815

ESTABLISHING PRECONDITIONS FOR EFFECTIVE DUODENOSCOPE REPROCESSING: AN OBSERVATIONAL COHORT STUDY

Date
May 20, 2024

Background: The use of contaminated duodenoscopes in endoscopic retrograde cholangiopancreatography (ERCP) has caused numerous healthcare-associated infection outbreaks. Despite adherence to reprocessing protocols, duodenoscopes often remain contaminated. Moreover, there's a lack of evidence outlining the prerequisites for adequate duodenoscope cleaning, disinfection, and storage to prevent contamination. This study aims to investigate the effect of manual cleaning and drying factors on duodenoscope contamination.
Methods: Duodenoscope cultures from Pentax ED34-i210T2 models were collected between February 2022 and June 2023. Contamination was determined by the presence of microorganisms of gut or oral origin (MGO). Data on duodenoscope usage, reprocessing start time, cleaning duration, personnel involved, and drying time were retrieved from electronic medical records. Risk factors, including delays in manual cleaning initiation and insufficient drying time, were determined based on reprocessing guidelines and literature. A generalized linear mixed-effects model was used to investigate the effect of these risk factors on duodenoscope contamination.
Results: A total of 242 duodenoscope cultures were collected from eight different duodenoscopes. Contamination with MGO was identified in 48 (19.8%) cultures. Over the study duration, the duodenoscopes underwent reprocessing 909 times. Manual cleaning durations of 7 minutes or less were associated with higher odds of contamination (aOR=1.63, 95% CI: 1.06-2.49, p=0.02). Interestingly, duodenoscope usage appeared to provide protection against contamination (aOR=0.78, 95% CI: 0.59-1.03, p=0.08). However, factors such as a 30-minute delay in initiating manual cleaning, drying times below 90 minutes or exceeding 7 days, and reprocessing personnel experience didn't demonstrate a clear association with contamination rates.
Conclusion: There are substantial knowledge gaps regarding the risk factors for duodenoscope contamination. Meticulous monitoring of the reprocessing timeline and steps may prove beneficial. Manual cleaning durations of 7 minutes or shorter are linked to increased odds of contamination with MGO. Future research is needed to determine whether heightened surveillance of manual cleaning duration could lead to reduced contamination.

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