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

Abstract

Background: Failure in the reprocessing of thermolabile flexible endoscopes has been reported as one of the most important threats to patient health. Method: A case report and observational study was conducted, from August 2014 to December 2019, in the Digestive Endoscopy Unit of a University Hospital in Italy, where two cases of Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae infections in patients undergoing endoscopic retrograde cholangio-pancreatography were observed. Following the risk/safety management practices, an epidemiological investigation was started, duodenoscopes were removed from use and the reprocessing practices reviewed. Moreover, microbiological surveillance of endoscopes was carried out according to the CDC guidelines. Results: In the first phase of sampling, 10/10 (100%) endoscopes were found to be non-compliant, of which 7 showed results for high-concern organisms (HCOs), such as KPC-K. pneumoniae, P. aeruginosa and E. coli. After implementing corrective actions, 12 out of 17 endoscopes were found to be non-compliant (70.5%), of which 8 showed results for HCOs, such as KPC-K. oxytoca and P. aeruginosa. During the last year of regular microbiological surveillance, only 23% of endoscopes (35/152) were found to be non-compliant, of which 7 showed results for HCOs, such as NDM-K. pneumoniae, P. aeruginosa and A. baumannii. The crucial issues were related to samples collected from the internal channels of duodenoscopes. Conclusion: Managing the risk associated with the reprocessing of digestive endoscopes, through risk assessment at every stage of the process, is important for the prevention of infections associated with the use of these device.

Adoption of Improved Reprocessing Decreased Microbiological Non-Compliance for Bronchoscopes

“…The microbiological sampling of washer–disinfectors and the storage cabinet was carried out as previously reported [ 23 ].…”

Eine systematische Analyse nosokomialer Ausbrüche von Infektionskrankheiten in der gastrointestinalen Endoskopie

“…Dies deckt sich mit Beobachtungen anderer, bei denen ebenfalls weniger als die Hälfte der Mitarbeiter der Endoskopieabteilung zuvor in diese Tätigkeiten ausreichend detailliert eingewiesen worden waren [11]. Um eine akzeptable Prozess-und damit auch Ergebnisqualität vorhalten zu können, erscheint es daher unverzichtbar, dass regelmäßig Schulungen zum korrekten Vorgehen bei der Endoskopanwendung und anschließenden -aufbereitung erfolgen [12,13].…”