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

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.

Multisociety guideline on reprocessing flexible GI endoscopes and accessories

“…72,75,77,79 Furthermore, an endoscope storage time of under 7 days was also associated with a lower bacterial contamination rate for any pathogen compared with an endoscope storage time 14 days (OR, .43; 95% CI, .19-.99). 72,80 Notably, when restricting the analyses to only bacterial contamination with pathogenic organisms, there was no difference between endoscope storage times of <7 days and 7 days (OR, .50; 95% CI, .13-1.97) (Fig. 4).…”

“…The storage time after which endoscopes should be reprocessed before use, termed "hang-time" or "shelflife," has been the subject of limited, small investigations. 72,[74][75][76][77][78][79][80] Eight studies have examined endoscope storage time evaluating microbial cultures in 1242 procedures. Among these studies there was tremendous variability in terms of endoscope storage time (range, 1-56 days), the timing of when the endoscope was cultured (range, 1-56 days), and which area(s) of the endoscope were cultured (varied among exterior surface, working channel, air/water/suction channels of the endoscope).…”

Storage of gastrointestinal endoscopes: when is the safe time for re-use?

“…The 11 studies that constituted the final review sample are distributed as follows: PubMed (5), BVS (2), Scopus (2) and Web of Science (2). They were carried out in the Czech Republic (1) (21) , France (1) (22) , Australia (2) (23)(24) , United States (3) (25)(26)(27) and Canada (4) (4,(28)(29)(30) . Regarding the level of evidence according to Stetler et al (20) , 18% (22,30) of the selected articles correspond to level 2 (experimental studies) and 82% (4,21,(23)(24)(25)(26)(27)(28)(29) to level 3 (time series).…”

“…It was found that about a third of the publications occurred between the years 2002 and 2007 (36%) (21,(23)(24)28) , but the predominance was from the period between 2008 and 2020 (64%) (4,22,(25)(26)(27)(29)(30) , characterized by a significant increase in cases of transmission of microorganisms by flexible endoscopes.…”

Aufbereitung flexibler Endoskope – offene Fragen und Antworten

“…al. [33] eine 2-phasige Untersuchung durch. In Phase 1 wurden 9 gastrointes-tinale Endoskope untersucht, die nach der maschinellen Aufbereitung mindestens 7 Tage gelagert worden waren.…”