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Duodenoscope-Associated Infections beyond the Elevator Channel: Alternative Causes for Difficult Reprocessing.

Gheorghe G Balan1, Irina Rosca2, Elena-Laura Ursu3

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Summary

Routine use and reprocessing of duodenoscopes can cause surface alterations, potentially leading to bacterial contamination and multidrug-resistant organism (MDRO) biofilm formation. These changes may compromise reprocessing effectiveness, increasing infection risks during endoscopic retrograde cholangiopancreatography (ERCP) procedures.

Keywords:
carbapenem-resistant enterobacteriaceaeendoscopic retrograde cholangiopancreatographynosocomial infectionsreprocessing

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Area of Science:

  • Medical Devices
  • Infectious Diseases
  • Materials Science

Background:

  • Duodenoscopes are crucial for ERCP procedures but have been linked to multidrug-resistant organism (MDRO) outbreaks.
  • Investigating duodenoscope surface integrity is essential to understand infection transmission routes.

Purpose of the Study:

  • To identify potential duodenoscope surface damages that could serve as a source of MDRO infections.
  • To evaluate the impact of procedural use and reprocessing on duodenoscope materials.

Main Methods:

  • Dismantled duodenoscopes and analyzed outer and inner channel surfaces.
  • Employed Fourier-transform infrared spectroscopy (FTIR), differential scanning calorimetry (DSC), thermogravimetric analysis (TGA), atomic force microscopy (AFM), and scanning electron microscopy (SEM).
  • Assessed antimicrobial activity and characterized surface alterations.

Main Results:

  • Observed progressive alterations on coating and working channel polymers from proximal to distal ends.
  • Surface texture and morphological changes were evident.
  • The coating remained effective against bacterial adhesion, despite observed alterations.

Conclusions:

  • Routine duodenoscope use and reprocessing cycles impact surface integrity.
  • Altered surfaces may increase susceptibility to bacterial contamination and MDRO biofilm formation.
  • Difficult reprocessing of damaged surfaces poses a significant challenge.