Real rates of Infections in Endoscopy
Author: Peiqi Wang, Tim Xu, Saowanee Ngamruengphong, Martin A Makary, Anthony Kalloo, Susan Hutfless
Date: May, 2018
Study Overview
This study investigates what the real rate of infections are Post Endoscopy. They checked emergency department visits in a number of centres in the US and simply asked the question, ‘Have you had a Endoscopy Procedure in the past 30 days’. The number of infections presented from people who had just undergone Endoscopy we a lot higher than the 1 in 1.8 million which is reported.
Results
The Rates of postendoscopy infections per 1000 procedures within 7 days were:
1.1 for screening Colonoscopies
1.6 for non-screening Colonoscopies
3.0 OGD
Following guidelines ensures a Safe Scope
Author: Peiqi Wang, Tim Xu, Saowanee Ngamruengphong, Martin A Makary, Anthony Kalloo, Susan Hutfless
Date: May, 2018
Study Overview
Followed 20 Scopes over 7 months and did 3 random inspections. Before this study, they taught each of the reprocessing techs/ nurses how to clean the scope in accordance with the Guidelines. They then visually inspected the scope channels using a Borescope and culturing, and had the following results
Results
Of the 20 Scopes investigated:
100% had visual irregularities (scratches, discolouration, debris, dents on external surfaces)
60% tested positive for Microbial Growth (2 potential pathogens were found)
20% Exceeded benchmarks for ATP and Proteins
95% had Residual Fluid
Real rates of Infections in Endoscopy
Following guidelines ensures a Safe Scope
Following guidelines ensures a Safe Scope
Title: Longitudinal assessment of reprocessing effectiveness for colonoscopes and gastroscopes
Author: Ofstead CL, Wetzler HP, Heymann OL, Johnson EA, Eiland JE, Shaw MJ.
Date: February, 2017
Study Overview
Followed 20 Scopes over 7 months and did 3 random inspections. Before this study, they taught each of the reprocessing techs/ nurses how to clean the scope in accordance with the Guidelines. They then visually inspected the scope channels using a Borescope and culturing, and had the following results
Results
Of the 20 Scopes investigated:
100% had visual irregularities (scratches, discolouration, debris, dents on external surfaces)
60% tested positive for Microbial Growth (2 potential pathogens were found)
20% Exceeded benchmarks for ATP and Proteins
95% had Residual Fluid
Reprocessing Errors are Ongoing and Numerous
Title: Endoscope Reprocessing Methods: A Prospective Study on the Impact of Human Factors and Automation
Author: Ofstead CL, Wetzler HP, Snyder AK, Horton RA
Date: August, 2010
Study Overview
The multisite observational study was to evaluate reprocessing practices. The methods used to collect the data were: Interviews, surveys and direct observations. They monitored the Manual Cleaning process and broke this down in to 12 key steps which also included Manual AER cleaning process.
Results
Only 1.4% performed reprocessing perfectly (all 12 steps).
Multiple steps were missed 45% of the time
Failure rate of the 2 most important steps occurred >50%
Incomplete Brushing (57%)
Not using forced Air (55%)
Global Review of Duodenoscope Contamination Issue
Title: Safely reprocessing duodenoscopes: current evidence and future directions
Author: Zachary A Rubin, Stephen Kim, Adarsh M Thaker, V Raman Muthusamy
Date: July, 2018
Study Overview
This study reviews all outbreaks documented to be caused by a Duodenoscope, including bacterial factors, Duodenoscope design factors and potential corrective actions, their strengths and weaknesses.
Results
Global outbreaks documented to be caused by Duodenoscope:
- 32 outbreaks involving ~400 patients
- above number must be only tip of iceberg, because outbreaks only
- most common pathogens involved: Klebsiella pneumoniae and Pseudomonas aeruginosa
- 8 outbreaks showed no defective reprocessing (5 showed defects, 19 didnt specify) EU outbreaks documented to be caused by Duodenoscope
- 9 outbreaks (FR:4, DE:2, NL:2, UK:1) involving ~100 patients
- above number must be only tip of iceberg, because outbreaks only
- most common pathogens involved: Klebsiella pneumoniae and Pseudomonas aeruginosa
- 1 outbreak showed no defective reprocessing (8 didn't specify)
15% of Duodenoscopes contaminated according to a study
Title: High prevalence rate of digestive tract bacteria in Duodenoscopes: a nationwide study
Author: Arjan W Rauwers, Anne F Voor in ’t holt, Jolanda G Buijs, Woutrinus de Groot, Bettina E Hansen, Marco J Bruno, Margreet C Vos
Date: February, 2018
Study Overview
Globally, first and only nation-wide study in Netherlands, having 73 ERCP centres testing 150 Duodenoscopes with 701 samples, showing that 15% of the 150 Duodenscopes are still contaminated desptit reprocessing.
Results
- Sixty-seven out of 73 centres (92%) sampled 745 sites of 155 duodenoscopes.
- Ten different duodenoscope types from three distinct manufacturers were sampled including 69 (46%) Olympus TJFQ180V,43 (29%) Olympus TJF-160VR, 11 (7%) Pentax, ED34-i10T, 8 (5%) Pentax ED-3490TK and 5 (3%), Fujifilm ED-530XT8. Thirty-three (22%) duodenoscopes
- from 26 (39%) centres were contaminated (AM20)
- On 23 (15%) duodenoscopes MGO were detected
- including Enterobacter cloacae, Escherichia coli, Klebsiella pneumonia and yeasts
Duodenoscope “attack rate” ~ 30%
Title: Independent root cause analysis of contributing factors, including dismantling of 2 duodenoscopes, to an outbreak of multidrug-resistant Klebsiella pneumoniae
Author: Arjan W. Rauwers, Annet Troelstra, Ad C. Fluit, Camiel Wissink, Arjo J. Loeve, Frank P. Vleggaar, Marco J. Bruno, Margreet C. Vos, Lonneke G.M. Bode, Jan F. Monkelbaan
Date: May, 2019
Study Overview
This paper reports on the investigation after the outbreak of a multidrug-resistant Klebsiella pneumoniae (MRKP) related to 2 Olympus TJF-Q180V duodenoscopes. Reprocessing procedures were audited and both duodenoscopes were fully dismantled to evaluate all potential contamination factors. .
Results
- In total, 102 patients who had undergone an ERCP procedure from January to August 2015 were invited for screening. Cultures were available of 81 patients, yielding 27 MRKP infected or colonized patients.
- Ten patients developed a MRKP-related active infection.
- The duodenoscopes had attack rates (the number of infected or colonized cases/number of exposed persons) of 35% (17/49) and 29% (7/24).
- The review revealed 4 major abnormalities:
- miscommunication about reprocessing
- undetected damaged parts
- inadequate repair of duodenoscope damage
- and duodenoscope design abnormalities, including the forceps elevator, elevator lever, and instrumentation port sealing.