Duodenoscope-Associated Infections beyond the Elevator Channel: Alternative Causes for Difficult Reprocessing

Abstract

Objectives: Duodenoscopes have been widely used for both diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP) procedures, but recently, numerous outbreaks of multidrug-resistant organisms (MDRO) infections have been reported which has led to extensive research for their possible causes. Consequently, the aim of this study is to search for possible duodenoscope surface damages that could provide an alternative and plausible source of infections. Materials and Methods: In order to assess both outer and inner surfaces, a duodenoscope was dismantled and samples were taken from the outer resin polymer and from the air/water, elevator, and working (biopsy) channels that were characterized by FTIR, DSC, TGA, AFM, SEM techniques and the antimicrobial activity were tested. Results: Alterations were noticed on both the coating and working channel polymers, with external alterations increasing progressively from the proximal sample to the distal sample near the tip of the scope. However, the results showed that the coating surface was still efficient against bacterial adhesion. Changes in surface texture and also morphological changes were shown. Conclusions: The study describes the impact of routine procedural use and reprocessing cycles on the duodenoscope, showing that these may possibly make it susceptible to bacterial contamination and MDRO biofilm formation due to difficult reprocessing of the altered surfaces.

Antibacterial Polysiloxane Polymers and Coatings for Cochlear Implants

“…The recording of the heat flow as a function of temperature induced composition-dependent transitions in, but not limited to polymer-based structures, playing a very important role in elucidating different material aging behaviors (microbiological, thermal, photochemical, etc.) [ 22 , 23 , 24 , 25 ].…”

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“…A recent study95 concluded that CO 2 emissions associated with single-use scopes is 24–47 times that of reusable scopes, with manufacturing accounting for over 90% of the greenhouse gas emissions. In this specific context, the use of disposable elevator caps might be a more sustainable alternative to disposable complete duodenoscopes95–98 and is recommended for further evaluation by national bodies 99. A reduction in transmissible infections after ERCP may therefore be achieved by innovations to endoscope design, optimising decontamination and reprocessing100 as well as adoption of quality assurance measures 77.…”

Integration eines roboterassistierten Systems in den Aufbereitungsprozess von flexiblen Endoskopen

“…Mehrere Eigenschaften wie das Design und der komplexe Aufbau flexibler Endoskope wurden als mögliche Risikofaktoren definiert, die zur Übertragung beitragen könnten [4,6,7]. Auch eine verzögerte oder unzureichende Trocknung vor der Lagerung und eine nicht strikte Einhaltung der Aufbereitungsvorschriften wurden als Risikofaktoren identifiziert [1].…”