Hostname: page-component-cd9895bd7-7cvxr Total loading time: 0 Render date: 2024-12-24T01:39:49.541Z Has data issue: false hasContentIssue false
  • English
  • Français

Association Between Storage Interval and Contamination of Reprocessed Flexible Endoscopes in a Pediatric Gastrointestinal Procedural Unit

Published online by Cambridge University Press:  07 November 2016

Patricia Scanlon ,
Kathleen Flaherty ,
Erik A. Reilly ,
Ellen G. Barth ,
Gail Potter-Bynoe ,
Jeff Cardini ,
Ann Marie Riley ,
Alexander J. McAdam  and
Thomas J. Sandora
Patricia Scanlon
Affiliation:
Infection Prevention and Control, Boston Children’s Hospital, Boston, Massachusetts
Kathleen Flaherty
Affiliation:
Infection Prevention and Control, Boston Children’s Hospital, Boston, Massachusetts
Erik A. Reilly
Affiliation:
Department of Nursing, Boston Children’s Hospital, Boston, Massachusetts
Ellen G. Barth
Affiliation:
Department of Nursing, Boston Children’s Hospital, Boston, Massachusetts
Gail Potter-Bynoe
Affiliation:
Infection Prevention and Control, Boston Children’s Hospital, Boston, Massachusetts
Jeff Cardini
Affiliation:
Department of Nursing, Boston Children’s Hospital, Boston, Massachusetts
Ann Marie Riley
Affiliation:
Department of Laboratory Medicine, Boston Children’s Hospital, Boston, Massachusetts
Alexander J. McAdam
Affiliation:
Department of Laboratory Medicine, Boston Children’s Hospital, Boston, Massachusetts
Thomas J. Sandora*
Affiliation:
Infection Prevention and Control, Boston Children’s Hospital, Boston, Massachusetts Division of Infectious Diseases, Boston Children’s Hospital, Boston, Massachusetts
*
Address correspondence to Thomas J. Sandora, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115 ([email protected]).
Get access Rights & Permissions [Opens in a new window]

Abstract

OBJECTIVE

The maximum safe storage interval after endoscope reprocessing remains unknown. We assessed the association between storage interval and endoscope contamination to evaluate the need for scope reprocessing prior to use.

METHODS

We conducted a study in 2 phases. In phase 1, we cultured 9 gastrointestinal (GI) endoscopes that had been stored for at least 7 days since reprocessing. Each scope was cultured in 3 places: external surfaces of hand piece, insertion tube, and internal channels. In phase 2, after reprocessing these scopes, we hung and cultured them prospectively in a similar fashion at 1-, 2-, 4-, 6-, and 8-week intervals without patient use. We defined clinically relevant contamination as >100 colony-forming units per milliliter (CFU/mL).

RESULTS

In phase 1, median hang time was 69 days (range, 8–555 days). Considering the 27 total cultures, 3 of 27 GI endoscopes (11.1%) had positive cultures, all with nonpathogenic skin flora at ≤100 CFU/mL. Median hang time was not statistically different between scopes with positive and negative cultures (P=.82). In phase 2, 7 of 131 prospective cultures (5.3%) from 6 of 9 GI endoscopes at varying storage intervals were positive, all at ≤100 CFU/mL. At 56 days after reprocessing (the longest storage interval studied), 1 of 24 cultures (4.2%) was positive (100 CFU/mL of Bacillus species from external biopsy/suction ports).

CONCLUSIONS

No endoscopes demonstrated clinically relevant contamination at hang times ranging from 7 to 555 days, and most scopes remained uncontaminated up to 56 days after reprocessing. Our data suggest that properly cleaned and disinfected GI endoscopes could be stored safely for longer intervals than currently recommended.

Infect. Control Hosp. Epidemiol. 2017;38:131–135

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 2 , February 2017 , pp. 131 - 135
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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.)

Footnotes

PREVIOUS PRESENTATION. These data were presented in part as an abstract at IDWeek 2014, October 11, 2014, Philadelphia, Pennsylvania.

References

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.Google Scholar
2. Wendorf, KA, Kay, M, Baliga, C, et al. Endoscopic retrograde cholangiopancreatography-associated AmpC Escherichia coli outbreak. Infect Control Hosp Epidemiol 2015;36:634–642.Google Scholar
3. Burlingame, B, Denholm, B, Link, T, et al. AORN guideline for processing flexible endoscopes. Guidelines for perioperative practice. Associaton of Perioperative Registered Nurses website. http://www.aornstandards.org/content/1/SEC34.extract. Published 2016. Accessed October 14, 2016.Google Scholar
4. Alvarado, CJ, Reichelderfer, M. APIC guideline for infection prevention and control in flexible endoscopy. Association for Professionals in Infection Control. Am J Infect Control 2000;28:138–155.Google Scholar
5. Petersen, BT, Chennat, J, Cohen, J, et al. Multisociety guideline on reprocessing flexible GI endoscopes: 2011. Infect Control Hosp Epidemiol 2011;32:527–537.Google Scholar
6. Schmelzer, M, Daniels, G, Hough, H. Safe storage time for reprocessed flexible endoscopes: a systematic review. JBI Database System Rev Implement Rep 2015;13:187–243.Google Scholar
7. Alfa, MJ, Sepehri, S, Olson, N, Wald, A. Establishing a clinically relevant bioburden benchmark: a quality indicator for adequate reprocessing and storage of flexible gastrointestinal endoscopes. Am J Infect Control 2012;40:233–236.Google Scholar
8. Ofstead, CL, Wetzler, HP, Doyle, EM, et al. Persistent contamination on colonoscopes and gastroscopes detected by biologic cultures and rapid indicators despite reprocessing performed in accordance with guidelines. Am J Infect Control 2015;43:794–801.Google Scholar
9. Bourdon, L. Addressing the complexities of flexible endoscope reprocessing. AORN J 2015;101:P7–P9.Google Scholar
10. Ofstead, CL, Wetzler, HP, Snyder, AK, Horton, RA. Endoscope reprocessing methods: a prospective study on the impact of human factors and automation. Gastroenterol Nurs 2010;33:304–311.Google Scholar
11. Rejchrt, S, Cermak, P, Pavlatova, L, McKova, E, Bures, J. Bacteriologic testing of endoscopes after high-level disinfection. Gastrointest Endosc 2004;60:76–78.Google Scholar
12. Riley, R, Beanland, C, Bos, H. Establishing the shelf life of flexible colonoscopes. Gastroenterol Nurs 2002;25:114–119.Google Scholar
13. Vergis, AS, Thomson, D, Pieroni, P, Dhalla, S. Reprocessing flexible gastrointestinal endoscopes after a period of disuse: is it necessary? Endoscopy 2007;39:737–739.Google Scholar
14. Brock, AS, Steed, LL, Freeman, J, Garry, B, Malpas, P, Cotton, P. Endoscope storage time: assessment of microbial colonization up to 21 days after reprocessing. Gastrointest Endosc 2015;81:1150–1154.Google Scholar
15. Ingram, J, Gaines, P, Kite, R, Morgan, M, Spurling, S, Winsett, RP. Evaluation of medically significant bacteria in colonoscopes after 8 weeks of shelf life in open air storage. Gastroenterol Nurs 2013;36:106–111.CrossRefGoogle ScholarPubMed
16. Shin, SP, Kim, WH. Recent update on microbiological monitoring of gastrointestinal endoscopes after high-level disinfection. Clin Endosc 2015;48:369–373.Google Scholar
17. Hansen, D, Benner, D, Hilgenhoner, M, Leisebein, T, Brauksiepe, A, Popp, W. ATP measurement as method to monitor the quality of reprocessing flexible endoscopes. Ger Med Sci 2004;2:Doc04.Google Scholar
18. Batailler, P, Saviuc, P, Picot-Gueraud, R, Bosson, JL, Mallaret, MR. Usefulness of adenosinetriphosphate bioluminescence assay (ATPmetry) for monitoring the reprocessing of endoscopes. Infect Control Hosp Epidemiol 2015;36:1437–1443.Google Scholar
19. Interim culture method for the duodenoscope—distal end and instrument channel. Centers for Disease Control and Prevention website. https://www.cdc.gov/hai/pdfs/lab/interim-duodenoscope-culture-method.pdf. Published 2015. Accessed June 8, 2016.Google Scholar
20. Heeg, P. Reprocessing endoscopes: national recommendations with a special emphasis on cleaning—the German perspective. J Hosp Infect 2004;56(Suppl 2):S23–S26.Google Scholar
21. 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.Google Scholar
22. Saviuc, P, Picot-Gueraud, R, Shum Cheong Sing, J, et al. Evaluation of the quality of reprocessing of gastrointestinal endoscopes. Infect Control Hosp Epidemiol 2015;36:1017–1023.Google Scholar
23. Interim protocol for healthcare facilities regarding surveillance for bacterial contamination of duodenoscopes after reprocessing. Centers for Disease Control and Prevention website. http://www.cdc.gov/hai/pdfs/cre/interim-duodenoscope-surveillance-Protocol.pdf. Published 2015. Accessed June 8, 2016.Google Scholar