Hostname: page-component-78c5997874-94fs2 Total loading time: 0 Render date: 2024-11-20T04:43:35.677Z Has data issue: false hasContentIssue false
  • English
  • Français

Application of Environmental Sampling to Flexible Endoscope Reprocessing: The Importance of Monitoring the Rinse Water

Published online by Cambridge University Press:  02 January 2015

Lawrence F. Muscarella
Lawrence F. Muscarella*
Affiliation:
Research and Development at Custom Ultrasonics, Inc., Ivyland, Pennsylvania
*
Research and Development, Custom Ultrasonics, Inc., 144 Railroad Ivyland, PA 18974
Get access Rights & Permissions [Opens in a new window]

Abstract

The routine sampling of environmental surfaces within a healthcare facility is generally not recommended by the Centers for Disease Control and Prevention (CDC), the Association for the Advancement of Medical Instrumentation (AAMI), and several other healthcare organizations. There are a few circumstances, however, for which some organizations do recommend this practice. For instance, the CDC and the Association for Professionals in Infection Control and Epidemiology (APIC) recommend environmental sampling as clinically required during an outbreak investigation. The CDC and AAMI also recommend routine sampling of the rinse water used during hemodialyzer (but not endoscope) reprocessing. The rationale for this recommendation is based in part on reports of pyrogenic responses, patient infections, and bacteremia due to waterborne, gram-negative bacteria during hemodialysis. To determine whether the basis for this rationale might similarly apply to the rinse water used during endoscope reprocessing, the Food and Drug Administration's medical device reporting database, the endoscope reprocessing literature, and other sources were reviewed. The results of this review indicate that nosocomial outbreaks linked to endoscopes contaminated with gram-negative bacteria have been frequently reported. As a result, for several reasons, including to minimize the risk of patient infection due to gram-negative bacteria following endoscopy, this article recommends routine microbiologic sampling of the rinse water used during endoscope reprocessing.

Type
Readers' Forum
Information
Infection Control & Hospital Epidemiology , Volume 23 , Issue 5 , May 2002 , pp. 285 - 289
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2002

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Garner, JS, Favero, M. CDC Guidelines. Am J Infect Control 1986;14:110–129.CrossRefGoogle ScholarPubMed
2.Gordon, SM, Tipple, M, Bland, LA, Jarvis, WR. Pyrogenic reactions associated with the reuse of disposable hollow-fiber hemodialyzers. JAMA 1988;260:2077–2081.Google Scholar
3.Association for the Advancement of Medical Instrumentation. American National Standards for Dialysis Systems. Arlington, VAAssociation for the Advancement of Medical Instrumentation; 1993.Google Scholar
4.Arduino, MJ, Bland, LA, Aguero, SM, Carson, L, Ridgeway, M, Favero, MS. Comparison of microbiologic assay methods for hemodialysis fluids. J Clin Microbiol 1991;29:592–594.CrossRefGoogle ScholarPubMed
5.Man, NK, Degremont, A, Darbord, JC, Collet, M, Vaillant, P. Evidence of bacterial biofilm in tubing from hydraulic pathway of hemodialysis system. Artif Organs 1998;22:596–600.CrossRefGoogle ScholarPubMed
6.Bland, LA. Microbiological and endotoxin assays of hemodialysis fluids. Adv Ren Replace Ther 1995;2:70–79.CrossRefGoogle ScholarPubMed
7.Jackson, BM, Beck-Sague, CM, Bland, LA, Arduino, MJ, Meyer, L, Jarvis, WR. Outbreak of pyrogenic reactions and gram-negative bacteremia in a hemodialysis center. Am J Nephrol 1994;14:85–89.Google Scholar
8.Pegues, DA, Oettinger, CW, Bland, LA, et al. A prospective study of pyrogenic reactions in hemodialysis patients using bicarbonate dialysis fluids filtered to remove bacteria and endotoxin. J Am Soc Nephrol 1992; 3:1002–1007.Google Scholar
9.Struelens, MJ, Rost, F, Deplano, A, et al. Pseudomonas aeruginosa and Enterobacteriaceae bacteremia after biliary endoscopy: an outbreak investigation using DNA macrorestriction analysis. Am J Med 1993; 95:489–498.Google Scholar
10.Alvarado, CJ, Stolz, SM, Maki, DG. Nosocomial infections from contaminated endoscopes: a flawed automated endoscope washer: an investigation using molecular epidemiology. Am J Med 1991;91(3B):272S–280S.CrossRefGoogle ScholarPubMed
11.Muscarella, LE. Déjà vu… all over again? The importance of instrument drying. Infect Control Hosp Epidemiol 2000;21:628–629.Google Scholar
12.Mitchell, DH, Hicks, LJ, Chiew, R, Montanaro, JC, Chen, SC. Pseudoepidemic of Legionella pneumophila serogroup 6 associated with contaminated bronchoscopes. J Hosp Infect 1997;37:19–23.Google Scholar
13.Muscarella, LE. Disinfecting endoscopes immediately before the first patient of the day. AORN J 2001;73:1159–1163.CrossRefGoogle ScholarPubMed
14.Food and Drug Administration. Guidance on Premarket Notification [510(k)] Submissions for Sterilizers Intended for Use in Healthcare Facilities. Rockville, MD: Center for Devices and Radiologic Health; 1993.Google Scholar
15.Ledebo, I, Nystrand, R. Defining the microbiological quality of dialysis fluid. Artif Organs 1999;23:37–43.Google Scholar
16.Ismail, N, Becker, BN, Hakim, RM. Water treatment for hemodialysis. Am J Nephrol 1996;16:60–67.Google Scholar
17.Yu, VL. Resolving the controversy on environmental cultures for Legionella: a modest proposal. Infect Control Hosp Epidemiol 1998; 19:893–897.CrossRefGoogle ScholarPubMed
18.Ta, AC, Stout, JE, Yu, VL, Wagener, MM. Comparison of culture methods for monitoring Legionella species in hospital potable water systems and recommendations for standardization of such methods. J Clin Microbiol 1995;33:2118–2123.CrossRefGoogle ScholarPubMed
19.Chow, J, Yu, VL. Legionella: a major opportunistic pathogen in transplant recipients. Semin Respir Infect 1998;13:132–139.Google Scholar
20.Lin, YE, Stout, JE, Yu, VL, Vidic, RD. Disinfection of water distribution systems for Legionella. Semin Respir Infect 1998;13:147–159.Google Scholar
21.Muscarella, LF. Limited surveillance in the endoscopic setting: has its time arrived? Am J Infect Control 2002;30:66–67.Google ScholarPubMed
22.Centers for Disease Control and Prevention. Epidemiologic notes and reports of bacteremia associated with reuse of disposable hollow-fiber hemodialyzers. MMWR 1986;35:417–418.Google Scholar
23.Alvarado, CJ, Reichelderfer, M. APIC guideline for infection prevention and control in flexible endoscopy. Am J Infect Control 2000;28:138–155.Google Scholar
24.Bond, WW, Hedrick, ER. Microbiological culturing of environmental and medical-device surfaces. In: Isenberg, HD, Gilchrist, MJR eds. Clinical Microbiology Procedures Handbook, Section 11: Epidemiologic and Infection Control Microbiology. Washington, DC: American Society for Microbiology; 1992:11.10.1–11.10.9.Google Scholar
25.Merighi, A, Contato, E, Scagliarini, Ret al. Quality improvement in gastrointestinal endoscopy: microbiologic surveillance of disinfection. Gastrointest Endosc 1996;43:457–462.Google Scholar
26.Muscarella, LF. Automatic flexible endoscope reprocessors. Gastrointest Endosc Clin N Am 2000;10:245–257.Google Scholar
27.Berlau, J. A new risk for high-tech surgery? Investor's Business Daily. February 14, 2000;16:A1, A26.Google Scholar
28.Hospital Infection Society. Quality of water for endoscopy equipment: a Working group of the HIS. Available at www.his.org.uk/work/qwee.html.Google Scholar
29.Humphreys, H, Lee, JV. Water quality for endoscope washer-disinfectors. J Hosp Infect 1999;42:76–78.Google Scholar
30.Phillips, G, McEwan, H, Butler, J. Quality of water in washer-disinfectors. J Hosp Infect 1995;31:152–154.CrossRefGoogle ScholarPubMed
31.Cooke, RPD, Whymant-Morris, A, Umasankar, RS, Goddard, SV. Bacteria-free water for automatic washer-disinfectors: an impossible dream? J Hosp Infect 1998;39:63–65.CrossRefGoogle ScholarPubMed