Improving the Reprocessing Quality of Flexible Thermolabile Endoscopes: How to Learn from Mistakes

Beatrice Casini, Benedetta Tuvo, Emanuele Marciano, Giuliana Del Magro, Giulia Gemignani, Grazia Luchini, Maria Luisa Cristina, Anna Laura Costa, Guglielmo Arzilli, Michele Totaro, Angelo Baggiani and Gaetano Privitera
Additional contact information
Beatrice Casini: Department of Translational Research, New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
Benedetta Tuvo: Department of Translational Research, New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
Emanuele Marciano: Endoscopy Service Division, University Hospital of Pisa, 56126 Pisa, Italy
Giuliana Del Magro: Endoscopy Service Division, University Hospital of Pisa, 56126 Pisa, Italy
Giulia Gemignani: Medical Direction, University Hospital of Pisa, 56126 Pisa, Italy
Grazia Luchini: Medical Direction, University Hospital of Pisa, 56126 Pisa, Italy
Maria Luisa Cristina: Department of Health Sciences, University of Genova, 16132 Genova, Italy
Anna Laura Costa: Department of Translational Research, New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
Guglielmo Arzilli: Department of Translational Research, New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
Michele Totaro: Department of Translational Research, New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
Angelo Baggiani: Department of Translational Research, New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
Gaetano Privitera: Department of Translational Research, New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy

IJERPH, 2021, vol. 18, issue 5, 1-15

Abstract: Background: Failure in the reprocessing of thermolabile flexible endoscopes has been reported as one of the most important threats to patient health. Method: A case report and observational study was conducted, from August 2014 to December 2019, in the Digestive Endoscopy Unit of a University Hospital in Italy, where two cases of Klebsiella pneumoniae carbapenemase ( KPC )-producing Klebsiella pneumoniae infections in patients undergoing endoscopic retrograde cholangio-pancreatography were observed. Following the risk/safety management practices, an epidemiological investigation was started, duodenoscopes were removed from use and the reprocessing practices reviewed. Moreover, microbiological surveillance of endoscopes was carried out according to the CDC guidelines. Results: In the first phase of sampling, 10/10 (100%) endoscopes were found to be non-compliant, of which 7 showed results for high-concern organisms (HCOs), such as KPC - K. pneumoniae, P. aeruginosa and E. coli . After implementing corrective actions, 12 out of 17 endoscopes were found to be non-compliant (70.5%), of which 8 showed results for HCOs, such as KPC-K. oxytoca and P. aeruginosa . During the last year of regular microbiological surveillance, only 23% of endoscopes (35/152) were found to be non-compliant, of which 7 showed results for HCOs, such as NDM-K. pneumoniae, P. aeruginosa and A. baumannii . The crucial issues were related to samples collected from the internal channels of duodenoscopes. Conclusion: Managing the risk associated with the reprocessing of digestive endoscopes, through risk assessment at every stage of the process, is important for the prevention of infections associated with the use of these device.

Keywords: endoscope reprocessing; duodenoscope; microbiological surveillance; KPC; NDM; Klebsiella pneumoniae (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2021
References: View complete reference list from CitEc
Citations: View citations in EconPapers (1)

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