In-hospital evaluation of contamination of duodenoscopes: a quantitative assessment of the effect of drying

Abstract

A prospective, quantitative assessment was undertaken of the effect of drying on the bacterial load in duodenoscopes that had been used for endoscopic retrograde cholangiopancreatography procedures. The endoscopes were washed and disinfected using an automatic washer and samples were taken through the suction channel at 2, 24 and 48 h post-disinfection. Twenty-one of the 42 duodenoscopes tested were contaminated. The ratio of Gram-negative bacilli to Gram-positive cocci increased from 70:1 at 2 h up to 4000:1 at 48 h for those duodenoscopes that were contaminated. Pseudomonas species (6 of 12 contaminated endoscopes) and Acinetobacter species (7 of 21 contaminated endoscopes) were the most common isolates. There was visible moisture remaining in the suction channel despite the use of the complete recommended automatic washer cycle. Bacterial concentrations reached as high as 1 × 10⁷ colony forming units (cfu) ml⁻¹. An additional 10 min of drying using either an ‘in house’ air line or the manual machine dry prevented bacterial overgrowth of all 19 endoscopes tested 48 h post-disinfection. If the additional 10 min of drying was used, then no alcohol rinse was required. Although no infections related to use of contaminated endoscopes were reported, it was apparent that Gram-negative bacilli were multiplying to unacceptably high concentrations and that this could be prevented by an additional 10 min of drying. The additional drying was only required at the end of the endoscopy list and not between patients.