Endoscopy 2018; 50(06): 588-596
DOI: 10.1055/s-0043-122378
Original article
© Georg Thieme Verlag KG Stuttgart · New York

A double-reprocessing high-level disinfection protocol does not eliminate positive cultures from the elevators of duodenoscopes

Douglas K. Rex
Division of Gastroenterology-Hepatology, Indiana University, Indianapolis, Indiana, USA
,
Marnie Sieber
Division of Infectious Diseases, Indiana University, Indianapolis, Indiana, USA
,
Glen A. Lehman
Division of Gastroenterology-Hepatology, Indiana University, Indianapolis, Indiana, USA
,
Douglas Webb
Division of Infectious Diseases, Indiana University, Indianapolis, Indiana, USA
,
Bryan Schmitt
Department of Pathology and Laboratory Medicine, Division of Clinical Microbiology, Indianapolis, Indiana, USA
,
Amy Beth Kressel
Division of Infectious Diseases, Indiana University, Indianapolis, Indiana, USA
,
Ji Young Bang
Division of Gastroenterology-Hepatology, Indiana University, Indianapolis, Indiana, USA
,
Jeffery Easler
Division of Gastroenterology-Hepatology, Indiana University, Indianapolis, Indiana, USA
,
Lee McHenry
Division of Gastroenterology-Hepatology, Indiana University, Indianapolis, Indiana, USA
,
Ihab El-Hajj
Division of Gastroenterology-Hepatology, Indiana University, Indianapolis, Indiana, USA
,
Evan Fogel
Division of Gastroenterology-Hepatology, Indiana University, Indianapolis, Indiana, USA
,
James Watkins
Division of Gastroenterology-Hepatology, Indiana University, Indianapolis, Indiana, USA
,
Stuart Sherman
Division of Gastroenterology-Hepatology, Indiana University, Indianapolis, Indiana, USA
› Author Affiliations
Further Information

Publication History

submitted 23 March 2017

accepted after revision 10 October 2017

Publication Date:
13 December 2017 (eFirst)

Abstract

Background and study aim Duodenoscopes have been the source of serious infection, despite correct performance of high-level disinfection (HLD). This study aimed to observe the impact of performing HLD twice on the rate of positive cultures from duodenoscope elevators.

Methods We performed double HLD (DHLD; i. e. complete manual cleaning followed by automated reprocessing, with the entire process repeated) and then randomly cultured the elevators of our duodenoscopes on about 30 % of occasions.

Results DHLD was associated with positive elevator cultures for any microorganism in 9.4 % of cases, with a 0.8 % rate of known pathogens (627 cultures) between May 2015 and February 2016. After February 2016, and in association with changing the precleaning fluid, as well as use of a new FDA-recommended cleaning brush, the rate of positive cultures for any microorganism after DHLD was 4.8 % and 0.2 % for known pathogens (420 cultures). In a third phase, characterized by a change in personnel performing DHLD and retirement of a duodenoscope with a high rate of positive cultures, the rate of positive cultures for any microorganism was 4.9 % (783 cultures) and the rate of positive culture for known pathogens was 0.3 %. To our knowledge, no duodenoscope transmission of infection occurred during the study interval.

Conclusions DHLD resulted in a low rate of positive cultures for known pathogens and for organisms of low pathogenic potential, but did not eliminate these, from duodenoscope elevators. Additional improvements in HLD protocols and/or duodenoscope design are needed.