Australian infection control in endoscopy consensus statements on carbapenemase‐producing Enterobacteriaceae

Abstract

Outbreaks of carbapenemase‐producing Enterobacteriaceae clinical infections related to endoscopic transmission are well documented. The high morbidity and mortality associated with these infections emphasizes the need to reassess endoscopic reprocessing protocols. The Gastroenterological Society of Australia established a multi‐society committee to formulate evidence‐based consensus statements on the prevention and management of endoscopic transmission of carbapenemase‐producing Enterobacteriaceae. A literature search was undertaken utilizing the MEDLINE database. Further references were sourced from published paper bibliographies. Nine statements were formulated. Using the Delphi methodology, the statements were initially reviewed electronically by the committee members and subsequently at a face‐to‐face meeting in Melbourne, Australia. After further discussion, four additional sub‐statements were added resulting in a total of 13 statements. Each statement was assessed for level of evidence, recommendation grade and the voting on recommendation was recorded. For a statement to be accepted, five out of six committee members had to “accept completely” or “accept with some reservation.” All 13 statements achieved consensus agreement. Eleven statements achieved 100% “accepted completely.” Two statements were 83% “accepted completely” and 17% “accepted with some reservation.” Of particular significance, automated flexible endoscope reprocessors were mandated for high‐level disinfection, and the use of forced‐air drying cabinets was mandated for endoscope storage. These evidence‐based statements encourage preventative strategies with the aim of ensuring the highest possible standards in flexible endoscope reprocessing thereby optimizing patient safety. They must be considered in addition to the broader published guidelines on infection control in endoscopy.

The Effectiveness of Drying on Residual Droplets, Microorganisms, and Biofilms in Gastrointestinal Endoscope Reprocessing: A Systematic Review

“…According to the Australian Infection Control in Endoscopy Consensus Statements [37], Korean Society of Gastrointestinal Endoscopy Guidelines [38], Multisociety guideline on reprocessing flexible GI endoscopes [39], American Society for Gastrointestinal Endoscopy (ASGE) [40], Association for Professionals in Infection Control (APIC) [41], Japan Gastroenterological Endoscopy Society (JGEC) [42], World Gastroenterology Organization/World Endoscopy Organization (WGO/WEO) Global Guidelines [43,44], Canada Infection Prevention and Control Guideline [45], and Society of Gastroenterology Nurses and Associates [46], 70% to 90% alcohol should be used to flush the endoscope working channel before storage, followed by thorough compressed air drying (AER or AER plus manual drying). Alcohol flushing can not only accelerate the drying process but also inhibit the possible existence of water microorganisms.…”

Monthly endoscopy surveillance culture facilitates detection of breaches in the scope reprocessing procedure: 5‐year experience in an endoscopy center

“…The microbiological culture of endoscopes is critical to understanding the e cacy of reprocessing and transmission of microorganisms during outbreak investigations [8, 17,18,[21][22][23]. However, the existing guidelines are inconsistent in terms of the recommended frequency and method of microbiological monitoring [7,9,24] (Table 6). In Europe [7] and Australia [9,10], endoscopy microbiology surveillance is regarded as a critical indicator of endoscope reprocessing quality.…”

“…7 The Australia guideline recommends that duodenoscopes and endoscopic ultrasound instruments are monitored every month, and other endoscopes are monitored every 3 months. 9 In the United States, microbiology testing of endoscopes after reprocessing, during storage, or before use is not advised. 2 The Digestive Endoscopy Society of Taiwan (DEST) recommends randomly testing at routine intervals.…”

Monthly endoscopy surveillance culture facilitates detection of breaches in the scope reprocessing procedure: 5 year-experience in an endoscopy center

“…The microbiological culture of endoscopes is critical to understanding the e cacy of reprocessing and transmission of microorganisms during outbreak investigations [8,17,18,[21][22][23]. However, the existing guidelines are inconsistent in terms of the recommended frequency and method of microbiological monitoring [7,9,24] (Table 6). In Europe [7] and Australia [9,10], endoscopy microbiology surveillance is regarded as a critical indicator of endoscope reprocessing quality.…”

“…However, the existing guidelines are inconsistent in terms of the recommended frequency and method of microbiological monitoring [7,9,24] (Table 6). In Europe [7] and Australia [9,10], endoscopy microbiology surveillance is regarded as a critical indicator of endoscope reprocessing quality. DEST recommend that microbiology surveillance is performed at a regular frequency [10].…”