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Assessment of a Novel Approach to Evaluate the Outcome of Endoscope Reprocessing

Published online by Cambridge University Press:  02 January 2015

C. V. Sciortino Jr.*
Affiliation:
Department of Pathology and Laboratory Medicine, Department of Veterans Affairs Medical Center, Louisville, Kentucky
Eric L. Xia
Affiliation:
Commonwealth Infectious Disease, Personal Service Corporation, Department of Veterans Affairs Medical Center, Louisville, Kentucky
Alberta Mozee
Affiliation:
Department of Medical Administration, Infection Control, Department of Veterans Affairs Medical Center, Louisville, Kentucky
*
Pathology and Laboratory Medicine Service (113), Department of Veterans Affairs Medical Center, 800 Zorn Avenue, Louisville, KY 40206

Abstract

Objective:

To investigate and evaluate the use of a portable luminometer system for detecting contamination following the reprocessing and high-level disinfection of flexible endoscopes.

Design:

Random sampling of endoscopes spaced at 1- to 2-week intervals following normal use in patients.

Methods:

Portable luminometer system testing of 31 endoscopes undergoing reprocessing, 63 stored endoscopes, and 15 reprocessed endoscopes that underwent in-depth microbiological analysis. For testing with the portable luminometer system, samples were collected by swabbing a 100-cm2 shank surface area and the internal tip end orifice. Standardization of portable luminometer system results was performed in vitro by comparison of serial dilutions of known quantities of microorganisms and blood, tested before and after sterilization by autoclave. Microbiological analysis included Gram stain, culture for aerobic bacteria, and gene probes for Mycobacterium tuberculosis, herpes simplex viruses 1 and 2, and Cytomegalovirus. Trichrome and calcofluor white stains were used to detect parasites and fungi. Legionella was detected by stain with fluorescent-labeled monoclonal antibody.

Setting:

The gastroendoscopy unit of a Veterans Affairs hospital.

Results:

The portable luminometer system was capable of detecting microbial and cellular contamination of flexible endoscopes following high-level disinfection and reprocessing. The sensitivity of the assay was sufficient for detecting low-level contamination.

Conclusions:

The system provided a rapid microbiological outcome monitor for the cleaning and disinfection process. The system was easy to use and relatively accurate.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2004

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References

1.Gorse, GJ, Messner, RL. Infection control practices in gastrointestinal endoscopy in the United States: a national survey. Infect Control Hosp Epidemiol 1991;12:289296.CrossRefGoogle ScholarPubMed
2.American Society for Testing Materials. Standard Practice for Cleaning and Disinfection of Flexible Fiberoptic and Video Endoscopes Used in the Examination of Hollow Viscera, Designation F1518-94. Philadelphia: American Society for Testing Materials; 2003.Google Scholar
3.Anonymous. Proposed recommended practices for chemical disinfection. AORN J 1994;60:463466.CrossRefGoogle Scholar
4.Volunteer Hospital Association, Inc. Endoscope Processing: A Guide for VHA Healthcare Organizations. Irving, TX: Volunteer Hospital Association, Inc.; 1993.Google Scholar
5.Anonymous. Liquid disinfecting and sterilizing reprocessors used for flexible endoscopes. Health Devices 1994;23:214239.Google Scholar
6.Axon, AT. Disinfection and endoscopy: summary and recommendations. J Gastroenterol Hepatol 1991;6:2324.CrossRefGoogle ScholarPubMed
7.Spach, DH, Silverstein, FE, Stamm, WE. Transmission of infection by gastrointestinal endoscopy and bronchoscopy. Ann Intern Med 1993;118:117128.CrossRefGoogle ScholarPubMed
8.Streulens, MJ, Rost, F, Deplano, A, et al.Pseudomonas aeruginosa and Enterobacteriaceae bacteremia after biliary endoscopy: an outbreak investigation using DNA macrorestriction analysis. Am J Med 1993;95:489498.CrossRefGoogle Scholar
9.McVicar, N. Patients facing risk of infection. Ft. Lauderdale Sun Sentinel. November 13, 1992:A6.Google Scholar
10.Appleby, J. Medical community debates scope-cleaning procedure. USA Today. April 8, 2002:B8.Google Scholar
11.Korn, P. The new AIDS mystery. Redbook Magazine. July 1994:80.Google Scholar
12.Finch, S. Unclean instruments. Hippocrates. February 1998;12:4047.Google Scholar
13.Reichert, M. Developing an effective procedure for cleaning and disinfecting GI flexible endoscopes. Journal of Healthcare Material Management 1992;10:19–22, 24–26, 28.Google ScholarPubMed
14.Martin, MA, Reichelderfer, M. APIC guidelines for infection prevention and control in flexible endoscopy. Am J Infect Control 1994;22:1938.CrossRefGoogle ScholarPubMed
15.Alvarado, CJ, Reichelderfer, M. APIC guideline for infection prevention and control in flexible endoscopy. Am J Infect Control 2000;28:138155.CrossRefGoogle ScholarPubMed
16.Miller, JM, Holmes, HT, Krisher, K. General principles of specimen collection and handling. In: Murray, PR, ed. Manual of Clinical Microbiology, ed. 8. Washington, DC: American Society for Microbiology Press; 2003:5566.Google Scholar
17.Kaczmarek, RG, Moore, RM Jr, McCrohan, J, et al.Multi-state investigation of the actual disinfection/sterilization of endoscopes in health care facilities. Am J Med 1992;92:257261.CrossRefGoogle ScholarPubMed
18.Malik, RE, Cooper, RA, Griffith, CJ. Use of audit tools to evaluate the efficacy of cleaning systems in hospitals. Am J Infect Control 2003;31:181187.CrossRefGoogle ScholarPubMed
19.Davis, CP, Aly, R, Maibach, HI. Normal flora. In: Baron, S, ed. Medical Microbiology, ed. 2. Menlo Park, CA: Addison Wesley; 1986:277285.Google Scholar
20.Sorin, M, Segal-Maurer, S, Mariano, N, Urban, C, Combest, A, Rahal, JJ. Nosocomial transmission of imipenem-resistant Pseudomonas aeruginosa following bronchoscopy associated with improper connection to the Steris System 1 processor. Infect Control Hosp Epidemiol 2001;22:409413.CrossRefGoogle Scholar
21.Centers for Disease Control and Prevention. Bronchoscopy-related infections and pseudoinfections: New York, 1996 and 1998. MMWR 1999;48:557560.Google Scholar
22.Muscarella, LF. Leading a horse to water: are crucial lessons in endoscopy and outbreak investigations being learned? Infect Control Hosp Epidemiol 2002;23:358360.CrossRefGoogle ScholarPubMed
23.Strelczyk, K. Pseudo-outbreak of acid-fast bacilli. Presented at the 27th Annual Meeting of the American Practitioners in Infection Control; June 20-24, 1999; Baltimore, MD.Google Scholar
24.Curchoe, R, Scott, A. Investigating a pseudo-outbreak of Mycobacterium fortuitum. Presented at the 27th Annual Meeting of the American Practitioners in Infection Control; June 20-24, 1999; Baltimore, MD.Google Scholar
25.Allen, JI, Allen, MO, Olson, MM, et al. Pseudomonas infection of the biliary system resulting from use of a contaminated endoscope. Gastroenterol 1987;92:759763.CrossRefGoogle ScholarPubMed