstract
Background and study aims Optimal hygiene is crucial for patients undergoing flexible endoscopy. Reprocessing is currently influenced by manual procedures performed by endoscopy staff. To overcome this limitation, we designed and evaluated the integration of robotic application for an automated endoscope processing pathway. Methods We used an endoscope reprocessing pass through machine with drying cabinet and a Franka Emika Panda robot. The robot was programmed to interact with its environment in a compliant way, guaranteeing desired contact force thresholds and therefore ensuring safety of both robot and medical equipment. Results In an initial phase we tested the robots' ability to handle a modified tray holding an endoscope as well as certain challenges (correct positioning, connection of tubing, undesired collisions). We added another Panda robot arm resulting in a device featuring two independent manipulators and tested the accuracy of each individual step. We evaluated 50 consecutive processing and transfer procedures, simulating the average daily throughput of an endoscopic unit. The endoscopes were removed in adapted tray using a specially designed lifting device and placed in an endoscope storage and venting cabinet. The mean time for the handling of the scope was 104.2 ± 1.2 seconds and an accuracy of 100 % (0 failures in 50 attempts) was achieved. Conclusions To the best of our knowledge, this is the first description and evaluation of an automated compliant robotic assistance in the processing of endoscopes. Further development could help to overcome shortcomings of the man handled endoscope processing and could lead to reproducible, standardized and certified endoscope processing.
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Affiliation(s)
- Hans Dieter Allescher
- Klinikum Garmisch-Partenkirchen, Teaching Hospital of the Ludwig Maximilians University Munich, Munich, Germany
| | - Florian Voigt
- Chair of Robotics Science and Systems Intelligence, Technical University of Munich, Munich, Germany
| | - Martin Mangold
- Klinikum Garmisch-Partenkirchen, Teaching Hospital of the Ludwig Maximilians University Munich, Munich, Germany
| | - Sami Haddadin
- Chair of Robotics Science and Systems Intelligence, Technical University of Munich, Munich, Germany
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Lisotti A, Fusaroli P, Napoleon B, Cominardi A, Zagari RM. Single-use duodenoscopes for the prevention of endoscopic retrograde cholangiopancreatography -related cross-infection – from bench studies to clinical evidence. World J Methodol 2022; 12:122-131. [PMID: 35721249 PMCID: PMC9157629 DOI: 10.5662/wjm.v12.i3.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 01/16/2022] [Accepted: 03/17/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Several strategies have been implemented to reduce or abolish the life-threatening risk of endoscopic retrograde cholangiopancreatography (ERCP)-related multidrug-resistant infections due to duodenoscopes contaminations; among those strategies, serial microbiologic tests, thorough reprocessing schedules, and use of removable scope cap have been adopted, but the potential cross-infection risk was not eliminated.
AIM To review available evidence in the field of single-use duodenoscopes (SUD) use for ERCP.
METHODS An overview on ongoing clinical studies was also performed to delineate which data will become available in the next future.
RESULTS One bench comparative study and four clinical trials performed with EXALT model-D (Boston Scientific Corp., United States) have been identified. Of them, one is a randomized controlled trial, while the other three studies are prospective single-arm, cross-over studies. Pooled technical success rate (4 studies, 368 patients) was 92.9% [95% confidence interval (CI): 89.9-95.5; I2: 11.8%]. Pooled serious adverse event (4 studies, 381 patients) rate was 5.9% [3.7%-8.5%; I2: 0.0%].
CONCLUSION Although few clinical trials are available, evidence is concordant in identifying an absolute feasibility and safety and feasibility for SUD use for ERCP. The expertise and quality of evidence in this field are going to be improved by further large clinical trials; data on cost-effectiveness and environmental impact will be needed for a worldwide spread of SUD use for ERCP.
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Affiliation(s)
- Andrea Lisotti
- Gastroenterology Unit, Hospital of Imola, University of Bologna, Imola 40026, BO, Italy
| | - Pietro Fusaroli
- Gastroenterology Unit, Hospital of Imola, University of Bologna, Imola 40026, BO, Italy
| | - Bertrand Napoleon
- Gastroenterology Unit, Hôpital privé Jean Mermoz - Ramsay Générale de Santé, Lyon 69008, FR, France
| | - Anna Cominardi
- Gastroenterology Unit, Hospital of Imola, University of Bologna, Imola 40026, BO, Italy
| | - Rocco Maurizio Zagari
- Dipertimento Di Scienze Mediche e Chirurgiche, Università di Bologna, Policlinico San Orsola Malpighi, Bologna 40138, Italy
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Yang SY, Choi JW, Kim KM, Kwon JS. Evaluation of the time-dependent efficacy of commercial denture or orthodontic appliance cleansers: An in vitro study. Dent Mater J 2021; 41:214-225. [PMID: 34789624 DOI: 10.4012/dmj.2021-200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The aim of this study was to evaluate the antimicrobial, stain and protein removal efficacy of denture or orthodontic appliance cleansers using in vitro test methods. Experimental cleansers were applied for experimental time in each evaluation method. To evaluate the microorganism removal efficacy, C. albicans and S. mutans removal rate was calculated from the specimen surface. Stain and protein removal rate was calculated using the spectrophotometer. Experimental cleansers significantly affected the microorganism removal rate for both C. albicans and S. mutans, as well as the stain and protein removal rates, at each experimental time (p<0.05). As the application time increased, the stain and protein removal rates of all experimental cleansers significantly increased (p<0.05). The present study provided in vitro evaluation methods to assess the efficacy of denture or orthodontic appliance cleansers. Also, manufacturers and researchers can predict clinical outcomes and ensure proper hygiene management of dentures or orthodontic appliances.
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Affiliation(s)
- Song-Yi Yang
- Department and Research Institute of Dental Biomaterials and Bioengineering, Yonsei University College of Dentistry
| | - Ji-Won Choi
- Department and Research Institute of Dental Biomaterials and Bioengineering, Yonsei University College of Dentistry.,BK21 FOUR Project, Yonsei University College of Dentistry
| | - Kwang-Mahn Kim
- Department and Research Institute of Dental Biomaterials and Bioengineering, Yonsei University College of Dentistry
| | - Jae-Sung Kwon
- Department and Research Institute of Dental Biomaterials and Bioengineering, Yonsei University College of Dentistry.,BK21 FOUR Project, Yonsei University College of Dentistry
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Casini B, Pan A, Guarini A, Rivara C, Zullo A, Monica F, Cimbro M, Casarano S, Inglese A, Vaghi A, Schiffino L, Capezzuto E, Da Massa Carrara P, Pasquale L. Multisocieties position paper: Microbiological surveillance on flexible endoscopes. Dig Liver Dis 2021; 53:1105-1111. [PMID: 34266792 DOI: 10.1016/j.dld.2021.06.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 06/14/2021] [Accepted: 06/15/2021] [Indexed: 12/11/2022]
Abstract
Transmission with endoscopes, particularly duodenoscope, of potential lethal infections prompted different scientific societies to deliver recommendations aimed reducing this risk. Some International societies extended recommendations on microbial surveillance to all the endoscopes and devices used in the reprocessing procedure. Considering the relevance of the topic, 8 Italian scientific societies of physicians, nurses and technical operators prepared a concerted document taking into account Institutional advisories and facilities in Italy. The rules for a correct microbial surveillance on endoscopes were detailed in term of what, how and when to perform the procedure, also suggesting behaviors in case of contamination.
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Affiliation(s)
- Beatrice Casini
- Dipartimento di Ricerca Traslazionale e Nuove Tecnologie in Medicina e Chirurgia Università di Pisa, Pisa.
| | | | | | - Cinzia Rivara
- Gastroenterologia, S.C. ASL TO4 Ciriè-Chivasso-Cuorgnè, Torino
| | - Angelo Zullo
- Gastroenterologia, Ospedale Nuovo Regina Margherita, Roma
| | - Fabio Monica
- Gastroenterologia, Azienda Ospedaliera Universitaria Cattinara, Trieste
| | | | | | | | - Adriano Vaghi
- Pneumologia, Ospedale Generale di Garbagnate Milanese, Milano
| | | | | | | | - Luigi Pasquale
- Gastroenterologia, S. O. Ospedale Frangipane, Ariano Irpino, Avellino
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Cheung DY, Jang BI, Kim SW, Kim JH, Kim HK, Shin JE, Yoon WJ, Lee YK, Chung KH, Cho SJ, Shin HP, Cho SY, Shin WG, Choi KD, Kim BW, Kwon JG, Yang HC, Gweon TG, Kim HG, Ahn DW, Cho KB, Kim SH, Hwang KH, Im HH. Multidisciplinary and Multisociety Practice Guideline on Reprocessing Flexible Gastrointestinal Endoscopes and Endoscopic Accessories. Clin Endosc 2020; 53:276-285. [PMID: 32506894 PMCID: PMC7280845 DOI: 10.5946/ce.2020.106] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 11/22/2022] Open
Abstract
The area of endoscopic application has been continuously expanded since its introduction in the last century and the frequency of its use also increased stiffly in the last decades. Because gastrointestinal endoscopy is naturally exposed to diseased internal organs and contact with pathogenic materials, endoscopy mediated infection or disease transmission becomes a major concern in this field. Gastrointestinal endoscopy is not for single use and the proper reprocessing process is a critical factor for safe and reliable endoscopy procedures. What needed in these circumstances is a practical guideline for reprocessing the endoscope and its accessories which is feasible in the real clinical field to guarantee acceptable prevention of pathogen transmission. This guideline contains principles and instructions of the reprocessing procedure according to the step by step. And it newly includes general information and updated knowledge about endoscopy-mediated infection and disinfection. Multiple societies and working groups participated to revise; Korean Association for the Study of the Liver, the Korean Society of Infectious Diseases, Korean College of Helicobacter and Upper Gastrointestinal Research, the Korean Society of Gastroenterology, Korean Society of Gastrointestinal Cancer, Korean Association for the Study of Intestinal Diseases, Korean Pancreatobiliary Association, the Korean Society of Gastrointestinal Endoscopy Nurses and Associates and Korean Society of Gastrointestinal Endoscopy. Through this cooperation, we enhanced communication and established a better concordance. We still need more researches in this field and fill up the unproven area. And our guidelines will be renewed accordingly.
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Affiliation(s)
- Dae Young Cheung
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Byung Ik Jang
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Sang Wook Kim
- Department of Internal Medicine, Jeonbuk National University Medical School, Jeonju, Korea
| | - Jie-Hyun Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Kroea
| | - Hyung Keun Kim
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Jeong Eun Shin
- Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Won Jae Yoon
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Yong Kang Lee
- Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Kwang Hyun Chung
- Department of Internal Medicine, Eulji University School of Medicine, Daejeon, Korea
| | - Soo-Jeong Cho
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun Phil Shin
- Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - Sun Young Cho
- Department of Internal Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Woon Geon Shin
- Department of Internal Medicine, Hallym University College of Medicine, Seoul, Korea
| | - Kee Don Choi
- Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Byung-Wook Kim
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Joong Goo Kwon
- Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Hee Chan Yang
- Department of Internal Medicine, Jeonbuk National University Medical School, Jeonju, Korea
| | - Tae-Geun Gweon
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Hyun Gun Kim
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Dong-Won Ahn
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Kwang Bum Cho
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | | | - Kyong Hwa Hwang
- The Catholic University of Korea Seoul St. Mary’s Hospital, Seoul, Korea
| | - Hee Hyuk Im
- Soon Chun Hyang University Seoul Hospital, Seoul, Korea
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Shin JE, Jung Y, Lee JH, Son BK, Jang JY, Kim HK, Jang BI. Updates on the Disinfection and Infection Control Process of the Accredited Endoscopy Unit. Clin Endosc 2019; 52:443-450. [PMID: 31591281 PMCID: PMC6785420 DOI: 10.5946/ce.2019.173] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 09/23/2019] [Indexed: 11/16/2022] Open
Abstract
A thorough disinfection and infection control process associated with gastrointestinal endoscopy is highly important for the health and safety of the examinee and the medical staff involved in the procedure. Endoscopic reprocessing and disinfection are two of the most important steps in quality control of endoscopy. In 2019, the Korean Society of Gastrointestinal Endoscopy updated the Accreditation of Qualified Endoscopy Unit assessment items for these quality indicators. Assessment of disinfection and infection control comprises 28 mandatory items in the categories of disinfection education, pre-cleaning, cleaning, disinfection, rinsing, drying, reprocessing, storage, endoscopic accessories, water bottle and connectors, space/facilities, personal protective equipment, disinfection ledger, and regulations regarding infection control and disinfection. The updated Accreditation of Qualified Endoscopy Unit assessment items are useful for improving the quality of endoscopy by ensuring thorough inspection of endoscopic disinfection and infection control.
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Affiliation(s)
- Jeong Eun Shin
- Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Yunho Jung
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Jeong Hoon Lee
- Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Byoung Kwan Son
- Department of Internal Medicine, Eulji University College of Medicine, Seoul, Korea
| | - Jae-Young Jang
- Department of Internal Medicine, Kyung Hee University College of Medicine, Seoul, Korea
| | - Hyung-Keun Kim
- Division of Gastroenterology, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Byung Ik Jang
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
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