4 areas of concern for endoscope surveillance

No single medical device has been linked to more healthcare-associated infections than endoscopes, according the CDC. As antibiotic resistance continues to mount, conducting microbial surveillance of endoscopes is a critical concern for infection prevention.

According to a report from the U.S. Senate Health, Education, Labor and Pensions Committee, closed-channel duodenoscopes were linked to 25 separate incidences of device-related infections from spring 2012 to spring 2015, infecting more than 250 patients with antibiotic resistant bacteria. Generally, the hospitals experiencing these incidences did not promptly alert federal regulators about the infections.

The report found the design of a scope itself can make device disinfection a difficult process, highlighting the need for optimized cleaning and microbial surveillance procedures for endoscopes.

During a Dec. 5 webinar sponsored by Healthmark Industries, Kaumudi Kulkarni, manager of research and development with Healthmark, and Alpa Patel, senior scientist with Nelson Labs, led a discussion on valuable lessons learned from recent endoscope-related outbreaks, pathogens of concern, available testing methods and how to proceed when a scope tests positive for growth.

Here are four things to know about microbial endoscope surveillance.

1. What is microbial surveillance? This is the process of culturing samples from the channels and distal end of the scopes after they've been cleaned to detect potential residual bacterial contamination that survives reprocessing. According to Ms. Patel, current literature on the subject recommends, at minimum, organizations test the instrument's suction channel.

2. Why perform surveillance? Reprocessing scopes can be a laborious process involving multiple steps and opportunities for error. Poor reprocessing protocols have been linked to several antibiotic resistant outbreaks. Microbial surveillance can serve as a quality control mechanism for the adequacy and completeness of an organization's reprocessing procedures.

"Reprocessing these scopes is very difficult," said Ms. Patel. "Microbiological surveillance would be an ideal way to monitor endoscope reprocessing efficacy."

3. Organisms of concern. During the webinar, Ms. Patel and Ms. Kulkarni discussed organisms of high concern regarding endoscope contamination as identified by the CDC. High concern organisms include those commonly associated with disease and gram negative bacteria, which often come into contact with scopes in the human intestinal tract. Hospitals should have plans in place to address the detection of high-concern organisms during surveillance.

Examples of high-concern organisms include:

Escherichia coli
Klebsiella pneumoniae
• Pseudomonas aeruginosa
• Staphylococcus aureus
• Beta-hemolytic Streptococcus
• Enterococcus species
• Yeasts

"A successfully disinfected culturing should not detect any high concern organisms," said Ms. Kulkarni. "Any detection of a high concern organism, that is one colony or greater, warrants further remedial action."

4. How to conduct microbial surveillance. There is some confusion surrounding best practices for microbial surveillance. Protocols should be established to avoid false positives and streamline quarantine measures after positive detection. According to Ms. Patel, there is still a lot of work being done to answer questions about surveillance. In the meantime, organizations like the CDC have outlined interim guidance on culturing scopes.

According to the CDC, facilities performing surveillance on scopes that have been fully reprocessed and dried should collect cultures periodically, monthly or after every 60 procedures for each duodenoscope. The CDC recommends that any duodenoscope testing positive for high-concern organisms be reprocessed and recultured. If a breach in reprocessing protocols is identified, the appropriate personnel should be immediately notified and corrective actions should be implemented. If cultures test positive three or more times, hospitals should evaluate reprocessing protocols and consider reaching out to the device manufacturer for evaluation of the equipment.

Not all hospitals are equipped with the proper tools to conduct thorough microbial surveillance. For this reason, Healthmark and Nelson Labs have worked together to create a mail-back service for endoscope samples. The kit allows for surveillance aligned with the CDC's recommendations and provides everything needed to collect and send a sample from a reprocessed endoscope for testing. To learn more about the product, click here.

To view a recording of the webinar, click here.

To view the webinar's slides, click here.

To view past webinars, click here.

More articles on infection control: 
Community hospitals' antibiotic stewardship challenge: 4 thoughts from Intermountain's stewardship director 
2 in 5 Americans received flu shots this year: 5 survey findings 
7 hospitals notifying patients of heater-cooler infection risks

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