Risk of infection transmission in curvilinear array echoendoscopes: results of a prospective reprocessing and culture registry

Background and Aims The complex design of the elevator mechanism in duodenoscopes has been recognized as a challenge for disinfection and recently implicated as a potential source of persistent bacterial contamination. Curvilinear array (CLA) echoendoscopes also have an elevator mechanism; however,...

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Bibliographic Details
Published in:Gastrointestinal endoscopy 2017-02, Vol.85 (2), p.390-397.e1
Main Authors: Chapman, Christopher G., MD, Siddiqui, Uzma D., MD, Manzano, Maricarmen, MD, Konda, Vani J., MD, Murillo, Cynthia, M(ASCP), CIC, Landon, Emily M., MD, Waxman, Irving, MD
Format: Article
Language:English
Subjects:
Acinetobacter baumannii - isolation & purification
Citrobacter freundii - isolation & purification
Cross Infection - epidemiology
Culture Techniques
Disinfection
Endosonography - instrumentation
Enterobacter cloacae - isolation & purification
Equipment Contamination
Gastroenterology and Hepatology
Hafnia alvei - isolation & purification
Humans
Klebsiella oxytoca - isolation & purification
Klebsiella pneumoniae - isolation & purification
Microbial Sensitivity Tests
Prospective Studies
Pseudomonas aeruginosa - isolation & purification
Pseudomonas putida - isolation & purification
Registries
Sphingomonas - isolation & purification
Stenotrophomonas maltophilia - isolation & purification
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Summary:Background and Aims The complex design of the elevator mechanism in duodenoscopes has been recognized as a challenge for disinfection and recently implicated as a potential source of persistent bacterial contamination. Curvilinear array (CLA) echoendoscopes also have an elevator mechanism; however, there are no recommendations or data regarding the risk of persistent bacterial contamination of echoendoscopes. Here we hoped to determine the yield of microbial growth with routine bacterial surveillance cultures of reprocessed CLA echoendoscopes. Methods Beginning in February 2015 to February 2016, CLA echoendoscopes at a single tertiary care center underwent prospective bacterial surveillance cultures after reprocessing. Any growth of gram-negative bacilli was considered to be critical. Echoendoscopes with a positive result underwent quarantine followed by repeat disinfection and culture. Results During the study period, 540 cultures were obtained; 521 (96.5%) were primary cultures obtained from 18 CLA echoendoscopes. Twenty-two primary cultures (4.2%) were positive for gram-negative bacilli after high-level disinfection reprocessing. Eleven different bacteria were isolated: Klebsiella pneumoniae , Citrobacter freundii , Escherichia coli , Pseudomonas aeruginosa , Klebsiella oxytoca , Sphingomonas paucimobilis , Acinetobacter baumanii , Enterobacter cloacae , Hafnia alvei , Pseudomonas putida , and Stenotrophomonas maltophilia . Antibiotic sensitivity data on 19 of 24 bacteria (79.2%) isolated from positive primary cultures revealed no documented cases of carbapenem-resistant enterobacteriaceae, cephalosporin-resistant- Klebsiella , or multidrug-resistant Acinetobacter. There have been no documented cases of patient-to-patient transmission. Conclusions After following standard high-level disinfection and reprocessing, CLA echoendoscopes can remain culture positive for high-concern organisms. Recommendations regarding infection risk should take into consideration elevator-containing echoendoscopes in addition to duodenoscopes to ensure patient safety and endoscope reprocessing efficacy.
ISSN:0016-5107
1097-6779
DOI:10.1016/j.gie.2016.07.049