BACKGROUND AND AIMS: Carbapenem-resistant Enterobacteriaceae (CRE) outbreaks have been implicated at several medical institutions involving gastroenterology laboratories and, specifically, duodenoscopes. Currently, there are no specific guidelines to eradicate or prevent the outbreak of this bacteria. We describe ethylene oxide (ETO) gas sterilizations of duodenoscopes to address this issue. METHODS: A complete investigation of the gastroenterology laboratory and an evaluation by the Centers for Disease Control and Prevention concluded that no lapses were found in the reprocessing of the equipment. With no deficiencies to address, we began a novel cleaning process using surgical ETO gas sterilizers in addition to standard endoscope reprocessing recommendations and guidelines, all while trying to eradicate the CRE contamination and prevent future recurrences. We also instituted a surveillance system for recurrence of CRE contamination via monthly cultures of the duodenoscopes. RESULTS: Between October 2013 and April 2014, 589 ERCPs were performed with 645 ETO gas sterilizations of 6 duodenoscopes. Given the extra 16 hours needed to sterilize the duodenoscopes, our institution incurred costs resulting from purchasing additional equipment and surveillance cultures. Four duodenoscopes sustained damage during this period; however, this could not be directly attributed to the sterilization process. Furthermore, after an 18-month success period we encountered a positive CRE culture after sterilization, albeit of a different strain than originally detected during the outbreak. The duodenoscope underwent additional ETO gas sterilization, with a negative repeated culture; all potentially exposed individuals screened negative for CRE. CONCLUSIONS: Proper use of high-level disinfection alone may not eliminate multidrug-resistant organisms from duodenoscopes. In this single-center study, the addition of ETO sterilization and frequent monitoring with cultures reduced duodenoscope contamination and eliminated clinical infections. As such, ETO gas sterilization may provide benefit in further decontamination of duodenoscopes, but further investigation is necessary.
BACKGROUND AND AIMS: Carbapenem-resistant Enterobacteriaceae (CRE) outbreaks have been implicated at several medical institutions involving gastroenterology laboratories and, specifically, duodenoscopes. Currently, there are no specific guidelines to eradicate or prevent the outbreak of this bacteria. We describe ethylene oxide (ETO) gas sterilizations of duodenoscopes to address this issue. METHODS: A complete investigation of the gastroenterology laboratory and an evaluation by the Centers for Disease Control and Prevention concluded that no lapses were found in the reprocessing of the equipment. With no deficiencies to address, we began a novel cleaning process using surgical ETO gas sterilizers in addition to standard endoscope reprocessing recommendations and guidelines, all while trying to eradicate the CRE contamination and prevent future recurrences. We also instituted a surveillance system for recurrence of CRE contamination via monthly cultures of the duodenoscopes. RESULTS: Between October 2013 and April 2014, 589 ERCPs were performed with 645 ETO gas sterilizations of 6 duodenoscopes. Given the extra 16 hours needed to sterilize the duodenoscopes, our institution incurred costs resulting from purchasing additional equipment and surveillance cultures. Four duodenoscopes sustained damage during this period; however, this could not be directly attributed to the sterilization process. Furthermore, after an 18-month success period we encountered a positive CRE culture after sterilization, albeit of a different strain than originally detected during the outbreak. The duodenoscope underwent additional ETO gas sterilization, with a negative repeated culture; all potentially exposed individuals screened negative for CRE. CONCLUSIONS: Proper use of high-level disinfection alone may not eliminate multidrug-resistant organisms from duodenoscopes. In this single-center study, the addition of ETO sterilization and frequent monitoring with cultures reduced duodenoscope contamination and eliminated clinical infections. As such, ETO gas sterilization may provide benefit in further decontamination of duodenoscopes, but further investigation is necessary.
Authors: Gheorghe G Balan; Catalin Victor Sfarti; Stefan Andrei Chiriac; Carol Stanciu; Anca Trifan Journal: Eur J Clin Microbiol Infect Dis Date: 2019-09-03 Impact factor: 3.267
Authors: Zachary L Smith; Arshish Dua; Kia Saeian; Nathan A Ledeboer; Mary Beth Graham; Murad Aburajab; Darren D Ballard; Abdul H Khan; Kulwinder S Dua Journal: Dig Dis Sci Date: 2017-07-05 Impact factor: 3.199
Authors: Michelle J Alfa; Harminder Singh; Zoann Nugent; Donald Duerksen; Gale Schultz; Carol Reidy; Patricia DeGagne; Nancy Olson Journal: Front Med (Lausanne) Date: 2017-11-07
Authors: Gheorghe G Bălan; Irina Roşca; Elena-Laura Ursu; Florica Doroftei; Andra-Cristina Bostănaru; Eugen Hnatiuc; Valentin Năstasă; Vasile Şandru; Gabriela Ştefănescu; Anca Trifan; Mihai Mareş Journal: Infect Drug Resist Date: 2018-05-17 Impact factor: 4.003
Authors: Charles Eugenio McCafferty; Marra Jai Aghajani; David Abi-Hanna; Iain Bruce Gosbell; Slade Owen Jensen Journal: Ann Clin Microbiol Antimicrob Date: 2018-10-10 Impact factor: 3.944
Authors: Rahul Pannala; Bruce Baldwin; Vijay Aluru; Thomas E Grys; Jordan Holmes; Laurence J Miller; M Edwyn Harrison; Cuong C Nguyen; Fred C Tenover; David Persing; Douglas O Faigel Journal: Endosc Int Open Date: 2018-01-12