Pseudomonas aeruginosa and Enterobacteriaceae bacteremia after biliary endoscopy: An outbreak investigation using DNA macrorestriction analysis

Struelens, Marc; Rost, F.; Deplano, Ariane; Maas, Axel; Schwam, Valérie; Serruys, Elisabeth Schoutens; Cremer, Michel

doi:10.1016/0002-9343(93)90331-i

Cited by 156 publications

(136 citation statements)

References 26 publications

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“…Although the risk of disease transmission during GI endoscopy is reported to be low, infections and outbreaks due to contaminated GI endoscopes, with associated patient morbidity and mortality, have been documented a number of times during the past 30 years, both prior to and since CRE's emergence [2,[4][5][6][7][8][9][10][11][12]14,33,34] . These cases include infections of bacteria, including P. aeruginosa, and viruses, namely, the hepatitis B (HBV) or C virus (HCV).…”

Section: Part 2: Gi Endoscopymentioning

confidence: 99%

“…Bacterial and viral outbreaks following GI endoscopy, with associated morbidity and mortality, have been reported (albeit infrequently) during the past 30 years, but the cause of virtually every one of these outbreaks was attributed to one or more infection control breaches -for example, to: (1) an endoscope reprocessing lapse, including the failure to clean the GI endoscope's instrument channel with a brush; or, the faulty reprocessing of the GI endoscope by an automated endoscope reprocessor, or AER, with a flawed internal design; (2) a damaged or improperly maintained or serviced GI endoscope; or (3) the unsterile administration of an intravenous (iv) medication [6][7][8][9][10][11][12][13][14] . Cleaning, high-level disinfection, and drying of the GI endoscope, either in strict accordance with the endoscope's labeling or, alternatively, consistent with any one of a number of recently published endoscope reprocessing guidelines, form the tridental cornerstone of infection control in the GI endoscopic setting.…”

Section: Introductionmentioning

confidence: 99%

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Risk of transmission of carbapenem-resistantEnterobacteriaceaeand related “superbugs” during gastrointestinal endoscopy

Muscarella¹

2014

WJGE

120

112

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To evaluate the risk of transmission of carbapenemresistant Enterobacteriaceae (CRE) and their related superbugs during gastrointestinal (GI) endoscopy. Reports of outbreaks linked to GI endoscopes contaminated with different types of infectious agents, including CRE and their related superbugs, were reviewed. Published during the past 30 years, both prior to and since CRE's emergence, these reports were obtained by searching the peer-reviewed medical literature (via the United States National Library of Medicine's "MEDLINE" database); the Food and Drug Administration's Manufacturer and User Facility Device Experience database, or "MAUDE"; and the Internet (via Google's search engine). This review focused on an outbreak of CRE in 2013 following the GI endoscopic procedure known as endoscopic retrograde cholangiopancreatography, or ERCP, performed at "Hospital X" located in the suburbs of Chicago (IL; United States). Part of the largest outbreak of CRE in United States history, the infection and colonization of 10 and 28 of this hospital's patients, respectively, received considerable media attention and was also investigated by the Centers for Disease Control and Prevention (CDC), which published a report about this outbreak in Morbidity and Mortality Weekly Report (MMWR), in 2014. This report, along with the results of an independent inspection of Hospital X's infection control practices following this CRE outbreak, were also reviewed. While this article focuses primarily on the prevention of transmissions of CRE and their related superbugs in the GI endoscopic setting, some of its discussion and recommendations may also apply to other healthcare settings, to other types of flexible endoscopes, and to other types of transmissible infectious agents. This review found that GI endoscopy is an important risk factor for the transmission of CRE and their related superbugs, having been recently associated with patient morbidity and mortality following ERCP. The CDC reported in MMWR that the type of GI endoscope, known as an ERCP endoscope, that Hospital X used to perform ERCP in 2013 on the 38 patients who became infected or colonized with CRE might be particularly challenging to clean and disinfect, because of the complexity of its physical design. If performed in strict accordance with the endoscope manufacturer's labeling, supplemented as needed with professional organizations' published guidelines, however, current practices for reprocessing GI endoscopes, which include high-level disinfection, are reportedly adequate for the prevention of transmission of CRE and their related superbugs. Several recommendations are provided to prevent CRE transmissions in the healthcare setting. CRE transmissions are not limited to contaminated GI endoscopes and also have been linked to other reusable flexible endoscopic instrumentation, including bronchoscopes and cystoscopes. In conclusion, contaminated GI endoscopes, particularly those used during ERCP, have been causally linked to outbreaks of CRE and their related su...

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Section: Part 2: Gi Endoscopymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Risk of transmission of carbapenem-resistantEnterobacteriaceaeand related “superbugs” during gastrointestinal endoscopy

Muscarella¹

2014

WJGE

120

112

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“…Microorganisms present in the colon such as Pseudomonas, Helicobacter pylori, Salmonella, Hepatitis B and C, and others have been hold responsible for endoscopy-related infections (14)(15)(16)(17). Another interesting question is whether endoscopy could be responsible for in-hospital spread of Norwalk-virus gastroenteritis.…”

Section: Discussionmentioning

confidence: 99%

Air Suctioning During Colon Biopsy Acquisition Reduces Bacterial Contamination

Vavricka¹,

Imhof²,

Wildi³

et al. 2006

Gastrointestinal Endoscopy

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Background and Aim: Contamination of endoscopy suites with bacteria during procedures is of concern particularly through droplets during handling of biopsy specimens. It has been advocated that suctioning while removing the biopsy forceps could help to reduce potentially hazardous bioaerosols. The aim of the present study was to evaluate the efficacy of air suctioning during removal of the biopsy forceps. Materials and Methods: Airborne bacteria were collected by an impactor air-sampler (MAS-100). Fifty liters of air were collected continuously for 30 seconds at a 30 cm distance from the colonoscope suction channel. Room air samples were taken in the endoscopy suite in the morning prior to the beginning of the endoscopy program, during colonoscopy with a sham biopsy in the descending colon with and without suctioning and at the end of the procedure day. Standard 90 mm Petri dishes containing a selective medium for gram-positive cocci (CNA blood agar) were used with the impaction sampler and colony forming units/m3 (cfu) were determined. Results: Measurements were performed at fifty consecutive colonoscopies. Prior to the beginning of the endoscopy program, the bioaerosol burden in the colonoscopy suite reached a mean of 4.2 cfu/m3. During colonoscopies performed without suctioning at biopsy the bioaerosol burden increased to 29.4 cfu/m3 whereas this burden increased only to 15.1 cfu/m3 when the suctioning was applied during removal of the biopsy forceps. The difference in bioaerosol burden between suctioning and no suctioning was highly significant (p < 0.0005). At the end of the procedure day the airborne bacteria count dropped to 15.6 cfu/m3. The analysis of the colonies on the CNA blood agar identified predominantly enterococci. Staphylococci spp. and other gram-positive bacteria were rarely isolated. Conclusion: The present study indicates that the bioaerosol burden during handling of biopsy specimens is not neglectable but can be reduced by the simple habit of applying suctioning during acquisition of biopsies. This practice might be an important infection-control measure during gastrointestinal endoscopies. Air Suctioning During Colon Abstract (Word count 245)Background and Aim: Contamination of endoscopy suites with bacteria during procedures is of concern. It has been advocated that suctioning while removing biopsy forceps could help to reduce hazardous bioaerosols. The aim of the present study was to evaluate the efficacy of air suctioning during removal of biopsy forceps. Materials and Methods:During colonoscopy endoscopists were asked to remove the biopsy forceps with and without suction after having touched the sigmoid mucosa.Fifty litres of air were collected continuously for 30 seconds at 30 cm distance from the colonoscope suction channel. Airborne bacteria were collected by an impactor air-sampler (MAS-100). Standard 90 mm Petri dishes with CNA blood agar were used to culture gram positive cocci. Room measurements prior to the first endoscopy and after the last endoscopy of the day were ...

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“…7 ' 9 One report linked contaminated filtered rinse water to an outbreak following gastrointestinal endoscopy. 9 It is unclear whether Sorin et al or the CDC's investigators sampled the filtered rinse water microbiologically for P. aeruginosa, as these data were not published. 12 Sampling the AER and its filtered rinse water, among other sites, is crucial to investigating and identifying the source of this cluster 3 (or any other) outbreak.…”

Section: To the Editormentioning

confidence: 99%

Leading a Horse to Water: Are Crucial Lessons in Endoscopy and Outbreak Investigations Being Learned?

Muscarella

2002

Infect. Control Hosp. Epidemiol.

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Pseudomonas aeruginosa and Enterobacteriaceae bacteremia after biliary endoscopy: An outbreak investigation using DNA macrorestriction analysis

Cited by 156 publications

References 26 publications

Risk of transmission of carbapenem-resistantEnterobacteriaceaeand related “superbugs” during gastrointestinal endoscopy

Risk of transmission of carbapenem-resistantEnterobacteriaceaeand related “superbugs” during gastrointestinal endoscopy

Air Suctioning During Colon Biopsy Acquisition Reduces Bacterial Contamination

Leading a Horse to Water: Are Crucial Lessons in Endoscopy and Outbreak Investigations Being Learned?

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