The American Gastroenterological Association convened a meeting with experts in gastroenterology, epidemiology and infectious disease to discuss how to prevent duodenoscope infections.
Duodenoscopes have been linked to a growing number of antibiotic-resistant infections, including an outbreak at Ronald Reagan UCLA Medical Center in Los Angeles that resulted in two deaths.
Present at the AGA meeting were representatives from the U.S. Food and Drug Administration, Centers for Disease Control and Prevention and the ECRI Institute, as well as experts from endoscope manufacturers Fuji and Pentax.
Together, the meeting participants came up with the following eight recommendations for physicians to improve patient safety associated with duodenoscopes.
- Treat all elevator-channel endoscopes — including both endoscopic ultrasound-guided fine-needle aspiration echoendoscopes and duodenoscopes — the same when disinfecting.
- Continue to heed recently enhanced manufacturer reprocessing guidelines while the FDA works with endoscope manufacturers to validate their enhanced reprocessing protocols.
- Track elevator-channel endoscopes by patient and by device serial number to enable retrospective identification in cases of infection.
- Establish an infection surveillance program with two steps: tracking all patients who have undergone a procedure with an elevator-channel endoscope and periodically collecting culture surveillance of all elevator-channel endoscopes.
- Get a baseline culture of all elevator-channel endoscopes. Be sure to thoroughly review reprocessing technique if a culture comes up positive.
- Develop a standardized reprocessing training program and audit reprocessing competency of the staff every six months, as well as when new model endoscopes are introduced.
- Contact the CDC immediately if you suspect a breach or infection to aid in the investigation.
- Looking long-term, further study should review alternative scope designs that might mitigate the risk of infection transmission.
More articles on duodenoscopes:
Are faulty cleaners, not complex scopes, to blame for 'superbug' infections?
Cedars-Sinai reports 'superbug' infections tied to hard-to-clean scopes: 6 things to know
ECRI Institute: Culture duodenoscopes to reduce CRE infections