Superbugs on Duodenoscopes: the Challenge of Cleaning and Disinfection of Reusable Devices

Abstract

Inadequate flexible endoscope reprocessing has been associated with infection outbreaks, most recently caused by carbapenem-resistant Enterobacteriaceae. Lapses in essential device reprocessing steps such as cleaning, disinfection/sterilization, and storage have been reported, but some outbreaks have occurred despite claimed adherence to established guidelines. Recommended changes in these guidelines include the use of sterilization instead of high-level disinfection or the use of routine microbial culturing to monitor efficacy of reprocessing. This review describes the current standards for endoscope reprocessing, associated outbreaks, and the complexities associated with both microbiological culture and sterilization approaches to mitigating the risk of infection associated with endoscopy.

FIG 1

Standard workflow for endoscope reprocessing and commonly identified lapses. These include inadequate cleaning (residual soil shields microorganisms from the disinfectant), inappropriate preparation of the disinfectant, inappropriate contact temperature and time, insufficient exposure of the device to the disinfectant (e.g., not immersing all parts or failing to flush internal lumens with the disinfectant), cross contamination during water rinsing, failing to store the reprocessed and dried device in a clean area to prevent recontamination, and overgrowth of bacteria/fungi during storage of wet devices.

FIG 2

Representation of the internal structure of a flexible endoscope.