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Marco J Bruno - One of the best experts on this subject based on the ideXlab platform.
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single use Duodenoscope for ercp performed by endoscopists with a range of experience in procedures of variable complexity
Gastrointestinal Endoscopy, 2021Co-Authors: Adam Slivka, Marco J Bruno, Andrew S. Ross, Bret T Petersen, Douglas K Pleskow, Divyesh V Sejpal, Raman V Muthusamy, Jennifer Chennat, Rajesh Krishnamoorthi, Calvin LeeAbstract:ABSTRACT BACKGROUND and AIMS Expert endoscopists previously reported ERCP outcomes for the first commercialized single-use Duodenoscope. We aimed to document usability of this device by endoscopists with different levels of ERCP experience. METHODS Fourteen “expert” (>2000 lifetime ERCPs) and 5 “less-expert” endoscopists performed consecutive ERCPs in patients without altered pancreaticobiliary anatomy. Outcomes included ERCP completion for the intended indication, rate of crossover to another endoscope, device performance ratings, and serious adverse events (SAEs). RESULTS Two hundred ERCPs including 81 (40.5%) with high complexity (American Society for Gastrointestinal Endoscopy grades 3-4) were performed. Crossover rate (11.3% vs 2.5%, P = .131), ERCP completion rate (regardless of crossovers) (96.3% vs 97.5%, P = .999), median ERCP completion time (25.0 vs 28.5 minutes, P = .130), mean cannulation attempts (2.8 vs 2.8, P = .954) and median overall satisfaction with the single-use Duodenoscope (8.0 vs 8.0, range 1.0-10.0, P = .840) were similar for “expert” versus “less-expert” endoscopists, respectively. The same metrics were similar by procedural complexity except for shorter median completion time for grade 1-2 versus grade 3-4 (P CONCLUSIONS In consecutive ERCPs including high complexity procedures, endoscopists with varying ERCP experience had good procedural success and reported high device performance ratings. ( Clinicaltrials.gov , Number: NCT04223830.)
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risk evaluation of Duodenoscope associated infections in the netherlands calls for a heightened awareness of device related infections a systematic review
Endoscopy, 2021Co-Authors: J Kwakman, Margreet C Vos, Nicole S Erler, Marco J BrunoAbstract:Background The risk of exogenous infections from endoscopic procedures is often cited as almost negligible (1 infection in 1.8 million procedures); however, this risk is based on older literature and does not seem to match the number of infectious outbreaks due to contaminated Duodenoscopes reported after endoscopic retrograde cholangiopancreatography (ERCP). Using Dutch data, we aimed to estimate the minimum risk of Duodenoscope-associated infection (DAI) and colonization (DAC) in patients undergoing ERCP. Methods A systematic literature search identified all DAI outbreaks in the Netherlands reported between 2008 and 2019. Included cases were confirmed by molecular matching of patient and Duodenoscope cultures. Risk ratios were calculated based on the total number of ERCPs performed during the study period. Results Three outbreaks were reported and published between 2008 and 2018, including 21 confirmed DAI cases and 52 confirmed DAC cases. The estimated number of ERCPs performed during the same period was 181 209–227 006. The calculated minimum estimated DAI risk was approximately 0.01 % and the minimum estimated DAC risk was 0.023 %–0.029 %. Conclusions The estimated risk of DAI in Dutch ERCP practice was at least 180 times higher than previously published risk estimates. The actual risk is likely to be (much) higher due to underreporting of infections caused by multidrug-resistant organisms and sensitive bacteria. Greater awareness by healthcare personnel involved in endoscopy and endoscope cleaning is required, as well as innovative technical solutions to contain and ultimately eliminate DAIs.
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nationwide risk analysis of Duodenoscope and linear echoendoscope contamination
Gastrointestinal Endoscopy, 2020Co-Authors: Arjan W Rauwers, Marco J Bruno, Anne Voor In F T Holt, Jolanda G Buijs, Woutrinus W De Groot, Nicole S Erler, Margreet C VosAbstract:Background and Aims Contaminated Duodenoscopes and linear echoendoscopes (DLEs) pose a risk for infectious outbreaks. To identify DLEs and reprocessing risk factors, we combined the data from the previously published nationwide cross-sectional PROCESS 1 study (Prevalence of contamination of complex endoscopes in the Netherlands) with the follow-up PROCESS 2 study. Methods We invited all 74 Dutch DLE centers to sample ≥2 Duodenoscopes during PROCESS 1, and all Duodenoscopes as well as linear echoendoscopes during PROCESS 2. The studies took place 1 year after another. Local staff sampled each DLE at ≤6 sites according to uniform methods explained by online videos. We used 2 contamination definitions: (1) any microorganism with ≥20 colony-forming units (CFU)/20 mL (AM20) and (2) presence of microorganisms with GI or oral origin, independent of CFU count (MGOs). We assessed the factors of age and usage by performing an analysis of pooled data of both PROCESS studies; additional factors including reprocessing characteristics were only recorded in PROCESS 2. Results Ninety-seven percent of all Dutch centers (72 of 74; PROCESS 1, 66; PROCESS 2, 61) participated in one of the studies, sampling 309 Duodenoscopes and 64 linear echoendoscopes. In total, 54 (17%) Duodenoscopes and 8 (13%) linear echoendoscopes were contaminated according to the AM20 definition. MGOs were detected on 47 (15%) Duodenoscopes and 9 (14%) linear echoendoscopes. Contamination was not age or usage dependent (all P values ≥.27) and was not shown to differ between the reprocessing characteristics (all P values ≥.01). Conclusions In these nationwide studies, we found that DLE contamination was independent of age and usage. These results suggest that old and heavily used DLEs, if maintained correctly, have a similar risk for contamination as new DLEs. The prevalence of MGO contamination of ∼15% was similarly high for Duodenoscopes as for linear echoendoscopes, rendering patients undergoing ERCP and EUS at risk for transmission of microorganisms.
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clinical evaluation of a single use Duodenoscope for endoscopic retrograde cholangiopancreatography
Clinical Gastroenterology and Hepatology, 2020Co-Authors: Raman V Muthusamy, Marco J Bruno, Richard A Kozarek, Bret T Petersen, Douglas K Pleskow, Divyesh V Sejpal, Adam Slivka, Joyce Peetermans, Matthew Rousseau, Gregory P TirrellAbstract:Background & Aims Disposable, single-use Duodenoscopes might reduce outbreaks of infections associated with endoscope reuse. We tested the feasibility, preliminary safety, and performance of a new single-use Duodenoscope in patients undergoing endoscopic retrograde cholangiopancreatography (ERCP). Methods We conducted a case-series study of the outcomes of ERCP with a single-use Duodenoscope from April through May 2019 at 6 academic medical centers. We screened consecutive patients (18 years and older) without alterations in pancreaticobiliary anatomy and enrolled 73 patients into the study. Seven expert endoscopists performed roll-in maneuvers (Duodenoscope navigation and visualization of duodenal papilla only) in 13 patients and then ERCPs in the 60 other patients. Outcomes analyzed included completion of ERCP for the intended clinical indication, crossover from a single-use Duodenoscope to a reusable Duodenoscope, endoscopist performance ratings of the device, and serious adverse events (assessed at 72 hours and 7 days). Results Thirteen (100%) roll-in maneuver cases were completed using the single-use Duodenoscope. ERCPs were of American Society for Gastrointestinal Endoscopy procedural complexity grade 1 (least complex; 7 patients [11.7%]), grade 2 (26 patients [43.3%]), grade 3 (26 patients [43.3%]), and grade 4 (most complex; 1 patient [1.7%]). Fifty-eight ERCPs (96.7%) were completed using the single-use Duodenoscope only and 2 ERCPs (3.3%) were completed using the single-use Duodenoscope followed by crossover to a reusable Duodenoscope. Median overall satisfaction was 9 out of 10. Three patients developed post-ERCP pancreatitis, 1 patient had post-sphincterotomy bleeding, and 1 patient had worsening of a preexisting infection and required rehospitalization. Conclusions In a case-series study, we found that expert endoscopists can complete ERCPs of a wide range of complexity using a single-use Duodenoscope for nearly all cases. This alternative might decrease ERCP-related risk of infection. Clinicaltrials.gov no: NCT03701958 .
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novel single use Duodenoscope compared with 3 models of reusable Duodenoscopes for ercp a randomized bench model comparison
Gastrointestinal Endoscopy, 2020Co-Authors: Andrew S. Ross, Marco J Bruno, Richard A Kozarek, Bret T Petersen, Douglas K Pleskow, Divyesh V Sejpal, Adam Slivka, Dale Moore, Karina Panduro, Joyce PeetermansAbstract:Background and Aims Multidrug-resistant infectious outbreaks associated with Duodenoscope reuse have been documented internationally. A single-use endoscope could eliminate exogenous patient-to-patient infection associated with ERCP. Methods We conducted a comparative bench simulation study of a new single-use and 3 models of reusable Duodenoscopes on a synthetic anatomic bench model. Four ERCP tasks were performed: guidewire locking (single-use and 1 reusable Duodenoscope only), plastic stent placement and removal, metal stent placement and removal, and basket sweeping. The study schedule included block randomization by 4 Duodenoscopes, 4 tasks, and 2 anatomic model ERCP stations. Ability to complete tasks, task completion times, and subjective ratings of overall performance, navigation/pushability, tip control, and image quality on a scale of 1 (worst) to 10 (best) were compared among Duodenoscopes. Results All 4 ERCP tasks (total 14 subtasks) were completed by 6 expert endoscopists using all 4 Duodenoscopes, with similar task completion times (median, 1.5-8.0 minutes per task) and overall performance ratings by task (median, 8.0-10.0). Navigation/pushability ratings were lower for the single-use Duodenoscope than for the 3 reusable Duodenoscopes (median, 8.0, 10.0, 9.0, and 9.0, respectively; P Conclusions A new single-use Duodenoscope was used to simulate 4 ERCP tasks in an anatomic model, with performance ratings and completion times comparable with 3 models of reusable Duodenoscopes.
Andrew S. Ross - One of the best experts on this subject based on the ideXlab platform.
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single use Duodenoscope for ercp performed by endoscopists with a range of experience in procedures of variable complexity
Gastrointestinal Endoscopy, 2021Co-Authors: Adam Slivka, Marco J Bruno, Andrew S. Ross, Bret T Petersen, Douglas K Pleskow, Divyesh V Sejpal, Raman V Muthusamy, Jennifer Chennat, Rajesh Krishnamoorthi, Calvin LeeAbstract:ABSTRACT BACKGROUND and AIMS Expert endoscopists previously reported ERCP outcomes for the first commercialized single-use Duodenoscope. We aimed to document usability of this device by endoscopists with different levels of ERCP experience. METHODS Fourteen “expert” (>2000 lifetime ERCPs) and 5 “less-expert” endoscopists performed consecutive ERCPs in patients without altered pancreaticobiliary anatomy. Outcomes included ERCP completion for the intended indication, rate of crossover to another endoscope, device performance ratings, and serious adverse events (SAEs). RESULTS Two hundred ERCPs including 81 (40.5%) with high complexity (American Society for Gastrointestinal Endoscopy grades 3-4) were performed. Crossover rate (11.3% vs 2.5%, P = .131), ERCP completion rate (regardless of crossovers) (96.3% vs 97.5%, P = .999), median ERCP completion time (25.0 vs 28.5 minutes, P = .130), mean cannulation attempts (2.8 vs 2.8, P = .954) and median overall satisfaction with the single-use Duodenoscope (8.0 vs 8.0, range 1.0-10.0, P = .840) were similar for “expert” versus “less-expert” endoscopists, respectively. The same metrics were similar by procedural complexity except for shorter median completion time for grade 1-2 versus grade 3-4 (P CONCLUSIONS In consecutive ERCPs including high complexity procedures, endoscopists with varying ERCP experience had good procedural success and reported high device performance ratings. ( Clinicaltrials.gov , Number: NCT04223830.)
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Duodenoscope as a vector for transmission
Gastrointestinal Endoscopy Clinics of North America, 2020Co-Authors: Jennifer T. Higa, Andrew S. RossAbstract:Elevator-based endoscope-related infections from patient cross-contamination is a multifactorial problem related to device design, maintenance, and function, with additional risk incurred from a high-level disinfection process that lacks quality controls. This article reviews the historical context for these outbreaks, technical aspects of scope design contributing to this risk, and innovations in endoscope technology that have the potential to overcome these shortcomings. Also reviewed are interim solutions and the data that support use of some of these interventions. Still needed are a validated manufacturer-recommended schedule for routine Duodenoscope and echoendoscope maintenance with reprocessing protocols that can be implemented in endoscopy units.
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novel single use Duodenoscope compared with 3 models of reusable Duodenoscopes for ercp a randomized bench model comparison
Gastrointestinal Endoscopy, 2020Co-Authors: Andrew S. Ross, Marco J Bruno, Richard A Kozarek, Bret T Petersen, Douglas K Pleskow, Divyesh V Sejpal, Adam Slivka, Dale Moore, Karina Panduro, Joyce PeetermansAbstract:Background and Aims Multidrug-resistant infectious outbreaks associated with Duodenoscope reuse have been documented internationally. A single-use endoscope could eliminate exogenous patient-to-patient infection associated with ERCP. Methods We conducted a comparative bench simulation study of a new single-use and 3 models of reusable Duodenoscopes on a synthetic anatomic bench model. Four ERCP tasks were performed: guidewire locking (single-use and 1 reusable Duodenoscope only), plastic stent placement and removal, metal stent placement and removal, and basket sweeping. The study schedule included block randomization by 4 Duodenoscopes, 4 tasks, and 2 anatomic model ERCP stations. Ability to complete tasks, task completion times, and subjective ratings of overall performance, navigation/pushability, tip control, and image quality on a scale of 1 (worst) to 10 (best) were compared among Duodenoscopes. Results All 4 ERCP tasks (total 14 subtasks) were completed by 6 expert endoscopists using all 4 Duodenoscopes, with similar task completion times (median, 1.5-8.0 minutes per task) and overall performance ratings by task (median, 8.0-10.0). Navigation/pushability ratings were lower for the single-use Duodenoscope than for the 3 reusable Duodenoscopes (median, 8.0, 10.0, 9.0, and 9.0, respectively; P Conclusions A new single-use Duodenoscope was used to simulate 4 ERCP tasks in an anatomic model, with performance ratings and completion times comparable with 3 models of reusable Duodenoscopes.
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optimizing Duodenoscope reprocessing rigorous assessment of a culture and quarantine protocol
Gastrointestinal Endoscopy, 2018Co-Authors: Jennifer T. Higa, Michael Gluck, Jaehoon Choe, Deborah Tombs, Andrew S. RossAbstract:Background and Aims Iatrogenic infections related to Duodenoscopes remain a top concern for medical centers where ERCP is performed. We assessed the long-term results and impact of key interventions in the optimization of a rigorous "culture and quarantine" program for Duodenoscope reprocessing. Methods We reviewed a prospectively collected, quality assurance database of all Duodenoscope cultures (n = 4307) obtained for the initial 3-year duration of culture and quarantine from 2014 to 2017 in a single U.S.-based, high-volume endoscopy center. All Duodenoscopes were subject to manual cleaning and automated reprocessing and drying, followed by sampling using a modified protocol developed by the Centers for Disease Control and Prevention. Duodenoscopes were cultured per-use. Results A total of 4307 Duodenoscope cultures were obtained during the study period. High-concern organisms were isolated from 33 of these cultures, resulting in a .697% high-level disinfection defect rate. Statistically significant interventions included withdrawal of a high-frequency culture-positive Duodenoscope (scope A) from clinical service in addition to implementation of new manufacturer-recommended cleaning protocols. Withdrawal of a second high-frequency culture-positive Duodenoscope (scope B) and a mandatory device retrofit had no effect on the observed rate of positive Duodenoscope cultures. Conclusions Withdrawal of Duodenoscopes with a high rate of culture positivity and optimizing manual cleaning practices have contributed to an overall decline in the high-level disinfection defect rate. A stringent culture and quarantine protocol allowed identification of the culprit endoscopes. There remains a much-needed role for an inexpensive and highly reliable method to check on the adequacy of reprocessing given the inherent complexity of these tasks.
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Duodenoscope reprocessing practice patterns in u s endoscopy centers a survey study
Gastrointestinal Endoscopy, 2017Co-Authors: Adarsh M Thaker, Andrew S. Ross, Raman V Muthusamy, Alireza Sedarat, Rabindra R Watson, Michael L Kochman, Stephen KimAbstract:Background and Aims After recent outbreaks of Duodenoscope-related infections from multidrug-resistant organisms (MDRO), the United States Food and Drug Administration (FDA) recommended implementing 1 or more of 4 enhanced reprocessing measures in addition to updated manual cleaning methods and high-level disinfection (HLD). The implementation of these techniques in endoscopy facilities and provider opinions regarding reprocessing priorities remain unknown. Methods Physicians, nurse managers, nurses, and infection control staff at endoscopy units performing ERCP in the United States were surveyed to assess current institutional practices and individual opinions regarding future reprocessing solutions. Results A total of 249 distinct institutions participated in the survey. Of these, 223 (89.6%) implemented at least 1 of the 4 supplemental reprocessing methods after MDRO outbreaks. Overall, 63% of centers used repeat HLD, 53% performed surveillance microbiological culturing, 35% used liquid chemical sterilization, and 12% used ethylene oxide sterilization. Thirty-seven centers (15%) routinely screened patients for MDRO. Forced-air drying after reprocessing was used by 47.8% of centers. Fifty percent of individual respondents, including 58.6% of physicians, believed that redesign of the Duodenoscope is the best long-term reprocessing solution. The majority (55.1%) identified efficacy to be the single most important factor in selecting a reprocessing technique. Conclusions Although most endoscopy centers have implemented enhanced Duodenoscope reprocessing techniques, there is a large variation in practice. Most providers believe that Duodenoscope redesign and identifying reprocessing techniques with maximal efficacy are the long-term priorities. Improved adherence to forced-air drying in Duodenoscope reprocessing is needed.
Bret T Petersen - One of the best experts on this subject based on the ideXlab platform.
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single use Duodenoscope for ercp performed by endoscopists with a range of experience in procedures of variable complexity
Gastrointestinal Endoscopy, 2021Co-Authors: Adam Slivka, Marco J Bruno, Andrew S. Ross, Bret T Petersen, Douglas K Pleskow, Divyesh V Sejpal, Raman V Muthusamy, Jennifer Chennat, Rajesh Krishnamoorthi, Calvin LeeAbstract:ABSTRACT BACKGROUND and AIMS Expert endoscopists previously reported ERCP outcomes for the first commercialized single-use Duodenoscope. We aimed to document usability of this device by endoscopists with different levels of ERCP experience. METHODS Fourteen “expert” (>2000 lifetime ERCPs) and 5 “less-expert” endoscopists performed consecutive ERCPs in patients without altered pancreaticobiliary anatomy. Outcomes included ERCP completion for the intended indication, rate of crossover to another endoscope, device performance ratings, and serious adverse events (SAEs). RESULTS Two hundred ERCPs including 81 (40.5%) with high complexity (American Society for Gastrointestinal Endoscopy grades 3-4) were performed. Crossover rate (11.3% vs 2.5%, P = .131), ERCP completion rate (regardless of crossovers) (96.3% vs 97.5%, P = .999), median ERCP completion time (25.0 vs 28.5 minutes, P = .130), mean cannulation attempts (2.8 vs 2.8, P = .954) and median overall satisfaction with the single-use Duodenoscope (8.0 vs 8.0, range 1.0-10.0, P = .840) were similar for “expert” versus “less-expert” endoscopists, respectively. The same metrics were similar by procedural complexity except for shorter median completion time for grade 1-2 versus grade 3-4 (P CONCLUSIONS In consecutive ERCPs including high complexity procedures, endoscopists with varying ERCP experience had good procedural success and reported high device performance ratings. ( Clinicaltrials.gov , Number: NCT04223830.)
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clinical evaluation of a single use Duodenoscope for endoscopic retrograde cholangiopancreatography
Clinical Gastroenterology and Hepatology, 2020Co-Authors: Raman V Muthusamy, Marco J Bruno, Richard A Kozarek, Bret T Petersen, Douglas K Pleskow, Divyesh V Sejpal, Adam Slivka, Joyce Peetermans, Matthew Rousseau, Gregory P TirrellAbstract:Background & Aims Disposable, single-use Duodenoscopes might reduce outbreaks of infections associated with endoscope reuse. We tested the feasibility, preliminary safety, and performance of a new single-use Duodenoscope in patients undergoing endoscopic retrograde cholangiopancreatography (ERCP). Methods We conducted a case-series study of the outcomes of ERCP with a single-use Duodenoscope from April through May 2019 at 6 academic medical centers. We screened consecutive patients (18 years and older) without alterations in pancreaticobiliary anatomy and enrolled 73 patients into the study. Seven expert endoscopists performed roll-in maneuvers (Duodenoscope navigation and visualization of duodenal papilla only) in 13 patients and then ERCPs in the 60 other patients. Outcomes analyzed included completion of ERCP for the intended clinical indication, crossover from a single-use Duodenoscope to a reusable Duodenoscope, endoscopist performance ratings of the device, and serious adverse events (assessed at 72 hours and 7 days). Results Thirteen (100%) roll-in maneuver cases were completed using the single-use Duodenoscope. ERCPs were of American Society for Gastrointestinal Endoscopy procedural complexity grade 1 (least complex; 7 patients [11.7%]), grade 2 (26 patients [43.3%]), grade 3 (26 patients [43.3%]), and grade 4 (most complex; 1 patient [1.7%]). Fifty-eight ERCPs (96.7%) were completed using the single-use Duodenoscope only and 2 ERCPs (3.3%) were completed using the single-use Duodenoscope followed by crossover to a reusable Duodenoscope. Median overall satisfaction was 9 out of 10. Three patients developed post-ERCP pancreatitis, 1 patient had post-sphincterotomy bleeding, and 1 patient had worsening of a preexisting infection and required rehospitalization. Conclusions In a case-series study, we found that expert endoscopists can complete ERCPs of a wide range of complexity using a single-use Duodenoscope for nearly all cases. This alternative might decrease ERCP-related risk of infection. Clinicaltrials.gov no: NCT03701958 .
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novel single use Duodenoscope compared with 3 models of reusable Duodenoscopes for ercp a randomized bench model comparison
Gastrointestinal Endoscopy, 2020Co-Authors: Andrew S. Ross, Marco J Bruno, Richard A Kozarek, Bret T Petersen, Douglas K Pleskow, Divyesh V Sejpal, Adam Slivka, Dale Moore, Karina Panduro, Joyce PeetermansAbstract:Background and Aims Multidrug-resistant infectious outbreaks associated with Duodenoscope reuse have been documented internationally. A single-use endoscope could eliminate exogenous patient-to-patient infection associated with ERCP. Methods We conducted a comparative bench simulation study of a new single-use and 3 models of reusable Duodenoscopes on a synthetic anatomic bench model. Four ERCP tasks were performed: guidewire locking (single-use and 1 reusable Duodenoscope only), plastic stent placement and removal, metal stent placement and removal, and basket sweeping. The study schedule included block randomization by 4 Duodenoscopes, 4 tasks, and 2 anatomic model ERCP stations. Ability to complete tasks, task completion times, and subjective ratings of overall performance, navigation/pushability, tip control, and image quality on a scale of 1 (worst) to 10 (best) were compared among Duodenoscopes. Results All 4 ERCP tasks (total 14 subtasks) were completed by 6 expert endoscopists using all 4 Duodenoscopes, with similar task completion times (median, 1.5-8.0 minutes per task) and overall performance ratings by task (median, 8.0-10.0). Navigation/pushability ratings were lower for the single-use Duodenoscope than for the 3 reusable Duodenoscopes (median, 8.0, 10.0, 9.0, and 9.0, respectively; P Conclusions A new single-use Duodenoscope was used to simulate 4 ERCP tasks in an anatomic model, with performance ratings and completion times comparable with 3 models of reusable Duodenoscopes.
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Duodenoscope reprocessing surveillance with adenosine triphosphate testing and terminal cultures a clinical pilot study
Gastrointestinal Endoscopy, 2015Co-Authors: Kavel Visrodia, Yuri Hanada, Kelly Pennington, Pritish K Tosh, Mark Topazian, Bret T PetersenAbstract:Background and Aims Recent reports of infectious outbreaks linked to Duodenoscopes have led to proposals for Duodenoscope surveillance culturing, which has inherent limitations. We aimed to assess the feasibility of real-time adenosine triphosphate (ATP) testing after manual cleaning and its ability to predict reprocessing adequacy, as determined by terminal Duodenoscope cultures. Methods Clinically used Duodenoscopes underwent reprocessing per current guidelines. After manual cleaning, ATP samples were obtained from the elevator, within the proximal biopsy port, and by flushing of the biopsy channel. After high-level disinfection (HLD), aerobic cultures of the elevator and biopsy channel were obtained using sterile technique. Duodenoscopes with any ATP sample ≥200 relative light units underwent repeated cycles of cleaning, ATP testing, HLD, and terminal culturing. Results Twenty clinically used Duodenoscopes were included; 18 underwent a second reprocessing cycle, and 6 underwent a third reprocessing cycle because of detection of high ATP. After the initial reprocessing cycle, 12 of 20 (60%) Duodenoscopes had positive culture results, most commonly yielding gram-negative bacilli (GNB, n = 11 from 9 Duodenoscopes), and catalase-positive gram-positive cocci (CP-GPC, n = 7 from 7 Duodenoscopes), suggesting staphylococcal organisms. Ambient environmental controls also showed GNB and CP-GPC growth. The overall sensitivity and specificity of ATP testing compared with terminal cultures were 30% and 53%, respectively. Conclusions ATP sampling appears to correlate poorly with terminal culture results and cannot be recommended as a surrogate for terminal cultures. The performance and interpretation of cultures remains complicated by the potential recovery of environmental contaminants.
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comparison of technical and clinical outcome with use of a malfunctioning versus properly functioning Duodenoscope
The American Journal of Gastroenterology, 2003Co-Authors: Michael J Levy, Bret T Petersen, Arnaldo B Feitoza, Todd H Baron, Christopher J Gostout, Maurits J Wiersema, Ashwin Rumalla, Beverly J OttAbstract:Comparison of technical and clinical outcome with use of a malfunctioning versus properly functioning Duodenoscope
Michele Jackson - One of the best experts on this subject based on the ideXlab platform.
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a survey of reprocessing methods residual viable bioburden and soil levels in patient ready endoscopic retrograde choliangiopancreatography Duodenoscopes used in canadian centers
Infection Control and Hospital Epidemiology, 2002Co-Authors: Michelle J Alfa, Nancy Olson, Pat Degagne, Michele JacksonAbstract:OBJECTIVES: To obtain information about current reprocessing practices and to obtain samples from the biopsy channel to quantitate soil levels and bioburden in patient-ready flexible Duodenoscopes used for endoscopic retrograde choliangiopancreatography (ERCP). DESIGN: Participating centers were sent a questionnaire and a kit for on-site collection of samples from the biopsy channel of the Duodenoscope. SETTING: Thirty-seven hospitals from across Canada participated. The only criterion was that they currently used and reprocessed flexible Duodenoscopes for ERCP procedures. METHODS: The questionnaire obtained information on reprocessing practices. The kit included a detailed instruction booklet outlining sample collection and all of the tubes, sterile water, and brushes needed for it. Samples were collected on-site from all ERCP scopes in each center on Monday morning and shipped by overnight courier on ice to the research center. Each sample was assayed by routine microbiologic methods for total viable count and protein, blood, carbohydrate, and endotoxin levels. RESULTS: Microbial overgrowth was present in 7% of 119 scope samples. Cleaning appeared to be reasonably well done in most of the centers, and 43% of the centers were in total compliance with basic national guidelines. The data from the scope samples indicated that there was significantly greater buildup of protein, carbohydrate, and endotoxin associated with ERCP scopes from centers using glutaraldehyde, compared with those using peracetic acid. Carbohydrate was the soil component detected most frequently and in the highest concentration in scope channels. CONCLUSIONS: Although cleaning was generally well done, areas for improvement included ensuring the availability of written reprocessing protocols, immersion of scopes during manual cleaning, use of adequate fluid volume for rinsing, adequate drying of scopes prior to storage, and the separation of ERCP valves from scopes during storage.
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a survey of reprocessing methods residual viable bioburden and soil levels in patient ready endoscopic retrograde choliangiopancreatography Duodenoscopes used in canadian centers
Infection Control and Hospital Epidemiology, 2002Co-Authors: Michelle J Alfa, Nancy Olson, Pat Degagne, Michele JacksonAbstract:OBJECTIVES: To obtain information about current reprocessing practices and to obtain samples from the biopsy channel to quantitate soil levels and bioburden in patient-ready flexible Duodenoscopes used for endoscopic retrograde choliangiopancreatography (ERCP). DESIGN: Participating centers were sent a questionnaire and a kit for on-site collection of samples from the biopsy channel of the Duodenoscope. SETTING: Thirty-seven hospitals from across Canada participated. The only criterion was that they currently used and reprocessed flexible Duodenoscopes for ERCP procedures. METHODS: The questionnaire obtained information on reprocessing practices. The kit included a detailed instruction booklet outlining sample collection and all of the tubes, sterile water, and brushes needed for it. Samples were collected on-site from all ERCP scopes in each center on Monday morning and shipped by overnight courier on ice to the research center. Each sample was assayed by routine microbiologic methods for total viable count and protein, blood, carbohydrate, and endotoxin levels. RESULTS: Microbial overgrowth was present in 7% of 119 scope samples. Cleaning appeared to be reasonably well done in most of the centers, and 43% of the centers were in total compliance with basic national guidelines. The data from the scope samples indicated that there was significantly greater buildup of protein, carbohydrate, and endotoxin associated with ERCP scopes from centers using glutaraldehyde, compared with those using peracetic acid. Carbohydrate was the soil component detected most frequently and in the highest concentration in scope channels. CONCLUSIONS: Although cleaning was generally well done, areas for improvement included ensuring the availability of written reprocessing protocols, immersion of scopes during manual cleaning, use of adequate fluid volume for rinsing, adequate drying of scopes prior to storage, and the separation of ERCP valves from scopes during storage (Infect Control Hosp Epidemiol 2002;23:198-206).
Michelle J Alfa - One of the best experts on this subject based on the ideXlab platform.
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the adenosine triphosphate test is a rapid and reliable audit tool to assess manual cleaning adequacy of flexible endoscope channels
American Journal of Infection Control, 2013Co-Authors: Michelle J Alfa, Iram Fatima, Nancy OlsonAbstract:Background The study objective was to verify that the adenosine triphosphate (ATP) benchmark of Methods All channels from patient-used colonoscopes (20) and Duodenoscopes (20) in a tertiary care hospital endoscopy clinic were sampled after manual cleaning and tested for residual ATP. The ATP test benchmark for adequate manual cleaning was set at 2 , and, for bioburden, it was 10 colony-forming units/cm 2 . Results Our data demonstrated that 96% (115/120) of channels from 20 colonoscopes and 20 Duodenoscopes evaluated met the ATP benchmark of Conclusion Our data confirmed that, by following the endoscope manufacturer's manual cleaning recommendations, 96% of channels in gastrointestinal endoscopes would have
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a survey of reprocessing methods residual viable bioburden and soil levels in patient ready endoscopic retrograde choliangiopancreatography Duodenoscopes used in canadian centers
Infection Control and Hospital Epidemiology, 2002Co-Authors: Michelle J Alfa, Nancy Olson, Pat Degagne, Michele JacksonAbstract:OBJECTIVES: To obtain information about current reprocessing practices and to obtain samples from the biopsy channel to quantitate soil levels and bioburden in patient-ready flexible Duodenoscopes used for endoscopic retrograde choliangiopancreatography (ERCP). DESIGN: Participating centers were sent a questionnaire and a kit for on-site collection of samples from the biopsy channel of the Duodenoscope. SETTING: Thirty-seven hospitals from across Canada participated. The only criterion was that they currently used and reprocessed flexible Duodenoscopes for ERCP procedures. METHODS: The questionnaire obtained information on reprocessing practices. The kit included a detailed instruction booklet outlining sample collection and all of the tubes, sterile water, and brushes needed for it. Samples were collected on-site from all ERCP scopes in each center on Monday morning and shipped by overnight courier on ice to the research center. Each sample was assayed by routine microbiologic methods for total viable count and protein, blood, carbohydrate, and endotoxin levels. RESULTS: Microbial overgrowth was present in 7% of 119 scope samples. Cleaning appeared to be reasonably well done in most of the centers, and 43% of the centers were in total compliance with basic national guidelines. The data from the scope samples indicated that there was significantly greater buildup of protein, carbohydrate, and endotoxin associated with ERCP scopes from centers using glutaraldehyde, compared with those using peracetic acid. Carbohydrate was the soil component detected most frequently and in the highest concentration in scope channels. CONCLUSIONS: Although cleaning was generally well done, areas for improvement included ensuring the availability of written reprocessing protocols, immersion of scopes during manual cleaning, use of adequate fluid volume for rinsing, adequate drying of scopes prior to storage, and the separation of ERCP valves from scopes during storage.
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a survey of reprocessing methods residual viable bioburden and soil levels in patient ready endoscopic retrograde choliangiopancreatography Duodenoscopes used in canadian centers
Infection Control and Hospital Epidemiology, 2002Co-Authors: Michelle J Alfa, Nancy Olson, Pat Degagne, Michele JacksonAbstract:OBJECTIVES: To obtain information about current reprocessing practices and to obtain samples from the biopsy channel to quantitate soil levels and bioburden in patient-ready flexible Duodenoscopes used for endoscopic retrograde choliangiopancreatography (ERCP). DESIGN: Participating centers were sent a questionnaire and a kit for on-site collection of samples from the biopsy channel of the Duodenoscope. SETTING: Thirty-seven hospitals from across Canada participated. The only criterion was that they currently used and reprocessed flexible Duodenoscopes for ERCP procedures. METHODS: The questionnaire obtained information on reprocessing practices. The kit included a detailed instruction booklet outlining sample collection and all of the tubes, sterile water, and brushes needed for it. Samples were collected on-site from all ERCP scopes in each center on Monday morning and shipped by overnight courier on ice to the research center. Each sample was assayed by routine microbiologic methods for total viable count and protein, blood, carbohydrate, and endotoxin levels. RESULTS: Microbial overgrowth was present in 7% of 119 scope samples. Cleaning appeared to be reasonably well done in most of the centers, and 43% of the centers were in total compliance with basic national guidelines. The data from the scope samples indicated that there was significantly greater buildup of protein, carbohydrate, and endotoxin associated with ERCP scopes from centers using glutaraldehyde, compared with those using peracetic acid. Carbohydrate was the soil component detected most frequently and in the highest concentration in scope channels. CONCLUSIONS: Although cleaning was generally well done, areas for improvement included ensuring the availability of written reprocessing protocols, immersion of scopes during manual cleaning, use of adequate fluid volume for rinsing, adequate drying of scopes prior to storage, and the separation of ERCP valves from scopes during storage (Infect Control Hosp Epidemiol 2002;23:198-206).
