Infection Control Today

JUN 2019

ICT delivers to infection preventionists & their colleagues in the operating room, sterile processing/central sterile, environmental services & materials management, timely & relevant news, trends & information impacting the profession & the industry

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Page 27 of 35

24 ICT June 2019 feature By Stephen Spanos, MD G astrointestinal endoscopy is common – every year doctors perform 18 million procedures in the United States. And endoscopes are increasingly being outfi tted with ultra-high defi nition cameras, 3-D images, and other technologies to improve diagnostic performance. Yet the guidelines governing the cleaning and disinfecting of endoscopes (colonoscopes, gastro- scopes, bronchoscopes, duodenoscopes, etc.) so that they can be used again are over 50 years old. This needs to change. The complexity of these scopes and the fact that they invariably become highly contaminated during use, makes cleaning and disinfecting them properly between uses very diffi cult. It has to be done exactly right or it's not effective in eradicating contaminants. In theory, the process of high-level disinfection (HLD) should completely eliminate all microorganisms (except small number of bacterial spores) from endoscopes. But repeated analysis has shown that even after being cleaned and disinfected according to protocol, 30 percent or more of endoscopes – especially duodenoscopes – remain contaminated with substantial numbers of potential pathogens. This presents a grave risk: In the past few years, there have been multiple reports of patients becoming infected and even dying from exposure to pathogens from contaminated endoscopes. A 2018 Johns Hopkins University study published in GUT, for example, found that of the 15 million colonoscopies performed each year at U.S. ambulatory surgical centers (ASGs), 1 out of 1,000 patients was infected. The same study concluded that of the 7 million osophagogastroduodenoscopies (OGDs) performed at ambulatory centers, 3 out of 1,000 patients were infected. Infections after bronchoscopies were even higher, 16 out of 1,000. Cori Ofstead, president and CEO of Ofstead & Associates, published a study last year in the journal As the MDRO Threat Mounts, It's Time to Update the Spaulding Classif cation Chest looking at bronchoscope contamination at three hospitals. She found that 100 percent of the scopes evaluated had residual contamination post manual cleaning. Fifty-eight percent of the fully reprocessed bronchoscopes showed microbial growth, including mold, Stenotrophomonas maltophilia, and Escherichia coli and Shigella spp. A study by infectious disease experts at Harvard Medical School published in the April 2019 issue of Clinical Infectious Diseases reported the fi rst documented healthcare "transmission of mcr-1-harboring bacteria in the U.S." The Harvard team reported that transmission "likely occurred via duodenoscope despite no identifi able breaches in reprocessing or infection control practices." "Duodenoscope design fl aws leading to transmission of multidrug-resistant organisms (MDROs) persist despite recent initiatives to improve device safety," the team wrote. In 2016, nine University of Colorado Hospital patients developed infections after undergoing surgeries with a duodenoscope. Three of the patients died, although it is unclear what role these infections played in their deaths. According to William A. Rutala, PhD, MPH, CIC, professor of medicine at the UNC School of Medicine and director of the Statewide Program for Infection Control and Epidemiology Division of Infectious Diseases, there have been at least nine cases of duodenoscope-related outbreaks of MDROs in the last several years. In all these cases, healthcare facilities followed proper reprocessing procedures, he said. In an article, "What's New in Reprocessing Endoscopes: Are We Going to Ensure the Needs of the Patient Came First by Shifting from Disinfection to Sterilization?" Rutala writes that "The Centers for Disease Control and Prevention and other investigators monitored endoscope reprocessing procedures used in these outbreaks and concluded that the institutions were compliant with the manufacturer's instructions for use (IFU) and professional organizational recommendations." Ò Duodenoscope design f aws leading to transmission of multidrug- resistant organisms (MDROs) persist despite recent initiatives to improve device safety.

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