Introduction A 2015 report highlighted potential for transmission of infection with duodenoscopes. Another publication (Endoscopy (2015) 47 493–502) described an outbreak of VIM-2 producing Pseudomonas aeruginosa and carbapenem-resistant Enterobacteriaceae (CRE). The Centre for Disease Control, USA reported that exposure to duodenoscopes was associated with transmission of CRE through bile. At ERCP bile leaks from the scope onto clothing worn. No studies have looked at bacterial seeding from the duodenoscope to protective clothing, which may increase risk of patient-to-patient transmission. Current practice at our unit does not involve sterilisation of protective clothing between procedures or after. At their discretion, staff may wear plastic aprons over a lead apron which is then discarded.
Aim Our unique study investigated whether ERCP was associated with bacterial seeding from duodenoscope to protective lead or plastic aprons.
Method 30 lead or plastic aprons worn by doctors carrying out ERCP between August-September 2016 were swabbed. Swabs were taken for routine culture and microscopy, CRE and pseudomonas from the chest, abdominal and pelvic regions. Swabs were taken pre and post ERCP from the outermost layer ie the lead or plastic apron. Doctors wore the same identifiable coat at each list.
Results 78 swabs were collected. 33/78 from plastic aprons, 44/78 from lead aprons and 1/78 unidentifiable. 25/78 from the chest, 28/78 abdominal and 22/78 pelvic. 3/78 swabs unlabelled. Only 16/78 grew no organism. Organisms grown included:
33/62 were non-pathogenic skin organisms: skin flora, Coag negative staphylococcus, Diphtheroids, Micrococcus and Massilia Timoniae. 11/62 were environmental contaminants: Acinetobacter, Arthrobacter, Bacillus species, Microbacterium, Moraxella. The remaining 18 isolates (highlighted above) grew Coliforms and Pseudomonas which may have originated from bile or small bowel equally distributed on lead and plastic aprons. Swabs from 28/33 plastic aprons grew organisms as did 33/44 from lead.
Conclusion This study highlights that ERCP carries a considerable risk of bacterial seeding from the scope to lead coats which may transmit infection to patients, a significant safety concern. Additional barrier protection with plastic aprons worn over the lead may reduce risk of transmission providing the plastic is discarded after each case. We believe lead aprons must be thoroughly decontaminated at the end of a list. We have informed our infection control.
Disclosure of Interest None Declared
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