Division of Gastroenterology-Hepatology, Indiana University, Indianapolis, Indiana, USA.
Division of Infectious Diseases, Indiana University, Indianapolis, Indiana, USA.
Endoscopy. 2018 Jun;50(6):588-596. doi: 10.1055/s-0043-122378. Epub 2017 Dec 13.
Duodenoscopes have been the source of serious infection, despite correct performance of high-level disinfection (HLD). This study aimed to observe the impact of performing HLD twice on the rate of positive cultures from duodenoscope elevators.
We performed double HLD (DHLD; i. e. complete manual cleaning followed by automated reprocessing, with the entire process repeated) and then randomly cultured the elevators of our duodenoscopes on about 30 % of occasions.
DHLD was associated with positive elevator cultures for any microorganism in 9.4 % of cases, with a 0.8 % rate of known pathogens (627 cultures) between May 2015 and February 2016. After February 2016, and in association with changing the precleaning fluid, as well as use of a new FDA-recommended cleaning brush, the rate of positive cultures for any microorganism after DHLD was 4.8 % and 0.2 % for known pathogens (420 cultures). In a third phase, characterized by a change in personnel performing DHLD and retirement of a duodenoscope with a high rate of positive cultures, the rate of positive cultures for any microorganism was 4.9 % (783 cultures) and the rate of positive culture for known pathogens was 0.3 %. To our knowledge, no duodenoscope transmission of infection occurred during the study interval.
DHLD resulted in a low rate of positive cultures for known pathogens and for organisms of low pathogenic potential, but did not eliminate these, from duodenoscope elevators. Additional improvements in HLD protocols and/or duodenoscope design are needed.
尽管已正确执行高水平消毒（HLD），但十二指肠镜仍是严重感染的源头。本研究旨在观察对十二指肠镜抬臂执行两次 HLD 对培养阳性率的影响。
我们对抬臂执行了两次 HLD（即先彻底手动清洁，再进行自动化处理，整个过程重复），然后在大约 30%的情况下对抬臂进行随机培养。
在 2015 年 5 月至 2016 年 2 月期间，DHLD 与任何微生物阳性抬臂培养相关，阳性率为 9.4%，已知病原体的检出率为 0.8%（627 个培养物）。2016 年 2 月之后，由于改变了预清洁液，并且使用了新的美国食品药品监督管理局推荐的清洁刷，两次 HLD 后任何微生物阳性培养的检出率为 4.8%，已知病原体的检出率为 0.2%（420 个培养物）。在第三阶段，特征为执行两次 HLD 的人员发生改变以及一台阳性培养率较高的十二指肠镜退役，任何微生物阳性培养的检出率为 4.9%（783 个培养物），已知病原体的检出率为 0.3%。据我们所知，在研究期间未发生十二指肠镜传播感染。
DHLD 可降低十二指肠镜抬臂已知病原体和低致病潜能病原体的阳性培养率，但不能消除这些病原体。需要进一步改进 HLD 方案和/或十二指肠镜设计。
