A survey of reprocessing methods, residual viable bioburden, and soil levels in patient-ready endoscopic retrograde choliangiopancreatography duodenoscopes used in Canadian centers.
OBJECTIVE
To obtain information about current reprocessing practices and to obtain samples from the biopsy channel to quantitate soil levels and bioburden in patient-ready flexible duodenoscopes used for endoscopic retrograde choliangiopancreatography (ERCP).


METHODS
Participating centers were sent a questionnaire and a kit for on-site collection of samples from the biopsy channel of the duodenoscope.


METHODS
Thirty-seven hospitals from across Canada participated. The only criterion was that they currently used and reprocessed flexible duodenoscopes for ERCP procedures.


METHODS
The questionnaire obtained information on reprocessing practices. The kit included a detailed instruction booklet outlining sample collection and all of the tubes, sterile water, and brushes needed for it. Samples were collected on-site from all ERCP scopes in each center on Monday morning and shipped by overnight courier on ice to the research center. Each sample was assayed by routine microbiologic methods for total viable count and protein, blood, carbohydrate, and endotoxin levels.


RESULTS
Microbial overgrowth was present in 7% of 119 scope samples. Cleaning appeared to be reasonably well done in most of the centers, and 43% of the centers were in total compliance with basic national guidelines. The data from the scope samples indicated that there was significantly greater buildup of protein, carbohydrate, and endotoxin associated with ERCP scopes from centers using glutaraldehyde, compared with those using peracetic acid. Carbohydrate was the soil component detected most frequently and in the highest concentration in scope channels.


CONCLUSIONS
Although cleaning was generally well done, areas for improvement included ensuring the availability of written reprocessing protocols, immersion of scopes during manual cleaning, use of adequate fluid volume for rinsing, adequate drying of scopes prior to storage, and the separation of ERCP valves from scopes during storage.
Alfa
Michefle J
MJ
Microbiology Department, St Boniface General Hospital, Winnipeg, Manitoba, Canada.
Olson
Nancy
N
DeGagne
Pat
P
Jackson
Michele
M
D002170:Canada; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000295:instrumentation*; D003625:Data Collection; D004203:Disinfection / Q000592:standards*; D020698:Duodenoscopes / Q000382:microbiology*; D004866:Equipment Contamination / Q000706:statistics & numerical data*; D019983:Guideline Adherence; D006302:Health Services Research; D006779:Hospitals, Public; D006801:Humans; D011786:Quality Control