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Impact of duodenoscope reprocessing factors on duodenoscope contamination: a retrospective observational study
K van der Ploeg1, M C Vos2, N S Erler3
1Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
Background:
Despite adherence to reprocessing protocols, duodenoscopes frequently remain contaminated, highlighting significant knowledge gaps in reprocessing efficiency.
Aim:
To identify risk factors in duodenoscope reprocessing procedures affecting contamination rates.
Methods:
Cultures from Pentax ED34-i10T2 duodenoscopes collected between February 2022 and December 2023 were included. Contamination was determined by the presence of micro-organisms of gut or oral origin (MGO). Data on duodenoscope use, reprocessing lead times and personnel were retrieved from electronic medical records. Risk factors were derived from reprocessing guidelines and literature. These included a delay >30 min in initiating manual cleaning, manual cleaning duration of ≤5 min, drying time <90 min, personnel reprocessing frequency, and storage exceeding seven days. A logistic mixed-effects model evaluated these factors' impact on duodenoscope contamination.
Findings:
Out of 307 duodenoscope cultures, 58 (18.9%) were contaminated with MGO. Throughout the study period, the duodenoscopes underwent 1296 reprocessing cycles. Manual cleaning times of ≤5 min significantly increased contamination odds (adjusted odds ratio (aOR): 1.61; 95% confidence interval (CI): 1.10-2.34; P = 0.01). Increased usage of a duodenoscope was associated with reduced odds of contamination (aOR: 0.80; 95% CI: 0.64-0.995; P = 0.045). Other studied risks showed no clear association with contamination rates.
Conclusion:
Manual cleaning times of ≤5 min increased the odds of contamination with MGO. Delays in reprocessing initiation and incomplete drying, traditionally considered as risk factors, were not associated with an increased risk of contamination in this study. Future research should explore whether enhanced surveillance of reprocessing times can mitigate duodenoscope contamination.
Insights
Short manual cleaning times (≤5 minutes) significantly increase duodenoscope contamination risks. Enhanced surveillance of reprocessing may reduce contamination rates in clinical settings.
Area of Science:
- Infection Control
- Medical Device Reprocessing
- Gastroenterology
Background:
- Duodenoscopes are prone to contamination despite adherence to reprocessing protocols.
- Significant knowledge gaps exist regarding the efficiency of current duodenoscope reprocessing methods.
- Identifying factors influencing duodenoscope contamination is crucial for patient safety.
Purpose of the Study:
- To identify specific risk factors within duodenoscope reprocessing procedures that contribute to contamination.
- To evaluate the impact of manual cleaning duration, reprocessing lead times, and personnel factors on contamination rates.
- To provide evidence-based recommendations for improving duodenoscope reprocessing efficacy.
Main Methods:
- Analysis of cultures from 307 Pentax ED34-i10T2 duodenoscopes processed between February 2022 and December 2023.
- Contamination defined by the presence of microorganisms of gut or oral origin (MGO).
- Logistic mixed-effects modeling used to assess risk factors including manual cleaning duration (≤5 min), delayed initiation (>30 min), drying time (<90 min), personnel frequency, and storage duration (>7 days).
Main Results:
- 18.9% of duodenoscope cultures (58/307) showed MGO contamination.
- Manual cleaning times of ≤5 minutes were significantly associated with increased contamination odds (aOR: 1.61, P=0.01).
- Increased duodenoscope usage correlated with reduced contamination odds (aOR: 0.80, P=0.045), while other factors showed no significant association.
Conclusions:
- Manual cleaning duration of ≤5 minutes is a significant risk factor for duodenoscope contamination with MGO.
- Contrary to traditional assumptions, delays in reprocessing initiation and incomplete drying did not show a significant association with contamination in this study.
- Further research into enhanced surveillance of reprocessing times is recommended to mitigate duodenoscope contamination.
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