Providence Health & Services, Renton, Washington, USA.
Gastrointest Endosc. 2016 Sep;84(3):392-399.e3. doi: 10.1016/j.gie.2016.03.1480. Epub 2016 Mar 28.
To assess the adequacy of currently recommended duodenoscope and linear echoendoscope (DLE) automatic endoscope reprocessing (AER) and high-level disinfection (HLD), we collected daily post-reprocessing surveillance cultures of 106 DLEs in 21 Providence and Affiliate Hospitals.
Daily qualitative surveillance of dried, post-HLD DLEs was conducted for a minimum of 30 days at each facility. Positivity rates for any microbial growth and growth of high-concern pathogens were reported. Potential effects of DLE manufacturer, age, and AER processor on culture-positivity rate were assessed.
Microbial growth was recovered from 201 of 4032 specimens (5%) or 189 of 2238 encounters (8.4%), including 23 specimens (.6%) or 21 encounters (.9%) for a high-concern pathogen. Wide variations in culture-positivity rate were observed across facilities. No striking difference in culture-positivity rate was seen among 8 DLE models, 3 DLE manufacturers, DLE age, manual or bedside cleanser, or automatic flushing system use. However, there was suggestive evidence that Custom Ultrasonics AER (Warminster, Pa, USA) had a lower culture-positivity rate than Medivators AER (Cantel Medical Corp., Little Falls, NJ, USA) for high-concern pathogen growth (0/1079 vs 21/2735 specimens or 0/547 vs 20/1582 encounters). Two endoscopes grew intestinal flora on several occasions despite multiple HLD. No multidrug-resistant organism was detected.
In this multicenter DLE surveillance study, microbial growth was recovered in 5.0% of specimens (8.4% of encounters), with most being environmental microbes. Enteric bacterial flora was recovered in .6% of specimens (.9% of encounters), despite compliance with 2014 U.S. guidelines and manufacturers' recommendations for cleaning and HLD process. The observed better performance of Custom Ultrasonics AER deserves further investigation.
为了评估目前推荐的十二指肠镜和线性回声内镜（DLE）自动内镜处理（AER）和高水平消毒（HLD）的充分性，我们收集了 21 家普罗维登斯和附属医院的 106 个 DLE 日常处理后监测培养物。
在每个设施中，对 DLE 进行了至少 30 天的每日定性监测。报告任何微生物生长和高关注病原体生长的阳性率。评估了 DLE 制造商、年龄和 AER 处理器对培养物阳性率的潜在影响。
从 4032 个标本中的 201 个（5%）或 2238 次接触中的 189 个（8.4%）中回收了微生物生长，包括 23 个标本（0.6%）或 21 次接触（0.9%）高关注病原体。不同设施之间的培养物阳性率存在很大差异。8 种 DLE 模型、3 种 DLE 制造商、DLE 年龄、手动或床边清洁剂或自动冲洗系统的使用之间没有明显的培养物阳性率差异。然而，有迹象表明，Custom Ultrasonics AER（宾夕法尼亚州沃明斯特）的高关注病原体生长的培养物阳性率低于 Medivators AER（新泽西州小瀑布市 Cantel Medical Corp.）（0/1079 与 21/2735 标本或 0/547 与 20/1582 接触）。尽管进行了多次 HLD，但仍有两个内镜多次出现肠道菌群生长。未检测到多药耐药菌。
在这项多中心 DLE 监测研究中，5.0%的标本（8.4%的接触）中回收了微生物生长，其中大多数是环境微生物。尽管遵守了 2014 年美国指南和制造商关于清洁和 HLD 过程的建议，但在 0.6%的标本（0.9%的接触）中回收了肠道细菌菌群。Custom Ultrasonics AER 的观察到的更好性能值得进一步研究。
