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ERCP and reprocessing in focus: what can we do to prevent or manage infection outbreaks?
01 June 2015 (online)
Since the late 1970s, there have been sporadic reports of endoscopic transmission of exogenous infections in gastrointestinal endoscopy. The majority of documented cases were the result of noncompliance with national and international guidelines, including :
failures and mistakes in the reprocessing procedure, in combination with inadequate systems of work and insufficient training of staff;
inadequate reprocessing equipment (e. g. inappropriate brushes);
damaged and improperly maintained endoscopes and washer disinfectors;
contaminated environment (e. g. contaminated surfaces, water);
insufficient hand hygiene;
inappropriate administration of intravenous medication.
Several endoscopic retrograde cholangiopancreatography (ERCP)-related outbreaks have been reported, caused by insufficiently reprocessed or stored endoscopes, contaminated washer disinfectors, or contaminated surfaces .
Infections by multidrug-resistant organisms have become more and more problematic for healthcare services worldwide. In recent years, outbreaks of multidrug-resistant pathogens associated with ERCP procedures have also been reported      . In February 2015, an outbreak of carbapenem-resistant Enterobacteriaceae (CRE) in conjunction with ERCP procedures caused big media attention in the USA . The FDA published several statements to raise awareness among healthcare professionals of the complex design of duodenoscopes that may impede effective reprocessing . The American Society for Gastrointestinal Endoscopy (ASGE) and the Society of Gastroenterology Nurses and Associates (SGNA) informed their members accordingly.
The outbreak reported by Verfaillie et al.  in this issue of Endoscopy gives helpful information on how to manage infection outbreaks with the support of a multidisciplinary team. The structured approach can be used by others in similar situations. It also highlights a number of important issues around reprocessing. Despite manufacturers’ responsibilities, what can endoscopy departments do to prevent or manage infectious outbreaks?
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