Society: ASGE

Background and aim: Despite extensive cleaning and disinfection protocols, 5-15% of ready-to-use duodenoscopes are still contaminated with high concern (HC) microorganisms such as Klebsiella pneumoniae, Escherichia coli and Pseudomonas aeruginosa. Changes in cleaning protocols might reduce the contamination rate and hereby prevent future outbreaks. This study aims to investigate the effect of a new endoscope cleaning brush on contamination of duodenoscopes with HC microorganisms.
Methods: In this retrospective observational study, the results of the duodenoscope surveillance cultures between March 2018 and June 2022 were collected. Contamination with HC microorganisms was defined as ≥1 colony-forming units of gastrointestinal microorganisms including P. aeruginosa or Staphylococcus aureus. Cultures of quarantined duodenoscopes were not included. From December 2020, a new endoscope cleaning brush with an additional wiper (Endoss Push and Pull brush, JPP50) was introduced for the manual pre-cleaning of the Pentax ED34-i10T2 duodenoscopes instead of the Pentax Single Use Brush (CS5522A). Using a generalized mixed effect model, the effect of the introduction of the new endoscope cleaning brush on Pentax ED34-i10T2 duodenoscope contamination with HC microorganisms was assessed. Other covariates were frequency of use, repairs by the manufacturer and the result of the prior culture.
Results: Data from 195 cultures of eight duodenoscopes was collected; 122 cultures prior to the introduction of the new brush and 73 after introduction. Prior to the introduction, 51/122 (41.8%) cultures were positive with HC microorganisms, especially with P. aeruginosa (29/122, 23.8%). After introduction of the brush only 7/73 (9.6%) were positive with HC microorganisms of which only one was positive with P. aeruginosa. Duodenoscopes cleaned with the new brush had a significantly lower odds of contamination with HC microorganisms compared to duodenoscopes cleaned with the old brush (OR = 0.17, 95 % CI [0.07, 0.42], p <0.001).
Conclusions: The Endoss Push and Pull brush significantly reduced contamination of ED34-i10T2 duodenoscopes, and it is therefore promising in the prevention of healthcare-associated infections and outbreaks. In the future, these results should be confirmed in a prospective study with different types of duodenoscopes.

Koen van der Ploeg

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