The Endoscopy Patient as a Vector and Victim

Chan, Brian; Berzin, Tyler M.

doi:10.1016/j.giec.2020.06.007

Cited by 2 publications

(3 citation statements)

References 106 publications

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“…10 Infections of endogenous origin are thought to be caused by translocation of normal flora into the blood stream during endoscopic procedures. 2 11 12 It is currently unknown which fraction of ERCP-related infections are endogenous in origin and which fraction results from exogenous bacteria that originate in the environment (e.g., from a contaminated duodenoscope). 10 13 Although there are likely additional reservoirs for those organisms involved in ERCP-related infections, at a minimum, infection risk assessments should consider patient risk factors and factors that put reusable duodenoscope inventories at risk for persistent contamination.…”

Section: Identifying Risk Factors For Infection In Patients Undergoing Endoscopic Retrograde Cholangiopancreatograpymentioning

confidence: 99%

“…1 2 In comparison, other endoscopic procedures that have known high rates of postprocedure bacteremia include esophageal dilation (12–22%) and sclerotherapy of esophageal varices (up to 52%). 2 12 Factors that increase the risk of post-ERCP infection are listed in Table 4 and discussed in detail below.…”

Section: Procedures Factors Associated With Increased Infection Riskmentioning

confidence: 99%

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Duodenoscope-Acquired Infections: Risk Factors to Consider

Thornhill

Dunkin

2021

Journal of Digestive Endoscopy

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In the wake of highly publicized duodenoscope-associated outbreaks caused by multidrug-resistant organisms (MDRO), a herculean effort was made to understand the conditions that led to these transmission events. Although there is now a clearer picture on how these outbreaks happened, there are still significant data gaps when it comes to understanding the rate of duodenoscope-acquired infections (DAIs), especially in nonoutbreak situations. Recent publications indicate that DAIs are still occurring and suggest that infection rates are higher than currently believed. Given this data gap, it is important to identify those patient populations that are most at risk of postprocedure infection, so that appropriate infection control measures may be implemented. Although those patients receiving antibiotic prophylaxis are most at risk for infection, there are additional risk factors that should be considered. For the purposes of this review, risk factors for infection were divided into three broad categories as follows: (1) those that increase patient susceptibility to infection, (2) those related to the endoscopic procedure, and (3) those factors that put reusable duodenoscope inventories at risk of contamination. Infection risk is a complex interaction between the immune status of the patient, the characteristics of the infectious agent (antibiotic sensitivity, virulence factors, and epidemiology), and the environment of care. Because of this complexity, any assessment of the risk of infection should be performed on a case-by-case basis. There is a dearth of information on infection risk for those patients undergoing endoscopic retrograde cholangiopancreatograpy (ERCP), especially in the context of the development and implementation of new device technology, and new endoscopic procedures that are increasing in complexity. This narrative review was developed using the Medical Subject Heading (MeSH) terms to perform an electronic search in PubMed with the goal of generating a summary of the patient, procedural, and duodenoscope-associated factors that increase the risk of infection in patients undergoing ERCP. This review provides practical information regarding the segmentation of ERCP patients by infection risk, so that endoscopists can make informed decisions about the risk benefits of using enhanced duodenoscope technologies in the care of their patients.

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Section: Identifying Risk Factors For Infection In Patients Undergoing Endoscopic Retrograde Cholangiopancreatograpymentioning

confidence: 99%

Section: Procedures Factors Associated With Increased Infection Riskmentioning

confidence: 99%

Duodenoscope-Acquired Infections: Risk Factors to Consider

Thornhill

Dunkin

2021

Journal of Digestive Endoscopy

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“…However, apart from environmental concerns, the use of SUDs may substantially increase the costs of ERCP procedures. In recent articles, discussion is ongoing to define the patient risk groups for whom the use of SUDs is most likely to be beneficial [8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Single-use duodenoscopes compared with reusable duodenoscopes in patients carrying multidrug-resistant microorganisms: a break-even cost analysis

et al. 2023

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Background and study aims Single-use duodenoscopes can prevent transmission of microorganisms through contaminated reusable duodenoscopes. Concerns regarding their economic and environmental impact impede the transition to single-use duodenoscopes. This study investigated the costs associated with two scenarios in which single-use duodenoscopes are used in patients carrying multidrug-resistant microorganisms (MDROs). Methods Break-even costs for single-use duodenoscopes were calculated for two scenarios in which patients were screened for MDRO carriage before undergoing endoscopic retrograde cholangiopancreatography (ERCP). Only direct costs related to the endoscopy were taken into consideration. In Scenario 1, patients were screened through microbiological culturing with a lag time in receiving the test result. In Scenario 2, screening was performed using GeneXpert analysis providing a rapid read-out. Calculations were performed using data from a Dutch tertiary care center and also with US healthcare data. Results In the Dutch situation, single-use duodenoscopes needed to be priced at a maximum of € 140 to € 250 to break-even. In the US analyses, break-even costs varied widely, depending on the duodenoscope-associated infection costs used, ERCP volume, and infection risk. The break-even costs in Scenario 1 ranged between $78.21 and $2,747.54 and in Scenario 2, between $248.89 and $2,209.23. Conclusions This study showed that a crossover scenario in which single-use duodenoscopes are only used in patients carrying MDROs could be an economically viable alternative to a complete transition to single-use duodenoscopes. In the Dutch setting, single-use duodenoscopes need to be priced much lower than in the United States to reach a per-procedure cost that is comparable with a scenario using reusable duodenoscopes exclusively.

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The Endoscopy Patient as a Vector and Victim

Cited by 2 publications

References 106 publications

Duodenoscope-Acquired Infections: Risk Factors to Consider

Duodenoscope-Acquired Infections: Risk Factors to Consider

Single-use duodenoscopes compared with reusable duodenoscopes in patients carrying multidrug-resistant microorganisms: a break-even cost analysis

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