Background and Aims

We aimed to determine whether monitoring of duodenoscope cleaning by rapid adenosine triphosphate (ATP) combined with channel-purge storage could eliminate high-concern microorganisms.

Methods

In a simulated-use study, suction channels, as well as lever recesses, from 2 duodenoscopes models and the unsealed elevator guidewire (EGW) channel from 1 of these 2 duodenoscopes (the other model has a sealed EGW) were perfused with ATS2015 containing approximately 8 Log₁₀ colony-forming units (CFU)/mL of both Enterococcus faecalis and Escherichia coli. Pump-assisted cleaning was monitored by rapid ATP testing. Duodenoscopes exceeding 200 relative light units (RLUs) were recleaned. Clean duodenoscopes were processed through an automated endoscope reprocessor and then stored in a channel-purge storage cabinet for 1 to 3 days. Cultures of EGW channel and instrument channel combined with the lever recess (IC-LR) were taken after storage. The impacts of extended cleaning and alcohol flush were evaluated.

Results

E coli was reliably eliminated in IC-LR and EGW channels of 119 duodenoscope tests (59 with sealed EGW and 60 with nonsealed EGW). However, actionable levels of E faecalis and environmental bacteria persisted. Neither alcohol flush nor extended cleaning resulted in a reduction of actionable levels for these organisms. Identification of isolates indicated that residual organisms in duodenoscope channels were hardy Gram-positive bacteria (often spore formers) that likely originated from environmental sources.

Conclusions

These data indicate that high-concern Gram-negative bacteria but not E faecalis or environmental bacteria can be reliably eliminated by use of the manufacturer’s instructions for reprocessing with ATP monitoring of cleaning and channel-purge storage conditions.

中文翻译：

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清洁监控与通道吹扫存储相结合对十二指肠镜消除大肠杆菌和环境细菌的影响

背景和目标

我们旨在确定通过快速三磷酸腺苷（ATP）结合通道清除存储监视十二指肠镜清洁是否可以消除高度关注的微生物。

方法

在一项模拟使用研究中，使用2个十二指肠镜型号的吸气通道以及杠杆凹槽和这2个十二指肠镜中的一个的未密封的电梯导丝（EGW）通道（另一个型号具有密封的EGW）灌注了ATS2015，其中包含约粪肠球菌和大肠杆菌的8 Log ₁₀菌落形成单位（CFU）/ mL。泵辅助清洁通过快速ATP测试进行监控。重新清洁了超过200个相对光单位（RLU）的十二指肠镜。清洁的十二指肠镜通过自动内窥镜洗消机进行处理，然后在通道吹扫存储柜中存储1至3天。存放后取EGW通道和仪器通道的培养物并结合杠杆凹槽（IC-LR）。评估了长时间清洁和酒精冲洗的影响。

结果

在119个十二指肠镜测试的IC-LR和EGW通道中，可靠地消除了大肠杆菌（密封EGW为59，非密封EGW为60）。但是，粪肠球菌和环境细菌的有效水平仍然存在。酒精冲洗和长时间清洁都不会导致这些生物的可操作水平降低。分离株的鉴定表明，十二指肠镜通道中的残留生物是强力的革兰氏阳性细菌（通常是孢子形成者），可能源自环境。

结论

这些数据表明，可以通过使用制造商的再处理说明（使用ATP监控清洁和通道清除存储条件进行再处理）来可靠地消除高关注的革兰氏阴性细菌，而不能排除粪便中的大肠杆菌或环境细菌。