Division of Gastroenterology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
Center of Excellence for Innovation and Endoscopy in Gastrointestinal Oncology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Endoscopy. 2020 Sep;52(9):754-760. doi: 10.1055/a-1145-3562. Epub 2020 Apr 16.
A newly designed duodenoscope with detachable distal cap may reduce bacterial contamination by allowing better access to the elevator. We compared bacterial contamination and organic residue evaluated by rapid adenosine triphosphate (ATP) test and culture from duodenoscopes with detachable vs. fixed distal caps after high-level disinfection (HLD).
During December 2018-April 2019, 108 used newly designed duodenoscopes were enrolled. In group A (n = 54), the distal cap of the duodenoscope was detached before manual cleaning. In group B (n = 54), the distal cap was not detached. After HLD, samples were collected from the elevator, submitted for culture, and evaluated using the ATP test, using the cutoff value of 40 relative light units (RLUs).
After HLD, the proportion of potential bacterial contamination and organic residue in group A was significantly lower than in group B (37.0 % vs. 75.9 %; < 0.001; relative risk 0.49, 95 % confidence interval 0.33-0.71), and also confirmed by median ATP values (45.2 vs. 141.0 RLU; < 0.001). In group B, one sample culture was positive for nonpathogenic bacteria. Pathogenic bacteria were not found in any culture from either group.
The detachable distal cap was more effective at eliminating bacterial contamination and reducing organic residue than a fixed cap. Nonpathogenic bacteria were detected in the fixed cap group after reprocessing. The ATP test with 40 RLU cutoff is a practical method to ensure the cleanliness of duodenoscope reprocessing without the need to wait for bacterial culture results.
一种新型带有可拆式远端帽的十二指肠镜，通过更好地接触到抬钳器，可能会减少细菌污染。我们比较了经过高水平消毒（HLD）后，可拆式与固定式远端帽的十二指肠镜的细菌污染和由快速三磷酸腺苷（ATP）检测和培养评估的有机残留物。
在 2018 年 12 月至 2019 年 4 月期间，纳入了 108 台使用过的新型十二指肠镜。在 A 组（n=54）中，十二指肠镜的远端帽在手动清洗前被拆除。在 B 组（n=54）中，远端帽未被拆除。HLD 后，从抬钳器上采集样本，进行培养，并使用 40 相对光单位（RLU）的截断值进行 ATP 检测。
HLD 后，A 组潜在细菌污染和有机残留物的比例明显低于 B 组（37.0%比 75.9%；<0.001；相对风险 0.49，95%置信区间 0.33-0.71），这也通过中位 ATP 值（45.2 比 141.0 RLU；<0.001）得到了证实。B 组中有一个样本的培养物呈非致病性细菌阳性。在两组中均未发现致病性细菌。
与固定式远端帽相比，可拆式远端帽更能有效消除细菌污染和减少有机残留物。在重新处理后，固定帽组中检测到非致病性细菌。40 RLU 截断值的 ATP 检测是一种实用的方法，可确保十二指肠镜重新处理的清洁度，而无需等待细菌培养结果。
