Background: Digestive endoscopy, in particular the use of duodenoscopes in endoscopic retrograde cholangiopancreatography (ERCP), was recently associated with clusters of Enterobacteriaceae Resistant to Carbapenems (CRE) infections/colonization, with increased morbidity and mortality in exposed patients. Persistent contamination was attributed to the complex design of ERCP duodenoscopes and to breaches in the reprocessing protocol. Methods: Following two cases of bacteremia due to KPC-producing Klebsiella pneumoniae (KPC-Kp) temporally related to ERCP in August 2014, in a large gastrointestinal endoscopy unit of a teaching hospital in Italy reprocessing activities were audited to ensure guideline compliance. After high-level disinfection/sterilization of 24 endoscopes (11 were duodenoscopes), contamination was assessed for high- and low-concern microorganisms in 4 sites (i.e. forceps elevator, flush of forceps elevator or air/water channels, flush and brush of suction and biopsy channel) of two distinct manufacturers (Pentax and Olympus) devices, according to the Interim Sampling Method, CDC 2015. Results: The audit highlighted manual cleansing procedures inadequacy and consequently high disinfection/sterilization ineffectiveness: only 2 out of 11 duodenoscopes (18,2%) complied with the standards, whereas 8 (72,7%) had 1 or more sample site contaminated by low-concern microorganisms, and 3 (27,3%) showed high-concern microorganisms (Escherichia coli, Klebsiella oxytoca) 2 being contaminated by KPC-Kp in flush of forceps elevator. Procedures were established and training for staff was provided to ensure that reusable devices were cleaned and disinfected/sterilized according to the manufacturer’s instructions. Conclusions: Surveillance cultures suggested that current reprocessing procedures were not adequate and a plan for implementation was developed in particular when duodenoscopes were used on KPC-Kp colonized/infected patients. Main messages: Given the complex design of duodenoscopes, new reprocessing technologies and methods for real-time monitoring reprocessing adequacy represent urgent patient safety needs.
Risk of transmission of KPC-producing Klebsiella pneumoniae in digestive endoscopy
CASINI, BEATRICE;VALENTINI, PAOLA;BAGGIANI, ANGELO;PRIVITERA, GAETANO PIERPAOLO
2016-01-01
Abstract
Background: Digestive endoscopy, in particular the use of duodenoscopes in endoscopic retrograde cholangiopancreatography (ERCP), was recently associated with clusters of Enterobacteriaceae Resistant to Carbapenems (CRE) infections/colonization, with increased morbidity and mortality in exposed patients. Persistent contamination was attributed to the complex design of ERCP duodenoscopes and to breaches in the reprocessing protocol. Methods: Following two cases of bacteremia due to KPC-producing Klebsiella pneumoniae (KPC-Kp) temporally related to ERCP in August 2014, in a large gastrointestinal endoscopy unit of a teaching hospital in Italy reprocessing activities were audited to ensure guideline compliance. After high-level disinfection/sterilization of 24 endoscopes (11 were duodenoscopes), contamination was assessed for high- and low-concern microorganisms in 4 sites (i.e. forceps elevator, flush of forceps elevator or air/water channels, flush and brush of suction and biopsy channel) of two distinct manufacturers (Pentax and Olympus) devices, according to the Interim Sampling Method, CDC 2015. Results: The audit highlighted manual cleansing procedures inadequacy and consequently high disinfection/sterilization ineffectiveness: only 2 out of 11 duodenoscopes (18,2%) complied with the standards, whereas 8 (72,7%) had 1 or more sample site contaminated by low-concern microorganisms, and 3 (27,3%) showed high-concern microorganisms (Escherichia coli, Klebsiella oxytoca) 2 being contaminated by KPC-Kp in flush of forceps elevator. Procedures were established and training for staff was provided to ensure that reusable devices were cleaned and disinfected/sterilized according to the manufacturer’s instructions. Conclusions: Surveillance cultures suggested that current reprocessing procedures were not adequate and a plan for implementation was developed in particular when duodenoscopes were used on KPC-Kp colonized/infected patients. Main messages: Given the complex design of duodenoscopes, new reprocessing technologies and methods for real-time monitoring reprocessing adequacy represent urgent patient safety needs.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
