Bomman Shivanand, Kozarek Richard A, Thaker Adarsh M, Kodama Camilla, Muthusamy V Raman, Ross Andrew S, Krishnamoorthi Rajesh
Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington, United States.
Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California, United States.
Endosc Int Open. 2021 Aug 23;9(9):E1404-E1412. doi: 10.1055/a-1515-2591. eCollection 2021 Sep.
Recent outbreaks attributed to contaminated duodenoscopes have led to the development of enhanced surveillance and reprocessing techniques (enhanced-SRT) aimed at minimizing cross-contamination. Common enhanced-SRT include double high-level disinfection (HLD), ethylene oxide (EtO) gas sterilization, and culture-based monitoring of reprocessed scopes. Adoption of these methods adds to the operational costs and we aimed to assess its economic impact to an institution. We compared the estimated costs of three enhanced-SRT versus single-HLD using data from two institutions. We examined the cost of capital measured as scope inventory and frequency of scope use per unit time, the constituent reprocessing costs required on a per-cycle basis, and labor & staffing needs. The economic impact attributable to enhanced-SRT was defined as the difference between the total cost of enhanced-SRT and single HLD. Compared to single HLD, adoption of double HLD increased the costs approximately by 47 % ($80 vs $118). Similarly, culture and quarantine and EtO sterilization increased costs by 160 % and 270 %, respectively ($80 vs $208 and $296). Enhanced-SRT introduced significant scope downtime due to prolonged techniques, necessitating a 3.4-fold increase in the number of scopes needed to maintain procedural volume. The additional annual budget required to implement enhanced-SRT approached $406,000 per year in high-volume centers. While enhanced-SRT may reduce patient risk of exposure to contaminated duodenoscopes, it significantly increases the cost of performing ERCP. Future innovation should focus on approaches that can ensure patient safety while maintaining the ability to perform ERCP in a cost-effective manner.
近期因十二指肠镜污染导致的疫情爆发促使了强化监测和再处理技术（enhanced-SRT）的发展，旨在将交叉污染降至最低。常见的enhanced-SRT包括双重高水平消毒（HLD）、环氧乙烷（EtO）气体灭菌以及对再处理后的内镜进行基于培养的监测。采用这些方法会增加运营成本，我们旨在评估其对机构的经济影响。我们使用来自两个机构的数据，比较了三种enhanced-SRT与单次HLD的估计成本。我们研究了以内镜库存和单位时间内镜使用频率衡量的资本成本、每个周期所需的再处理成本以及劳动力和人员配备需求。enhanced-SRT的经济影响定义为enhanced-SRT总成本与单次HLD总成本之间的差异。与单次HLD相比，采用双重HLD使成本增加了约47%（80美元对118美元）。同样，培养和检疫以及EtO灭菌分别使成本增加了160%和270%（80美元对208美元和296美元）。由于技术时间延长，enhanced-SRT导致了显著的内镜停机时间，因此需要将内镜数量增加3.4倍以维持手术量。在高流量中心，实施enhanced-SRT每年所需的额外预算接近40.6万美元。虽然enhanced-SRT可能会降低患者接触受污染十二指肠镜的风险，但它显著增加了进行内镜逆行胰胆管造影（ERCP）的成本。未来的创新应侧重于能够确保患者安全同时保持以具有成本效益的方式进行ERCP能力的方法。
