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Gastrointestinal endoscope contamination rates - elevators are not only to blame: a systematic review and
Hemant Goyal1,2, Sara Larsen3, Abhilash Perisetti4
1Center for Interventional Gastroenterology at UTHealth (iGUT), Division of Gastroenterology, Hepatology & Nutrition, McGovern Medical School, UTHealth, Houston, Texas, United States.
Abstract:
Background and study aims Duodenoscopes that are contaminated due to inadequate reprocessing are well-documented. However, studies have demonstrated poor reprocessing of other kinds of endoscopes as well, including echoendoscopes, gastroscopes, and colonoscopes. We estimated the contamination rate beyond the elevator of gastrointestinal endoscopes based on available data. Methods We searched PubMed and Embase from January 1, 2010 to October 10, 2020, for studies investigating contamination rates of reprocessed gastrointestinal endoscopes. A random-effects model was used to calculate the contamination rate of patient-ready gastrointestinal endoscopes. Subgroup analyses were conducted to investigate differences among endoscope types, countries, and colony-forming unit (CFU) thresholds. Results Twenty studies fulfilled the inclusion criteria, including 1,059 positive cultures from 7,903 samples. The total contamination rate was 19.98 % ± 0.024 (95 % confidence interval [Cl]: 15.29 %-24.68 %; I 2 = 98.6 %). The contamination rates of colonoscope and gastroscope channels were 31.95 % ± 0.084 and 28.22 % ± 0.076, respectively. Duodenoscope channels showed a contamination rate of 14.41 % ± 0.029. The contamination rates among studies conducted in North America and Europe were 6.01 % ± 0.011 and 18.16% ± 0.053 %, respectively. The contamination rate among studies using a CFU threshold > 20 showed contamination of 30.36 % ± 0.094, whereas studies using a CFU threshold < 20 showed a contamination rate of 11 % ± 0.026. Conclusions On average, 19.98 % of reprocessed gastrointestinal endoscopes may be contaminated when used in patients and varies between different geographies. These findings highlight that the elevator mechanism is not the only obstacle when reprocessing reusable endoscopes; therefore, guidelines should recommend more surveillance of the endoscope channels as well.
Insights
Nearly 20% of reprocessed gastrointestinal endoscopes show contamination, with rates varying by geography and endoscope type. Inadequate reprocessing highlights the need for enhanced surveillance of endoscope channels beyond the elevator mechanism.
Area of Science:
- Gastroenterology
- Infectious Disease Control
- Medical Device Reprocessing
Background:
- Inadequate reprocessing of duodenoscopes is a known issue, but contamination extends to other gastrointestinal endoscopes like echoendoscopes, gastroscopes, and colonoscopes.
- Previous studies have focused on duodenoscope elevator contamination, necessitating an evaluation of contamination rates in other endoscope types and locations.
Purpose of the Study:
- To estimate the overall contamination rate of reprocessed gastrointestinal endoscopes beyond the elevator mechanism.
- To analyze contamination rates based on endoscope type, geographical region, and colony-forming unit (CFU) thresholds.
Main Methods:
- Systematic literature search of PubMed and Embase databases (January 2010 - October 2020).
- Inclusion of 20 studies reporting contamination rates of reprocessed gastrointestinal endoscopes.
- Application of a random-effects model to calculate pooled contamination rates and conduct subgroup analyses.
Main Results:
- A total contamination rate of 19.98% (95% CI: 15.29%-24.68%) was observed across 7,903 samples from 1,059 positive cultures.
- Contamination rates varied significantly by endoscope type: colonoscopes (31.95%), gastroscopes (28.22%), and duodenoscopes (14.41%).
- Geographical differences were noted, with lower rates in North America (6.01%) compared to Europe (18.16%). Higher CFU thresholds (>20) correlated with higher contamination rates (30.36%).
Conclusions:
- Approximately 20% of reprocessed gastrointestinal endoscopes remain contaminated, posing a risk to patient safety.
- Endoscope channel contamination is a widespread issue, not solely confined to the elevator mechanism.
- Current reprocessing guidelines should be updated to include more rigorous surveillance of all endoscope channels.
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