Background and Aims

Iatrogenic infections related to duodenoscopes remain a top concern for medical centers where ERCP is performed. We assessed the long-term results and impact of key interventions in the optimization of a rigorous “culture and quarantine” program for duodenoscope reprocessing.

Methods

We reviewed a prospectively collected, quality assurance database of all duodenoscope cultures (n = 4307) obtained for the initial 3-year duration of culture and quarantine from 2014 to 2017 in a single U.S.-based, high-volume endoscopy center. All duodenoscopes were subject to manual cleaning and automated reprocessing and drying, followed by sampling using a modified protocol developed by the Centers for Disease Control and Prevention. Duodenoscopes were cultured per-use.

Results

A total of 4307 duodenoscope cultures were obtained during the study period. High-concern organisms were isolated from 33 of these cultures, resulting in a .697% high-level disinfection defect rate. Statistically significant interventions included withdrawal of a high-frequency culture-positive duodenoscope (scope A) from clinical service in addition to implementation of new manufacturer-recommended cleaning protocols. Withdrawal of a second high-frequency culture-positive duodenoscope (scope B) and a mandatory device retrofit had no effect on the observed rate of positive duodenoscope cultures.

Conclusions

Withdrawal of duodenoscopes with a high rate of culture positivity and optimizing manual cleaning practices have contributed to an overall decline in the high-level disinfection defect rate. A stringent culture and quarantine protocol allowed identification of the culprit endoscopes. There remains a much-needed role for an inexpensive and highly reliable method to check on the adequacy of reprocessing given the inherent complexity of these tasks.

中文翻译：

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优化十二指肠镜的后处理：严格评估文化和检疫协议

背景和目标

与十二指肠镜有关的医源性感染仍然是进行ERCP的医疗中心的头等大事。我们评估了十二指肠镜后处理的严格“培养和检疫”计划的最优化的长期结果和主要干预措施的影响。

方法

我们回顾了一个前瞻性收集的，所有十二指肠镜培养物（n = 4307）的质量保证数据库，该数据库是在2014年至2017年最初的三年培养和检疫期间在美国一家大型内窥镜检查中心获得的。所有十二指肠镜均需进行手动清洁，自动后处理和干燥，然后使用由疾病控制与预防中心开发的改进方案进行采样。每次使用十二指肠镜进行培养。

结果

在研究期间共获得了4307个十二指肠镜培养物。从这些培养物中的33种中分离出了高关注度的生物，因此高水平的消毒缺陷率达到了6.697％。具有统计意义的干预措施包括高频波培养阳性十二指肠镜（范围A）从临床服务中退出，以及实施新的制造商建议的清洁方案。撤出第二台高频培养阳性十二指肠镜（范围B）和强制性设备改造对观察到的十二指肠镜阳性培养率没有影响。

结论

具有较高培养阳性率的十二指肠镜的撤出和优化的手动清洁操作已导致高水平消毒缺陷率的总体下降。严格的文化和隔离协议允许识别罪魁祸首内窥镜。考虑到这些任务的内在复杂性，一种廉价且高度可靠的方法仍然需要检查后处理的适当性。