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Abstract
Objective Contaminated duodenoscopes caused several hospital outbreaks. Despite efforts to reduce contamination rates, 15% of patient-ready duodenoscopes are still contaminated with gastrointestinal microorganisms. This study aimed to provide an overview of duodenoscope contamination over time, identify risk factors and study the effects of implemented interventions.
Design Duodenoscope culture sets between March 2015 and June 2022 at a Dutch tertiary care centre were analysed. Contamination was defined as (1) the presence of microorganisms of oral or gastrointestinal origin (MGO) or (2) any other microorganism with ≥20 colony-forming units/20 mL (AM20). A logistic mixed effects model was used to identify risk factors and assess the effect of interventions, such as using duodenoscopes with disposable caps, replacing automated endoscope reprocessors (AER) and conducting audits in the endoscopy department.
Results A total of 404 culture sets were analysed. The yearly contamination rate with MGO showed great variation, ranging from 14.3% to 47.5%. Contamination with AM20 increased up to 94.7% by 2022. For both MGO and AM20, the biopsy and suction channels were the most frequently contaminated duodenoscope components. The studied interventions, including audits, AER replacement and implementation of duodenoscopes with disposable caps, did not show a clear association with contamination rates.
Conclusion Duodenoscope contamination remains a significant problem, with high contamination rates despite several interventions. Reprocessing the biopsy and suction channels is especially challenging. Changes in the design of reusable duodenoscopes, such as enabling sterilisation or easily replaceable channels, are necessary to facilitate effective duodenoscope reprocessing and to eliminate the risk of duodenoscope-associated infections.
- BACTERIAL TRANSLOCATION
- ENDOSCOPIC PROCEDURES
- ENDOSCOPIC RETROGRADE PANCREATOGRAPHY
- ENTERIC BACTERIAL MICROFLORA
- EPIDEMIOLOGY
Data availability statement
All data relevant to the study are included in the article or uploaded as online supplemental information.
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- BACTERIAL TRANSLOCATION
- ENDOSCOPIC PROCEDURES
- ENDOSCOPIC RETROGRADE PANCREATOGRAPHY
- ENTERIC BACTERIAL MICROFLORA
- EPIDEMIOLOGY
Data availability statement
All data relevant to the study are included in the article or uploaded as online supplemental information.
Footnotes
MCV and MJB contributed equally.
Contributors KvdP: study concept and design; acquisition of data; analysis and interpretation of data; drafting of the manuscript; critical revision of the manuscript for important intellectual content; statistical analysis. CPH: analysis and interpretation of data; statistical analysis; critical revision of the manuscript for important intellectual content. AFV: analysis and interpretation of data; statistical analysis; critical revision of the manuscript for important intellectual content. WdG: acquisition of data; critical revision of the manuscript for important intellectual content. AJCB: acquisition of data; critical revision of the manuscript for important intellectual content. NSE: analysis and interpretation of data; statistical analysis; critical revision of the manuscript for important intellectual content. BCGCM-S: analysis and interpretation of data; critical revision of the manuscript for important intellectual content. JAS: analysis and interpretation of data; critical revision of the manuscript for important intellectual content. MCV: acquisition of data; analysis and interpretation of data; critical revision of the manuscript for important intellectual content. MJB: study concept and design; analysis and interpretation of data; critical revision of the manuscript for important intellectual content; study supervision; study guarantor.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests KvdP, CPH, AFV, WdG, AJCB, NSE, BCGCM-S and JAS have no conflicts of interest to disclose. MCV has received research support from Boston Scientific, 3M and Pentax Medical. MJB has received research support from Boston Scientific, Cook Medical, Pentax Medical, Mylan, ChiRoStim and acted as a consultant/lecturer for Boston Scientific, Cook Medical, Pentax Medical and AMBU.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.
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