Hygiene: The Looming Achilles Heel in Endoscopy

Abstract

Background: Since the late 1970s there have been sporadic reports of nosocomial infections linked to endoscopic procedures. Infections by multidrug-resistant organisms (MDRO) have an increasing impact on healthcare systems worldwide. Since 2010 outbreaks involving MDRO have been reported as a result of endoscopic retrograde cholangiopancreatography (ERCP) from the USA, France, Germany and the Netherlands. Methods: This article evaluates the recent outbreaks and developments and demonstrates a structural approach to how to prevent future infections. Current national and international guidelines were used as a basis for discussions. Results: In some cases insufficient cleaning or drying supported the outbreak. In the majority of cases, outbreaks occurred despite the apparently appropriate reprocessing protocols being in use. Microlesions were identified on a number of endoscopes, which supported the growth of bacteria and represented a vehicle for the transmission of infectious material. National official bodies responded with warnings. Manufacturers informed their customers accordingly. Separate, purpose-designed reprocessing rooms and a sufficient number of competent staff provide the structural quality for a safe reprocessing. The process quality includes a thorough cleaning of all endoscope channels and crucial instrument components, followed by an automated and validated reprocessing procedure. Strict adherence to manufacturers' recommendations is essential. The outcome quality should be evaluated by regular audits, validation of reprocessing procedures and microbiological surveillance. If outbreaks occur, a close co-operation with official bodies and manufacturers is essential. Conclusion: Health care professionals and manufacturers should be aware of their responsibility to ensure patient safety. A structural approach is key in prevention of endoscopy-associated infections.

Accreditation program for gastrointestinal endoscopes reprocessing in Italy: An on-site survey

“…It is known that safe reprocessing is the key to patient safety and that non-compliance with guidelines and deviations from standardized protocols lead to reprocessing faults with the possibility of patient-to-patient transmission. Recent outbreaks of multidrug-resistant bacteria show how narrow the margin of safety is without compliance with protocols 25 . However, most endoscope reprocessing lapses are never reported or associated infections are not recognized, and if an outbreak has not been contained, it may not be reported.…”

Integration of robotic in the reprocessing and transfer of endoscopes

“…In addition, strict adherence to a fully completed and error-free cycle is of central importance for the cleaning result. Hygiene and the cleaning of gastrointestinal endoscopes has been identified as the major problem in further development of flexible endoscopy 8 .…”

Improving the Reprocessing Quality of Flexible Thermolabile Endoscopes: How to Learn from Mistakes

“…Deviation from the manufacturer’s recommendations can potentially lead to residual microorganisms being left on the device, thus increasing the risk of infection. In this context, microbiological surveillance is a valid tool for detecting procedural errors or microlesions of the endoscope, which can facilitate biofilms formation and cause positivity to microbial cultures [ 2 ]. However, infections associated with contaminated endoscopes on which the reprocessing procedure was correctly performed have been reported [ 3 , 4 , 5 , 6 ].…”