2015-03-24 21:19:50 UTC

How To Stop Duodenoscope Infections

March 26, 2015

AGA recently convened key experts in GI and infectious disease, leaders from CDC, FDA and ECRI Institute, and device manufacturers (Fuji and Pentax) for a productive day-long discussion on how to prevent device-associated infections.

AGA recently convened key experts in GI and infectious disease, leaders from CDC, FDA and ECRI Institute, and device manufacturers (Fuji and Pentax) for a productive day-long discussion on how to prevent device-associated infections. Here are our recommendations.

  1. Treat all elevator-channel endoscopes the same, including both fine-needle aspiration (FNA) echoendoscopes (endoscopic ultrasound, or EUS) and duodenoscopes.
  2. Continue to follow enhanced reprocessing guidelines as published recently by FDA. Currently, FDA is working with each endoscope manufacturer to further validate enhanced reprocessing protocols.
  3. Elevator-channel endoscopes should be tracked by patient and by device serial number to facilitate retrospective identification in case of infection.
  4. Establish a two-phase infection surveillance program: a) track all patients who have had a procedure with an elevator-channel endoscope and b) periodically perform culture surveillance of all elevator-channel endoscopes in your unit (until there is an FDA-validated enhanced reprocessing protocol available).
  5. Performing baseline cultures of all elevator-channel endoscopes, following the recently published CDC protocol, is prudent; the sensitivity of this protocol is unknown at this time. Importantly, a positive culture should trigger a thorough review of your reprocessing technique.
  6. Develop a standard device reprocessing training program and ensure technicians demonstrate competency at initial hire and then every six months, as well as when new model endoscopes are introduced.
  7. If you suspect a breach or infection, contact CDC immediately to aid in investigation.

More information on this issue, as well as information to guide conversations with patients, is available on the AGA website.

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