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Are ‘patient-ready’ endoscopes free of microbial contamination?

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Medical Bulletins

Gastrointestinal endoscopies are high volume procedures performed worldwide.1–5 Researchers have linked inadequate reprocessing to outbreaks involving multidrug resistant bacteria.6

Bacterial contamination may persist on endoscopes despite reprocessing according to guidelines and endoscope instructions for use.1,6,7

Residual bacterial contamination survives within biofilm. High-level disinfection may be unable to completely remove biofilm.8–12

  1. Deb A, Perisetti A, Goyal H, et al. Gastrointestinal Endoscopy-Associated Infections: Update on an Emerging Issue. Dig Dis Sci. 2022;67(5):1718-1732.
  2. Peery AF, Crockett SD, Murphy CC, et al. Burden and Cost of Gastrointestinal, Liver, and Pancreatic Diseases in the United States: Update 2018. Gastroenterology. 2019;156(1):254-272.e11.
  3. Rutter MD, Senore C, Bisschops R, et al. The European Society of Gastrointestinal Endoscopy Quality Improvement Initiative: developing performance measures. Endoscopy. 2016;48:81-89.
  4. Tanaka K. Japan Endoscopy Database project. Dig Endosc. 2022;34 Suppl 2:20-22.
  5. Zhou S, Zhu Z, Dai W, et al. National survey on sedation for gastrointestinal endoscopy in 2758 Chinese hospitals. Br J Anaesth. 2021;127:56-64.
  6. Grein JD, Murthy RK. New Developments in the Prevention of Gastrointestinal Scope-Related Infections. Infect Dis Clin N Am. 2018;32(4):899-913.
  7. Ofstead C, Buro B, Hopkins K, Eiland J, Wetzler H, Lichtenstein D. Duodenoscope-associated infection prevention: A call for evidence-based decision making. Endosc Int Open. 2020;08(12):E1769-E1781.
  8. Brunke MS, Konrat K, Schaudinn C, et al. Tolerance of biofilm of a carbapenem-resistant Klebsiella pneumoniae involved in a duodenoscopy-associated outbreak to the disinfectant used in reprocessing. Antimicrob Resist Infect Control. 2022;11(1):81.
  9. Lichtenstein D, Alfa MJ. Cleaning and Disinfecting Gastrointestinal Endoscopy Equipment. Clin Gastrointest Endosc. 2019;(JAMA 312 2014):32-50.e5.
  10. Kovaleva J. Infectious complications in gastrointestinal endoscopy and their prevention. Best Pract Res Clin Gastroenterology. 2016;30(5):689-704.
  11. Rauwers AW, Troelstra A, Fluit AC, et al. Independent root-cause analysis of contributing factors, including dismantling of 2 duodenoscopes, to investigate an outbreak of multidrug-resistant Klebsiella pneumoniae. Gastrointest Endosc. 2019;90(5):793-804.
  12. Ribeiro MM, Oliveira AC de. Analysis of the air/water channels of gastrointestinal endoscopies as a risk factor for the transmission of microorganisms among patients. Am J Infect Control. 2012;40(10):913-916.