Carbapenem-resistant Enterobacteriaceae and endoscopy: An evolving threat

Area of Science:

• Infectious Diseases
• Gastroenterology
• Medical Device Reprocessing

Background:

• Recent Carbapenem-resistant Enterobacteriaceae (CRE) outbreaks have been linked to contaminated endoscopes.
• Existing guidelines for endoscope-associated transmission mitigation are interim, lacking systematic evaluation.
• There is a need for a comprehensive review of CRE prevention practices in endoscopy.

Purpose of the Study:

• To systematically review endoscope-associated CRE infection episodes.
• To analyze outbreak detection, mitigation strategies, patient outcomes, and recurrence prevention measures.
• To identify challenges and best practices in endoscope reprocessing.

Main Methods:

• Systematic literature review of endoscope-associated CRE infection outbreaks.
• Abstraction of data on outbreak characteristics, cleaning protocols, and sterilization effectiveness.
• Analysis of reported difficulties in reprocessing complex endoscope components.

Main Results:

• Seven distinct CRE outbreaks were identified, primarily associated with duodenoscopes (5/7).
• Difficulties in cleaning hard-to-access areas, like the duodenoscope elevator, were frequently noted.
• No sterilization failures were reported, but the effectiveness and execution of routine reprocessing remain unclear.

Conclusions:

• Enhanced cleaning protocols and increased surveillance are crucial for preventing and detecting future CRE outbreaks.
• Further investigation is required to ascertain if more rigorous measures, such as sterilization, are necessary for duodenoscopes.
• Addressing reprocessing challenges is essential for patient safety in endoscopic procedures.