Faculty Collaboration Database

A Novel Protocol Obviates Endoscope Sampling for Carbapenem-Resistant Enterobacteriaceae: Experience of a Center with a Prior Outbreak. Dig Dis Sci 2017 Nov;62(11):3100-3109

Date

07/07/2017

Pubmed ID

28681083

DOI

10.1007/s10620-017-4669-9

Scopus ID

2-s2.0-85021843628 (requires institutional sign-in at Scopus site)   11 Citations

Abstract

BACKGROUND: Numerous published outbreaks, including one from our institution, have described endoscope-associated transmission of multidrug-resistant organisms (MDROs). Individual centers have adopted their own protocols to address this issue, including endoscope culture and sequestration. Endoscope culturing has drawbacks and may allow residual bacteria, including MDROs, to go undetected after high-level disinfection.

AIM: To report the outcome of our novel protocol, which does not utilize endoscope culturing, to address our outbreak.

METHODS: All patients undergoing procedures with elevator-containing endoscopes were asked to permit performance of a rectal swab. All endoscopes underwent high-level disinfection according to updated manufacturer's guidance. Additionally, ethylene oxide (EtO) sterilization was done in the high-risk settings of (1) positive response to a pre-procedure risk stratification questionnaire, (2) positive or indeterminate CRE polymerase chain reaction (PCR) from rectal swab, (3) refusal to consent for PCR or questionnaire, (4) purulent cholangitis or infected pancreatic fluid collections. Two endoscopes per weekend were sterilized on a rotational basis.

RESULTS: From September 1, 2015 to April 30, 2016, 556 endoscopy sessions were performed using elevator-containing endoscopes. Prompted EtO sterilization was done on 46 (8.3%) instances, 3 from positive/indeterminate PCR tests out of 530 samples (0.6%). No CRE transmission was observed during the study period. Damage or altered performance of endoscopes related to EtO was not observed.

CONCLUSION: In this pilot study, prompted EtO sterilization in high-risk patients has thus far eliminated endoscope-associated MDRO transmission, although no CRE infections were noted throughout the institution during the study period. Further studies and a larger patient sample will be required to validate these findings.

Author List

Smith ZL, Dua A, Saeian K, Ledeboer NA, Graham MB, Aburajab M, Ballard DD, Khan AH, Dua KS

Authors

Kulwinder S. Dua MD Professor in the Medicine department at Medical College of Wisconsin
Mary Beth Graham MD Associate Chief, Professor in the Medicine department at Medical College of Wisconsin
Nathan A. Ledeboer PhD Vice Chair, Professor in the Pathology department at Medical College of Wisconsin
Kia Saeian MD Professor in the Medicine department at Medical College of Wisconsin
Zachary Smith DO Associate Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Carbapenems
Cholangiopancreatography, Endoscopic Retrograde
Cross Infection
Disease Outbreaks
Disinfectants
Drug Resistance, Bacterial
Duodenoscopes
Endosonography
Enterobacteriaceae
Enterobacteriaceae Infections
Equipment Contamination
Equipment Reuse
Ethylene Oxide
Female
Humans
Male
Microbial Sensitivity Tests
Middle Aged
Pilot Projects
Program Evaluation
Rectum
Risk Factors
Sterilization
Wisconsin