A pair of studies suggest that sterilizing GI endoscopes, rather than high-level disinfecting them, may be necessary to prevent the transmission of multi-drug resistant organisms which have been found to survive standard reprocessing practices.
One study, published last week in JAMA, recounts the discovery of an outbreak of a rare strain of Carbapenem-resistant Enterobacteriaceae (CRE) among patients at Advocate Lutheran General Hospital in Park Ridge, Ill.
An investigation assisted by epidemiologists at the Centers for Disease Control and Prevention in Atlanta as well as the Illinois, Cook County and Chicago public health departments linked the outbreak to a duodenoscope used in endoscopic retrograde cholangiopancreatography (ERCP) procedures. The scopes cross-contaminated patients despite a disinfection process that fully complied with their manufacturers' recommendations. After they were sterilized with ethylene oxide, however, no additional infections were observed.
"The complicated design of duodenoscopes makes cleaning difficult," the researchers note. In addition to switching to sterilization, they advise routine testing for residual contamination.
The other study, presented this weekend at ID Week, the annual meeting for infectious disease professionals, reports similar findings from UPMC Presbyterian Hospital in Pittsburgh, Pa. There, researchers tracked an increase in antibiotic-resistant infections among ERCP patients before determining that standard disinfection failed to entirely eliminate bacteria from the flexible scopes' channels. Sterilization with ethylene oxide likewise halted the infectious spread.
"We are confident that the change from disinfection to sterilization of GI scopes is necessary in preventing serious infections and we are glad to share our findings with hospitals nationwide," says lead author Carlene Muto, MD, MS, UPMC Presbyterian's director of infection prevention.
In an editorial accompanying the JAMA study, epidemiologists William A. Rutala, PhD, MPH, and David J. Weber, MD, MPH, of the University of North Carolina, urge healthcare workers to keep an eye out for outbreaks.
"Clinicians should be encouraged to report and publish cases of infectious diseases related to endoscopy, especially if current reprocessing methods were adhered to," they write, "so it can be determined if the [study] is the tip of the iceberg or an isolated occurrence. If the former, then revision of the endoscope reprocessing guidelines will be necessary to ensure patient safety."