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Scope cleaning not adequate

Erasmus MC researchers found microorganisms in 15% of the endoscopes used in the Netherlands for examinations of the gallbladder and pancreas. The likelihood of falling ill as a result of these microorganisms is small, but for specific patients they could pose a risk.

According to the researchers, the current cleaning and process control procedures for this type of endoscopes are not adequate and safe, but treatment using these endoscopes continues to be important and can even save lives.

Complex design
On behalf of Erasmus MC, PhD student Arjan Rauwers conducted a study on the duodenoscopes used in the 73 endoscopy centers in the Netherlands. 67 of these centers participated in the study. A total of 745 sites of 155 duodenoscopes were examined. The microorganisms of previous patients were found on 23 duodenoscopes, which indicates that the cleaning and disinfection was insufficient in some cases, possibly due to the complex design of the duodenoscope.

It is unclear to what extent patients actually become infected with these bacteria. Previously published outbreaks were recognized because of a striking pattern of resistant strains of bacteria. The detection of outbreaks of non-resistant bacteria is rarely possible in clinical practice, which means that is not unlikely that patient contamination and outbreaks occur on a larger scale than currently assumed. Nevertheless, duodenoscopes continue to be invaluable instruments in the treatment of severe and life-threatening diseases.

Prof. Marco Bruno, gastroenterologist and head of the department of Gastroenterology and Hepatology, emphasizes that the duodenoscope is used to perform life-saving treatment. "In the Netherlands, a new guideline will soon be published that describes the sampling and culture methods, and the interpretation of the results. We are also investigating whether there are more practical control methods possible as culture results take time."

Infection prevention
Manufacturers, monitoring authorities, the government, gastroenterologists, and medical microbiologists have already taken several steps to minimize the risk of infection by contaminated endoscopes. Infection prevention is an important objective of the new types of endoscopes being developed. Furthermore, the American Food and Drug Administration (FDA) has instructed endoscopy manufacturers to review the cleaning and disinfection procedures and to conduct their own surveillance studies.

The study, entitled 'High prevalence rate of digestive tract bacteria in duodenoscopes: a nationwide study', has been published in Gut.

Date published: 26 April 2018.

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