Endoscopy 2018; 50(04): S109
DOI: 10.1055/s-0038-1637353
ESGE Days 2018 ePoster Podium presentations
20.04.2018 – Complications
Georg Thieme Verlag KG Stuttgart · New York

ENDOSCOPY-ASSOCIATED INFECTIONS – A COMPREHENSIVE REVIEW OF LITERATURE WITH ANALYSIS OF TRANSMISSION CAUSES

J Boban
1   Josephs-Hospital Warendorf, Academic Teaching Hospital, University of Muenster, Department of Medicine I, Warendorf, Germany
2   University of Muenster, Department of Medicine B, Muenster, Germany
,
P Lenz
2   University of Muenster, Department of Medicine B, Muenster, Germany
3   University of Muenster, Institute of Palliative Care, Muenster, Germany
,
A Mellmann
4   University of Muenster, Institute for Hygiene, Muenster, Germany
,
I Herrmann
5   Reflux Center Duesseldorf, Duesseldorf, Germany
,
D Domagk
1   Josephs-Hospital Warendorf, Academic Teaching Hospital, University of Muenster, Department of Medicine I, Warendorf, Germany
2   University of Muenster, Department of Medicine B, Muenster, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
27 March 2018 (online)

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Aims:

In the past two years, transmission of carbapenem-resistant Enterobacteriaceae via duodenoscopes has attracted broad attention in the endoscopic community and also in media. Flexible endoscopes are considered “semi-critical” medical devices which are associated with an increased risk of infectious transmission. In this study, we performed a comprehensive literature review on endoscopy associated infections to receive a systematic overview on endoscopy-associated infections with the aim to illuminate the factors leading to an insufficient reprocessing of flexible endoscopes and to allow recommendations for quality improvement to minimize the risks of infections.

Methods:

A review and synthesis of the literature was performed in PubMed using medical subject headings (MeSH). We identified 291 publications of which 85 were included after reviewing the publications with respect to relevance and applicability. In the following, these 85 papers were scanned with respect to the citations: By this means, further 99 relevant publications could be identified.

Results:

Following the comprehensive literature search, 86 studies, 50 reviews, 24 expert opinions, and 24 guidelines were found allowing a qualitative analysis of the relevant studies and reviews. For a long time, most experts and specialist societies assumed that reprocessing protocols may guarantee a secure endoscopy and that outbreaks were due to violations of these recommendations; this rating, however, has changed with respect to the facts of vulnerable endoscope design (e.g., fixation of the distal cap hampering cleaning and disinfection) and micro-trauma within the working channel.

Conclusions:

Outbreaks and infections caused by contaminated flexible endoscopes have been documented for the past 30 years initiating controversies on reprocessing and disinfection and its implications for patients’ safety. Endoscope design modifications may compromise microbiological safety. Furthermore, routine cleaning procedures may not remove biofilm reliably from endoscope channels as formerly presumed), which might explain the unexpected failure of decontamination encountered in practice despite good adherence to infection control guidelines.