scholarly journals Evaluation of Bacterial Contamination on Endoscopic Retrograde Cholangiopancreatography Duodenoscopes Before and After Cleaning and High-Level Disinfection

2015 ◽  
Vol 2 (suppl_1) ◽  
Author(s):  
Michaela A. Gazdik ◽  
Jana Coombs ◽  
Kristin Dascomb ◽  
Carrie W. Taylor ◽  
Jeannette Prochazka ◽  
...  
Keyword(s):  
Endoscopic Retrograde Cholangiopancreatography ◽  
Bacterial Contamination ◽  
Endoscopic Retrograde ◽  
Before And After ◽  
High Level

scholarly journals 1197. Microbiological Surveillance of Duodenoscopes Before and After High-Level Disinfection Following Endoscopic Retrograde Cholangiopancreatography (ERCP)

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S362-S362
Author(s):  
Bert K Lopansri ◽  
Tasha Fernley ◽  
Jana Coombs ◽  
Michaela A Gazdik ◽  
Lori Smit ◽  
...  
Keyword(s):  
Endoscopic Retrograde Cholangiopancreatography ◽  
Bacterial Colonization ◽  
Resistant Bacteria ◽  
Resistant Organism ◽  
Antibiotic Resistant Bacteria ◽  
Endoscopic Retrograde ◽  
Antibiotic Resistant ◽  
Before And After ◽  
Intermountain Healthcare ◽  
High Level

Abstract Background Transmission of antibiotic-resistant bacteria during endoscopic retrograde cholangiopancreatography (ERCP) has been linked to the complex design of the duodenoscope (scope) elevator channel and cantilever. We implemented a scope culturing program to monitor the efficacy of disinfection and to identify frequency of pre-disinfection exposure to antibiotic-resistant bacteria. Methods Facilities performing ERCPs within the Intermountain Healthcare system voluntarily submit scope cultures to the Infectious Diseases Epidemiology Laboratory. Cultures are collected at designated intervals based on procedure volumes at each site. Samples are submitted by endoscopy techs trained to collect flush and swab samples of the distal end of the scope using a previously described method before (PRE) and after (POST) high-level disinfection. Selective media is used to screen for Gram-negative bacilli-resistant to third-generation cephalosporins (ESBL) and vancomycin-resistant Enterococcus (VRE). Results Between March 7, 2016 and April 18, 2018, 1,255 scope samples from 10 facilities were cultured (533 PRE samples and 722 POST samples). 483 (90.6%) PRE samples were positive, with 75 (15.5%) screening positive for an antibiotic-resistant organism (60 ESBL and 15 VRE). 19 (2.6%) POST samples were positive, with 4 (21.1%) screening positive for ESBL. One of the four ESBL positive POST samples had a corresponding PRE sample for comparison; E. coli and Klebsiella variicola were isolated in both indicating residual contamination. Two of the ESBL-positive POST cultures did not have corresponding PRE samples and one had a PRE culture negative for ESBL. No POST samples contained VRE. Endoscopy personnel were contacted for each positive POST culture and endoscopy reprocessing practices were reviewed. Additionally, scopes were quarantined, reprocessed and re-cultured. Scopes were returned to use once POST cultures were negative. Conclusion Contamination of scopes with antibiotic-resistant bacteria during ERCP is common. High-level disinfection is effective at reducing bacterial burden but is imperfect. Routine surveillance for post-reprocessing bacterial colonization has been helpful to minimize patient exposure and to maintain focus on the importance of reprocessing. Disclosures All authors: No reported disclosures.

Adenosine Triphosphate Quantification Correlates Poorly with Microbial Contamination of Duodenoscopes

2017 ◽  
Vol 38 (06) ◽  
pp. 678-684 ◽  
Author(s):  
Lovisa B. Olafsdottir ◽  
Sharon B. Wright ◽  
Anne Smithey ◽  
Riley Heroux ◽  
Elizabeth B. Hirsch ◽  
...  
Keyword(s):  
Correlation Coefficient ◽  
Adenosine Triphosphate ◽  
Bacterial Contamination ◽  
Care Facility ◽  
High Volume ◽  
Relative Light Unit ◽  
Spearman Correlation ◽  
Endoscopic Retrograde ◽  
Colony Forming Units ◽  
High Level

OBJECTIVE The aim of this study was to quantify the correlation between adenosine triphosphate (ATP) measurements and bacterial cultures from duodenoscopes for evaluation of contamination following high-level disinfection. DESIGN Duodenoscopes used for any intended endoscopic retrograde cholangiopancreatography (ERCP) procedure were included. Microbiologic and ATP data were collected concomitantly and in the same manner from ERCP duodenoscopes. SETTING A high-volume endoscopy unit at a tertiary referral acute-care facility. METHODS Duodenoscopes were sampled for ATP and bacterial contamination in a contemporaneous and highly standardized fashion using a “flush-brush-flush” method for the working channel (WC) and a dry flocked swab for the elevator mechanism (EM). Specimens were processed for any aerobic bacterial growth (colony-forming units, CFU). Growth of CFU>0 and ATP relative light unit (RLU)>0 was considered a contaminated result. Frequency of discord between among WC and EM measurements were calculated using 2×2 contingency tables. The Spearman correlation coefficient was used to calculate the relatedness of bacterial contamination and ATP as continuous measurements. RESULTS The Spearman correlation coefficient did not demonstrate significant relatedness between ATP and CFU for either a WC or EM site. Among 390 duodenoscope sampling events, ATP and CFU assessments of contamination were discordant in 82 of 390 WC measurements (21%) and 331 of 390 of EM measurements (84.9%). The EM was frequently and markedly positive by ATP measurement. CONCLUSION ATP measurements correlate poorly with a microbiologic standard assessing duodenoscope contamination, particularly for EM sampling. ATP may reflect biological material other than nonviable aerobic bacteria and may not serve as an adequate marker of bacterial contamination. Infect Control Hosp Epidemiol 2017;38:678–684

scholarly journals 1223. Endoscopic Retrograde Cholangiopancreatography (ERCP)-Associated Carbapenem-resistant Enterobacteriaceae (CRE) Before and After Implementation of Ethylene Oxide (ETO) Sterilization of Duodenoscopes

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S439-S440
Author(s):  
Kathleen Bonisa ◽  
Anupama Neelakanta ◽  
Jessica Layell ◽  
Jessica Mclain ◽  
Haecherl Lana ◽  
...  
Keyword(s):  
Ethylene Oxide ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Tertiary Care ◽  
P Value ◽  
Endoscopic Retrograde ◽  
Carbapenem Resistant ◽  
Clinical Culture ◽  
High Level ◽  
The Impact ◽  
Carbapenem Resistant Enterobacteriaceae

Abstract Background Reusable duodenoscopes utilized for Endoscopic Retrograde Cholangiopancreatography (ERCP) procedures are challenging to clean thoroughly. Outbreaks of carbapenem-resistant Enterobacteriaceae (CRE) have been associated with the use of duodenoscopes even when no clear breaches in manufacturer-recommended manual cleaning and high-level disinfection have been found. We evaluate the impact of implementation of ethylene oxide (ETO) sterilization on rates of ERCP-associated CRE. Methods The charts of all patients who developed CRE colonization or infection between 2012 and 2018 in a large tertiary care teaching hospital were reviewed to determine whether the patient had an ERCP in the 90 days prior to the CRE culture date. Rates of CRE acquisition per 100 ERCPs performed were calculated and compared pre (ERCP performed January 2012 through February 2015) and post-implementation (ERCP performed March 2015 thru December 2018) of routine ETO sterilization of duodenoscope following high-level disinfection (HLD) with an automatic endoscope reprocessor (AER) rather than HLD alone. Results Between 2012 and 2018, 44 patients had first clinical culture with CRE within 90 days of ERCP (36% blood, 34% wound/surgical, 25% urinary and 7% respiratory sources). ETO sterilization of duodenoscopes following manufacturer recommended HLD was implemented March 2015. Rates of first CRE clinical culture within 90 days of ERCP decreased from 0.80 with HLD alone to 0.25 per 100 ERCP procedures with HLD plus ETO (unadjusted IRR 0.31 ETO vs. HLD alone, 95% CI 0.16–0.57, p-value < 0.001). This decrease occurred despite implementation of updated CLSI carbapenem breakpoints in July 2016. Figure 1 shows post ERCP CRE clinical culture trends over time Conclusion Implementation of ETO sterilization for duodenoscopes following HLD reduced our rates of post ERCP CRE in clinical cultures within 90 days of the procedure. Disclosures All authors: No reported disclosures.

scholarly journals Immune dysfunction in patients with obstructive jaundice before and after endoscopic retrograde cholangiopancreatography

2016 ◽  
Vol 130 (17) ◽  
pp. 1535-1544 ◽  
Author(s):  
Abeed H. Chowdhury ◽  
Miguel Camara ◽  
Luisa Martinez-Pomares ◽  
Abed M. Zaitoun ◽  
Oleg Eremin ◽  
...  
Keyword(s):  
Obstructive Jaundice ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Biliary Drainage ◽  
Recovery Phase ◽  
Duodenal Mucosa ◽  
Myeloid Dendritic Cells ◽  
Endoscopic Retrograde ◽  
Cytokine Responses ◽  
Before And After ◽  
Immunological Assays

This prospective observational study investigated monocyte cytokine responses to lipopolysaccharide (LPS) in patients with obstructive jaundice (OJ) before and after endoscopic biliary drainage. Dendritic cell (DC) subsets and their expression of co-stimulatory molecules were also studied. Forty patients with OJ and ten non-jaundiced patients with normal gastroscopy findings were recruited. Ten healthy volunteers provided control blood samples for immunological assays. Patients with OJ had blood and duodenal mucosa sampled at the time of endoscopic retrograde cholangiopancreatography (ERCP) and further blood sampled during the recovery phase. Monocyte cytokine responses to LPS, DC subsets and co-stimulatory molecule expression were compared with controls. Duodenal morphology and occludin expression were also assessed. Monocytes obtained before ERCP from jaundiced patients demonstrated reduced cytokine responses to endotoxin compared with controls (IL-1β: 2678 compared with 4631 pg/ml, P=0.04 and IL-6: 3442 compared with 6157 pg/ml, P=0.002). Monocytes from patients with malignancy had poorer responses to endotoxin than from those with benign OJ (IL-1β: 2025 compared with 3332 pg/ml, P=0.001). After ERCP, the secretion of inflammatory cytokines by monocytes obtained from jaundiced patients increased (IL-1β: 2150 compared with 2520 pg/ml, P=0.03 and IL-6: 2488 compared with 3250 pg/ml, P=0.01). Occludin expression (85 compared with 95%, P=0.004) and mean duodenal villus height (334 compared with 404 μm, P=0.03) were lower in jaundiced patients. Before biliary drainage, patients with OJ had a higher percentage of myeloid dendritic cells (mDCs) and greater mDC expression of CD40 (P=0.04) and CD86 (P=0.04). Monocytes from patients with OJ had lower proinflammatory cytokine secretion in response to LPS, an effect reversed following biliary drainage.

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