Reprocessing machine cultures negative
As a result of an investigation by the Centers for Disease Control and Prevention (CDC) into a recent outbreak of carbapenem-resistant Enterobacteriaceae (CRE), Advocate Lutheran General Hospital in Park Ridge, IL, changed endoscopic retrograde cholangiopancreatography (ERCP) endoscope reprocessing from automated high-level disinfection to gas sterilization in September 2013.
No new cases with exposure to a gas-sterilized ERCP endoscope have been identified. Retrospective review and direct observation of endoscope reprocessing by CDC investigators did not identify lapses in the cleaning and disinfection protocol.
"The automated reprocessor was the same for all cases," says Alexander Kallen, MD, MPH, a medical epidemiologist and outbreak response coordinator in the CDC Division of Healthcare Quality Promotion. "Multiple cultures of the AER [automated endoscope reprocessor] did not grow any CRE. The machine was also thoroughly evaluated by the manufacturer. So, although this is possible, we were not able to identify any abnormalities. In total there were three implicated endoscopes — all the same brand and model."
Previous studies have shown an association between ERCP endoscopes and transmission of multidrug-resistant bacteria, as the complex design of the endoscopes might make them difficult to clean.1,2
Bret Petersen, MD, FASGE, a member of the governing board of the American Society for Gastrointestinal Endoscopy, says, "We know that cleaning an ERCP scope is a little more challenging than cleaning a regular scope because of the complexity and so many different channels." Indeed, the author of one of the published reports indicated that "the problem may have arisen from inadequate processing of the endoscopes given that the terminal parts of some of the scopes contain intricate structures that may harbor biologic debris where [CRE] may multiply and flourish."3
REFERENCES
- Muscarella LF. Investigation and prevention of infectious outbreaks during endoscopic retrograde cholangiopancreatography. Endoscopy 2010; 42:9579.
- Alrabaa SF, Nguyen P, Sanderson R, et al. Early identification and control of carbapenemase-producing Klebsiella pneumoniae, originating from contaminated endoscopic equipment. Am J Infect Control 2013; 41:5624.
- Alrabaa SF. Early identification and control of carbapenemase-producing Klebsiella pneumoniae, originating from contaminated endoscopic equipment. Correspondence. Am J Infect Control 2013; 41:850.
