A Novel Protocol Obviates Endoscope Sampling for Carbapenem-Resistant Enterobacteriaceae: Experience of a Center with a Prior Outbreak

Autor: Abdul H. Khan, Kulwinder S. Dua, Darren D. Ballard, Murad Aburajab, Kia Saeian, Mary Beth Graham, Nathan A. Ledeboer, Arshish Dua, Zachary L. Smith
Rok vydání: 2017
Předmět:
0301 basic medicine
Adult
Ethylene Oxide
Male
medicine.medical_specialty
Endoscope
Physiology
030106 microbiology
Pilot Projects
Carbapenem-resistant enterobacteriaceae
Microbial Sensitivity Tests
Disease Outbreaks
Endosonography
03 medical and health sciences
0302 clinical medicine
Wisconsin
Enterobacteriaceae
Risk Factors
Drug Resistance
Bacterial
medicine
Equipment Reuse
Humans
Duodenoscopes
Aged
Cholangiopancreatography
Endoscopic Retrograde
Cross Infection
medicine.diagnostic_test
business.industry
Gastroenterology
Enterobacteriaceae Infections
Rectum
Outbreak
Sterilization
Sterilization (microbiology)
Middle Aged
Surgery
Endoscopy
Positive response
Carbapenems
Risk stratification
Equipment Contamination
030211 gastroenterology & hepatology
Rectal swab
Female
business
Disinfectants
Program Evaluation
Zdroj: Digestive diseases and sciences. 62(11)
ISSN: 1573-2568
Popis: Numerous published outbreaks, including one from our institution, have described endoscope-associated transmission of multidrug-resistant organisms (MDROs). Individual centers have adopted their own protocols to address this issue, including endoscope culture and sequestration. Endoscope culturing has drawbacks and may allow residual bacteria, including MDROs, to go undetected after high-level disinfection. To report the outcome of our novel protocol, which does not utilize endoscope culturing, to address our outbreak. All patients undergoing procedures with elevator-containing endoscopes were asked to permit performance of a rectal swab. All endoscopes underwent high-level disinfection according to updated manufacturer’s guidance. Additionally, ethylene oxide (EtO) sterilization was done in the high-risk settings of (1) positive response to a pre-procedure risk stratification questionnaire, (2) positive or indeterminate CRE polymerase chain reaction (PCR) from rectal swab, (3) refusal to consent for PCR or questionnaire, (4) purulent cholangitis or infected pancreatic fluid collections. Two endoscopes per weekend were sterilized on a rotational basis. From September 1, 2015 to April 30, 2016, 556 endoscopy sessions were performed using elevator-containing endoscopes. Prompted EtO sterilization was done on 46 (8.3%) instances, 3 from positive/indeterminate PCR tests out of 530 samples (0.6%). No CRE transmission was observed during the study period. Damage or altered performance of endoscopes related to EtO was not observed. In this pilot study, prompted EtO sterilization in high-risk patients has thus far eliminated endoscope-associated MDRO transmission, although no CRE infections were noted throughout the institution during the study period. Further studies and a larger patient sample will be required to validate these findings.
Databáze: OpenAIRE
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