Lui Jennifer Y, Chapman Christopher G, Waxman Irving, Siddiqui Uzma D
Center for Endoscopic Research and Therapeutics, UChicago Medicine, Chicago, IL, USA.
Dig Dis Sci. 2022 Mar;67(3):947-952. doi: 10.1007/s10620-021-06930-6. Epub 2021 Mar 13.
The challenging disinfection process for the elevator mechanism on duodenoscopes and linear echoendoscopes has been identified as a source of clinically significant bacterial transmission. Despite increased awareness, there continues to be a lack of definitive guidelines for bacterial culturing protocols for elevator-containing endoscopes.
To compare two different prospective bacterial surveillance protocols for duodenoscopes and linear echoendoscopes with regard to accuracy, efficiency, and cost.
Consecutive duodenoscopes and linear echoendoscopes used at a single tertiary care center were reprocessed following hospital and manufacturer guidelines, dried using an automatic endoscope-drying machine, and hung overnight in an upright position. Following reprocessing, culture samples were sequentially obtained from each endoscope using two methods, first, the brush protocol followed immediately by the swab protocol.
A total of 532 primary cultures were collected from 17 duodenoscopes and eight linear echoendoscopes. Of these, 266 cultures gathered using the brush protocol were negative, while 266 cultures gathered using the swab protocol resulted in three positive cultures (1.1%). Positive cultures showed Enterobacter cloacae and Klebsiella pneumoniae from one duodenoscope and two linear echoendoscopes. Yearly, the brush protocol amounts to approximately 520 nursing hours, and the swab protocol takes an estimated 42 nursing hours. Annually, the swab protocol could save over $26,500 and 478 nursing hours.
The proposed swab protocol was superior to the brush protocol when evaluating the presence of residual bacteria on elevator-containing endoscopes following reprocessing and saves cost and nursing hours.
十二指肠镜和线性超声内镜的抬钳器机制消毒过程具有挑战性，已被确定为具有临床意义的细菌传播源。尽管人们的认识有所提高，但对于含抬钳器内镜的细菌培养方案仍缺乏明确的指导原则。
比较十二指肠镜和线性超声内镜的两种不同前瞻性细菌监测方案在准确性、效率和成本方面的差异。
在一家三级医疗中心连续使用的十二指肠镜和线性超声内镜按照医院和制造商的指南进行再处理，使用自动内镜干燥机干燥，并垂直悬挂过夜。再处理后，使用两种方法从每个内镜依次获取培养样本，首先是刷检方案，紧接着是拭子方案。
从17台十二指肠镜和8台线性超声内镜共收集了532份原始培养物。其中，使用刷检方案收集的266份培养物为阴性，而使用拭子方案收集的266份培养物中有3份阳性培养物（1.1%）。阳性培养物显示一株十二指肠镜和两台线性超声内镜检出阴沟肠杆菌和肺炎克雷伯菌。每年，刷检方案大约需要520个护理小时，拭子方案估计需要42个护理小时。每年，拭子方案可节省超过26,500美元和478个护理小时。
在评估含抬钳器内镜再处理后残留细菌的存在情况时，所提议的拭子方案优于刷检方案，且节省成本和护理时间。
