2015-09-22 21:28:53 UTC

Getting to Zero: Reducing the Risk for Duodenoscope-Related Infections

Sept. 23, 2015

AGA leaders author a commentary in Annals of Internal Medicine on this ongoing issue.

In recent months, recognition of “superbug infections” from agents transmitted by duodenoscopes (specialized endoscopes used for ERCP) has prompted investigation and development of action plans by AGA, FDA and CDC. Leaders from the AGA Center for GI Innovation and Technology, including Michael L. Kochman, MD (chair), Jeffrey L. Tokar, MD, AGAF (subcommittee member), and John I. Allen, MD, AGAF (past AGA president), authored a commentary in Annals of Internal Medicine (login required) highlighting the situation and the efforts underway to better understand the problem, develop creative solutions and, above all, ensure patient safety.

The commentary highlights the following important facts:

  • The complex duodenoscope design is now widely believed to create hard-to-reach areas that may prevent optimal mechanical cleaning and disinfection.
  • While all facilities should follow manufacturers' reprocessing instructions, CDC recommends health-care facilities go one step further and consider establishing duodenoscope surveillance programs.
  • Providers should take an active role and participate in risk reduction efforts being undertaken in their facility; this will allow for more informative and honest discussions with patients about risks and precautions.
  • ERCP plays an important role in clinical practice (more than 500,000 procedures are performed annually); patients should be reminded that, for those who need it, ERCP is a life-saving procedure and the absolute incidence of infection is low.
  • Physicians who use duodenoscopes must keep current with information generated by AGA, FDA and CDC, and should be familiar with published guidelines describing appropriate indications and patient selection for ERCP.
  • The AGA Center for GI Innovation and Technology has taken the lead in addressing this issue and remains committed to providing patients with the safest endoscopic environment possible. Last spring, the center convened key thought leaders for a “Getting to Zero” call-to-action meeting to outline paths toward eliminating duodenoscope-related infections and will continue to push for a safe path forward.

Read the full commentary in Annals of Internal Medicine (login required)

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