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The Use of Rapid Indicators for the Detection of Organic Residues on Clinically Used Gastrointestinal Endoscopes with and without Visually Apparent Debris

Published online by Cambridge University Press:  10 May 2016

Kavel H. Visrodia ,
Cori L. Ofstead ,
Hannah L. Yellin ,
Harry P. Wetzler ,
Pritish K. Tosh  and
Todd H. Baron
Kavel H. Visrodia
Affiliation:
Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
Cori L. Ofstead*
Affiliation:
Ofstead and Associates, Saint Paul, Minnesota Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
Hannah L. Yellin
Affiliation:
Ofstead and Associates, Saint Paul, Minnesota
Harry P. Wetzler
Affiliation:
Ofstead and Associates, Saint Paul, Minnesota
Pritish K. Tosh
Affiliation:
Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota
Todd H. Baron
Affiliation:
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
*
Ofstead and Associates, 400 Selby Avenue, Suite V, Blair Arcade West, Saint Paul, MN 55102 (cori@ofsteadinsights.com).
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Extract

Background

Outbreaks of multidrug-resistant organisms have been linked to endoscope reprocessing lapses. Meticulous manual cleaning before high-level disinfection (HLD) is essential in reducing residual contamination that can interfere with HLD. Current reprocessing guidelines state that visual inspection is sufficient to confirm adequate cleaning.

Objective

Our aim was to evaluate contamination of clinically used endoscopes, using visual inspection and rapid indicator tests before and after manual cleaning. A second objective was to determine which rapid indicator instruments and methods could be used for quality improvement initiatives in endoscope reprocessing.

Design

Clinical use study of endoscope reprocessing effectiveness.

Setting

Tertiary care teaching hospital with an inpatient endoscopy center.

Methods

Researchers sampled endoscopes used for gastrointestinal procedures before and after manual cleaning. The external surfaces and 1 channel of each endoscope were visually inspected and tested with rapid indicators to measure protein, blood, and adenosine triphosphate (ATP) contamination levels.

Results

Multiple components were sampled during 37 encounters with 12 unique endoscopes. All bedside-cleaned endoscopes had high levels of ATP and detectable blood or protein, whether or not any residue was visible. Although there was no visible residue on any endoscopes after manual cleaning, 82% had at least 1 positive rapid indicator test.

Conclusions

Relying solely on visual inspection of endoscopes prior to HLD is insufficient to ensure reprocessing effectiveness. For quality assurance initiatives, tests of different endoscope components using more than 1 indicator may be necessary. Additional research is needed to validate specific monitoring protocols.

Information

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue 8 , August 2014 , pp. 987 - 994
Copyright
© 2014 by The Society for Healthcare Epidemiology of America. All rights reserved.

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References

1. Rutala, WA, Weber, DJ; Healthcare Infection Control Practices Advisory Committee. Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008. Atlanta: Centers for Disease Control and Prevention, 2008.Google Scholar
2. Petersen, BT, Chennat, J, Cohen, J, et al. Multisociety guideline on reprocessing flexible GI endoscopes: 2011. Infect Control Hosp Epidemiol 2011;32(6):527–537.Google Scholar
3. Nelson, DB, Muscarella, LF. Current issues in endoscope reprocessing and infection control during gastrointestinal endoscopy. World J Gastroenterol 2006;12(25):3953–3964.Google Scholar
4. Ofstead, CL, Wetzler, HP, Snyder, AK, Horton, RA. Endoscope reprocessing methods: a prospective study on the impact of human factors and automation. Gastroenterol Nurs 2010;33(4):304–311.Google Scholar
5. Jolly, JD, Hildebrand, EA, Branaghan, RJ. Better instructions for use to improve reusable medical equipment (RME) sterility. Human Factors 2013;55(2):397–410.Google Scholar
6. Ribeiro, MM, de Oliveira, AC, Ribeiro, SM, Watanabe, E, de Resende Stoianoff, MA, Ferreira, JA. Effectiveness of flexible gastrointestinal endoscope reprocessing. Infect Control Hosp Epidemiol 2013;34(3):309–312.Google Scholar
7. Dirlam Langlay, AM, Ofstead, CL, Mueller, NJ, Tosh, PK, Baron, TH, Wetzler, HP. Reported gastrointestinal endoscope reprocessing lapses: the tip of the iceberg. Am J Infect Control 2013;41(12):1188–1194.CrossRefGoogle ScholarPubMed
8. Alfa, MJ, Degagne, P, Olson, N. Worst-case soiling levels for patient-used flexible endoscopes before and after cleaning. Am J Infect Control 1999;27(5):392–401.Google Scholar
9. Association for the Advancement of Medical Instrumentation (AAMI). Standard 58: Chemical Sterilization and High-Level Disinfection in Health Care Facilities. Arlington, VA: AAMI, 2010.Google Scholar
10. Seoane-Vazquez, E, Rodriguez-Monguio, R. Endoscopy-related infection: relic of the past? Curr Opin Infect Dis 2008;21(4):362–366.CrossRefGoogle ScholarPubMed
11. Kovaleva, J, Peters, FT, van der Mei, HC, Degener, JE. Transmission of infection by flexible gastrointestinal endoscopy and bronchoscopy. Clin Microbiol Rev 2013;26(2):231–254.Google Scholar
12. Bronowicki, JP, Venard, V, Botte, C, et al. Patient-to-patient transmission of hepatitis C virus during colonoscopy. N Engl J Med 1997;337(4):237–240.Google Scholar
13. Bajolet, O, Ciocan, D, Vallet, C, et al. Gastroscopy-associated transmission of extended-spectrum beta-lactamase-producing Pseudomonas aeruginosa . J Hosp Infect 2013;83(4):341–343.Google Scholar
14. Vancouver Island Health Authority (VIHA). Backgrounder: ERCP Scope Reprocessing and Infection Control. http://www.viha.ca/NR/rdonlyres/8E35C250-1841-4ADD-B9F7-353780C29272/0/BG_ercp_scope_disinfection.pdf. Vancouver: VIHA, 2010.Google Scholar
15. Watts, R. VIHA Warns 500 Patients of Possible Blood-Borne Virus Infection. http://www.remedyspot.com/showthread.php/1121062-VIHA-warns-500-patients-of-possible-blood-borne-virus-infection. RemedySpot.com, 2010. Accessed November 6, 2013.Google Scholar
16. Gastmeier, P, Vonberg, RP. Klebsiella spp. in endoscopy-associated infections: we may only be seeing the tip of the iceberg. Infection 2014;42(1)15–21.Google Scholar
17. Aumeran, C, Poincloux, L, Souweine, B, et al. Multidrug-resistant Klebsiella pneumoniae outbreak after endoscopic retrograde cholangiopancreatography. Endoscopy 2010;42(11):895–899.Google Scholar
18. Carbonne, A, Thiolet, JM, Fournier, S, et al. Control of a multi-hospital outbreak of KPC-producing Klebsiella pneumoniae type 2 in France, September to October 2009. Euro Surveil 2010;15(48):1–6.Google Scholar
19. 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(6):562–564.Google Scholar
20. Society of Gastroenterology Nurses and Associates (SGNA). Standards of Infection Control in Reprocessing of Flexible Gastrointestinal Endoscopes. Chicago: SGNA, 2012:1–23.Google Scholar
21. Beilenhoff, U, Neumann, CS, Rey, JF, et al. ESG-ESGENA guideline for quality assurance in reprocessing: microbiological surveillance testing in endoscopy. Endoscopy 2007;39:175–181.Google Scholar
22. Health Service Executive (HSE) Advisory Group. HSE Standards and Recommended Practices for Endoscope Reprocessing Units. Tipperary, Ireland: HSE, 2012. http://www.hse.ie/eng/about/Who/qualityandpatientsafety/resourcesintelligence/Quality_and_Patient_Safety_Documents/endoscope_reprocessing_version22.pdf. Accessed December 6, 2013.Google Scholar
23. Gastoenterological Society of Australia (GESA). Infection Control in Endoscopy. Victoria, Australia: GESA, 2011. http://www.gesa.org.au/professional.asp?cid=9&id=123. Accessed December 6, 2013.Google Scholar
24. Alfa, MJ, Olson, N, Degagne, P, Simner, PJ. Development and validation of rapid use scope test strips to determine the efficacy of manual cleaning for flexible endoscope channels. Am J Infect Control 2012;40(9):860–865.Google Scholar
25. Alfa, MJ, Fatima, I, Olson, N. Validation of adenosine triphosphate to audit manual cleaning of flexible endoscope channels. Am J Infect Control 2013;41(3):245–248.Google Scholar
26. Fushimi, R, Takashina, M, Yoshikawa, H, et al. Comparison of adenosine triphosphate, microbiological load, and residual protein as indicators for assessing the cleanliness of flexible gastrointestinal endoscopes. Am J Infect Control 2013;41(2):161–164.Google Scholar
27. Obee, PC, Griffith, CJ, Cooper, RA, Cooke, RP, Bennion, NE, Lewis, M. Real-time monitoring in managing the decontamination of flexible gastrointestinal endoscopes. Am J Infect Control 2005;33(4):202–206.Google Scholar
28. Aiken, ZA, Wilson, M, Pratten, J. Evaluation of ATP bioluminescence assays for potential use in a hospital setting. Infect Control Hosp Epidemiol 2011;32(5):507–509.Google Scholar
29. Hansen, D, Benner, D, Hilgenhoner, M, Leisebein, T, Brauksiepe, A, Popp, W. ATP measurement as method to monitor the quality of reprocessing flexible endoscopes. Ger Med Sci 2004;2:Doc04.Google Scholar
30. Siemens Healthcare Diagnostics. Siemens Healthcare Diagnostics Reagent Strips for Urinalysis: Instructions for Use. Tarrytown, NY: Siemens Healthcare Diagnostics, 2010.Google Scholar
31. 3M. Clean-Trace Surface Protein-High Sensitivity: Instructions for Use. Saint Paul, MN: 3M, 2010:1–4.Google Scholar
32. 3M. Clean-Trace ATP Surface Test: Instructions for Use. Saint Paul, MN: 3M, 2010:1–4.Google Scholar
33. 3M. Clean-Trace ATP Water Test: Instructions for Use. Saint Paul, MN: 3M, 2011:1–4.Google Scholar
34. Alfa, MJ, Fatima, I, Olson, N. The adenosine triphosphate test is a rapid and reliable audit tool to assess manual cleaning adequacy of flexible endoscope channels. Am J Infect Control 2013;41(3):249–253.Google Scholar
35. Alfa, MJ, Howie, R. Modeling microbial survival in buildup biofilm for complex medical devices. BMC Infect Dis 2009;9:56.CrossRefGoogle ScholarPubMed
36. Azizi, J, Basile, RJ. Doubt and proof: the need to verify the cleaning process. Biomed Instrum Technol 2012;46:49–54.Google Scholar
37. Herve, R, Keevil, CW. Current limitations about the cleaning of luminal endoscopes. J Hosp Infect 2013;83(1):22–29.Google Scholar
38. Martiny, H, Floss, H, Zuhlsdorf, B. The importance of cleaning for the overall results of processing endoscopes. J Hosp Infect 2004;56(suppl 2):S16–S22.Google Scholar
39. Rutala, WA, Weber, DJ. New developments in reprocessing semicritical items. Am J Infect Control 2013;41(5 suppl):S60–S66.Google Scholar
40. Department of Health and Human Services, Healthcare Financing Administration. Statement of Deficiencies and Plan of Correction. Monroeville, PA: Forbes Regional Hospital, April 7, 2005. State License 311101.Google Scholar