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Observational Study
. 2023 Sep;44(9):1485-1489.
doi: 10.1017/ice.2022.319. Epub 2023 Jan 16.

Endoscopic retrograde cholangiopancreatography and endoscopic ultrasound endoscope reprocessing: Variables impacting contamination risk

Ashley M Ayres  1 , Julia Wozniak  1 , Jose O'Neil  2 , Kimberly Stewart  2 , John St Leger  2 , A William Pasculle  3 , Casey Lewis  1 , Kevin McGrath  2 , Adam Slivka  2 , Graham M Snyder  1   4
Affiliations
Observational Study

Endoscopic retrograde cholangiopancreatography and endoscopic ultrasound endoscope reprocessing: Variables impacting contamination risk

Ashley M Ayres et al. Infect Control Hosp Epidemiol. 2023 Sep.

Abstract

Objective: To evaluate variables that affect risk of contamination for endoscopic retrograde cholangiopancreatography and endoscopic ultrasound endoscopes.

Design: Observational, quality improvement study.

Setting: University medical center with a gastrointestinal endoscopy service performing ∼1,000 endoscopic retrograde cholangiopancreatography and ∼1,000 endoscopic ultrasound endoscope procedures annually.

Methods: Duodenoscope and linear echoendoscope sampling (from the elevator mechanism and instrument channel) was performed from June 2020 through September 2021. Operational changes during this period included standard reprocessing with high-level disinfection with ethylene oxide gas sterilization (HLD-ETO) was switched to double high-level disinfection (dHLD) (June 16, 2020-July 15, 2020), and duodenoscopes changed to disposable tip model (March 2021). The frequency of contamination for the co-primary outcomes were characterized by calculated risk ratios.

Results: The overall pathogenic contamination rate was 4.72% (6 of 127). Compared to duodenoscopes, linear echoendoscopes had a contamination risk ratio of 3.64 (95% confidence interval [CI], 0.69-19.1). Reprocessing using HLD-ETO was associated with a contamination risk ratio of 0.29 (95% CI, 0.06-1.54). Linear echoendoscopes undergoing dHLD had the highest risk of contamination (2 of 18, 11.1%), and duodenoscopes undergoing HLD-ETO and the lowest risk of contamination (0 of 53, 0%). Duodenoscopes with a disposable tip had a 0% contamination rate (0 of 27).

Conclusions: We did not detect a significant reduction in endoscope contamination using HLD-ETO versus dHLD reprocessing. Linear echoendoscopes have a risk of contamination similar to that of duodenoscopes. Disposable tips may reduce the risk of duodenoscope contamination.

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Conflict of interest statement

All authors report no conflicts of interest relevant to this article.

Figures

Fig. 1.
Fig. 1.
Analysis periods for duodenoscope contamination, including by method of reprocessing, change to duodenoscope with disposable tip, and change from clinical to commercial laboratory. Note. dHLD, double high-level disinfection; HLD-ETO, high-level disinfection/ethylene oxide gas sterilization.
See this image and copyright information in PMC

References

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