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Is bacteriologic surveillance in endoscope reprocessing stringent enough?
J Kovaleva1, N E L Meessen, F T M Peters
1Department of Medical Microbiology, University Medical Centre Groningen, University of Groningen, 9700 RB Groningen, The Netherlands. j.kovaleva@mmb.umcg.nl
Abstract:
Endoscopes, including duodenoscopes, are medical devices that are frequently associated with outbreaks of nosocomial infections. We investigated an outbreak of multidrug-resistant PSEUDOMONAS AERUGINOSA sepsis affecting three patients after endoscopic retrograde cholangiopancreaticography (ERCP). Epidemiologic investigation supplemented by molecular typing revealed that one ERCP scope was the source of infection with P. AERUGINOSA. No contamination with this microorganism was found after screening of washer-disinfectors, connecting tubes, and environmental surfaces in the endoscopy center. PSEUDOMONAS isolates from blood and endoscope channels before gas sterilization with ethylene oxide (ETO) were characterized by molecular typing as "linked isolates". Though the current surveillance system did not prevent the infections in three patients, our microbiological surveillance protocol with routine culturing of endoscopes was helpful in detecting the source of contamination and probably avoided numerous cross-contaminations in other patients who underwent ERCP procedures with endoscopes.
Insights
A contaminated duodenoscope caused multidrug-resistant Pseudomonas aeruginosa sepsis in three patients. Routine endoscope culturing identified the scope as the infection source, preventing further spread.
Area of Science:
- Infectious Diseases
- Medical Device Contamination
- Microbiology
Background:
- Endoscopes, particularly duodenoscopes, are linked to nosocomial infections.
- Endoscopic retrograde cholangiopancreaticography (ERCP) procedures carry a risk of infection transmission.
Observation:
- An outbreak of multidrug-resistant Pseudomonas aeruginosa sepsis occurred in three patients post-ERCP.
- Molecular typing identified a single ERCP scope as the source of P. aeruginosa transmission.
Findings:
- No contamination was found in washer-disinfectors, tubing, or environmental surfaces.
- Pseudomonas isolates from patient blood and the endoscope channels before ethylene oxide (ETO) sterilization were molecularly linked.
- Routine microbiological surveillance of endoscopes successfully detected the contaminated device.
Implications:
- Despite not preventing initial infections, endoscope culturing aids in identifying contamination sources.
- This surveillance protocol likely prevented additional cross-contaminations in subsequent ERCP procedures.
- Enhanced disinfection and surveillance protocols are crucial for medical device safety.
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