Background and Aims

After recent outbreaks of duodenoscope-related infections from multidrug-resistant organisms (MDRO), the United States Food and Drug Administration (FDA) recommended implementing 1 or more of 4 enhanced reprocessing measures in addition to updated manual cleaning methods and high-level disinfection (HLD). The implementation of these techniques in endoscopy facilities and provider opinions regarding reprocessing priorities remain unknown.

Methods

Physicians, nurse managers, nurses, and infection control staff at endoscopy units performing ERCP in the United States were surveyed to assess current institutional practices and individual opinions regarding future reprocessing solutions.

Results

A total of 249 distinct institutions participated in the survey. Of these, 223 (89.6%) implemented at least 1 of the 4 supplemental reprocessing methods after MDRO outbreaks. Overall, 63% of centers used repeat HLD, 53% performed surveillance microbiological culturing, 35% used liquid chemical sterilization, and 12% used ethylene oxide sterilization. Thirty-seven centers (15%) routinely screened patients for MDRO. Forced-air drying after reprocessing was used by 47.8% of centers. Fifty percent of individual respondents, including 58.6% of physicians, believed that redesign of the duodenoscope is the best long-term reprocessing solution. The majority (55.1%) identified efficacy to be the single most important factor in selecting a reprocessing technique.

Conclusions

Although most endoscopy centers have implemented enhanced duodenoscope reprocessing techniques, there is a large variation in practice. Most providers believe that duodenoscope redesign and identifying reprocessing techniques with maximal efficacy are the long-term priorities. Improved adherence to forced-air drying in duodenoscope reprocessing is needed.

中文翻译：

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美国内窥镜中心的十二指肠镜后处理实践模式：一项调查研究

背景和目标

在最近爆发了由多药耐药生物（MDRO）引起的与十二指肠镜相关的感染之后，美国食品药品管理局（FDA）建议在更新的手动清洁方法和高级消毒措施之外，还实施4种增强后处理措施中的1种或更多措施（ HLD）。在内窥镜检查设施中如何实施这些技术以及提供者关于再处理优先级的意见仍然未知。

方法

对在美国进行ERCP的内窥镜检查科的内科医生，护士管理人员，护士和感染控制人员进行了调查，以评估当前的机构做法以及有关未来后处理解决方案的个人意见。

结果

共有249个不同的机构参与了调查。其中，有223（89.6％）人在MDRO爆发后实施了4种补充后处理方法中的至少一种。总体而言，有63％的中心使用重复HLD，53％的中心进行了监控微生物培养，35％的中心采用了液体化学灭菌，而12％的中心采用了环氧乙烷灭菌。37个中心（15％）定期对患者进行MDRO筛查。47.8％的中心使用了后处理后的强制风干。50％的个体受访者（包括58.6％的医师）认为，十二指肠镜的重新设计是最好的长期再处理解决方案。大多数（55.1％）认为功效是选择后处理技术的最重要因素。

结论

尽管大多数内窥镜检查中心已实施了增强的十二指肠镜后处理技术，但实践中仍存在很大差异。大多数提供者认为，十二指肠镜的重新设计和确定具有最大功效的后处理技术是长期的优先事项。需要在十二指肠镜后处理中改善对强制风干的依从性。