Endoscopes – What is the problem?

Glenys Harrington

 

Gastrointestinal endoscopes are complex devices that can be difficult to clean and disinfect. Over the last few years there have been increasing reports of outbreaks associated with endoscopes in particular duodenoscopes which are used for endoscopic retrograde cholangiopancreatography (ERCP) procedures.

These outbreaks have been associated with multidrug resistant organism’s including Carbapenem-resistant Enterobacteriaceae (CRE). Some of these outbreaks occurred in settings where the manufacturers’ instructions had been followed correctly and others in settings of inadequate cleaning, inappropriate disinfection and design flaws associated with the endoscopes.

Gastrointestinal endoscopes become heavily contaminated (107 – 1010 bacteria) during use. Researchers have shown that the cleaning step results in a 2-6 log10 reduction of microbes and the high level disinfection step results in another 4-6 log10 reduction.  Hence the margin of safety is minimal and if there is any deviation from correct reprocessing procedures it may result in the endoscope remaining contaminated and possible patient-to-patient transmission.

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