title: Measures to improve microbial quality surveillance of gastrointestinal endoscopes.
abstract: OBJECTIVE
  Infectious outbreaks associated with the use of gastrointestinal endoscopes have increased in line with the spread of highly resistant bacteria. The aim of this study was to determine the measures required to improve microbial quality surveillance of gastrointestinal endoscopes.
  
  
  METHODS
  We reviewed the results of all microbiological surveillance testing of gastrointestinal endoscopes and automatic endoscope reprocessors (AERs) performed at Brest Teaching Hospital from 1 January 2008 to 1 June 2015. We analyzed the influence of the time of incubation on the rate of positive results using the Kaplan - Meier method. We also studied risk factors for gastrointestinal endoscope contamination using a multivariable logistic regression model.
  
  
  RESULTS
  Over the study period, 1100 microbiological tests of gastrointestinal endoscopes (n = 762) and AERs (n = 338) were performed. A total of 264 endoscope tests (34.6 %) showed a level of contamination higher than the target. After 2 days of incubation, contamination was apparent in only 55.5 % of the endoscopes that were later shown to be contaminated (95 % confidence interval [CI] 49.2 - 61.8). Multivariable analysis showed that the use of storage cabinets for heat-sensitive endoscopes significantly reduced the risk of endoscope contamination (odds ratio [OR] 0.23, 95 %CI 0.09 - 0.54; P  < 0.001) and that the use of endoscopes older than 4 years significantly increased this risk (OR ≥ 6 vs. < 2 years 2.92, 95 %CI 1.63 - 5.24; P < 0.001).
  
  
  CONCLUSIONS
  Microbiological culture technique, mainly incubation duration, strongly influenced the results of endoscope sampling. Samples should be cultured for more than 2 days to improve the detection of contaminated endoscopes. Particular attention should be paid to endoscopes older than 2 years and to those that are not stored in storage cabinets for heat-sensitive endoscopes.
authors.affiliation: Infection Control Unit, Brest Teaching Hospital, Brest, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Saliou
authors.affiliation: Department of Microbiology, Brest Teaching Hospital, Brest, France.
authors.forename: Hervé
authors.initials: H
authors.lastname: Le Bars
authors.affiliation: Department of Microbiology, Brest Teaching Hospital, Brest, France.
authors.forename: Christopher
authors.initials: C
authors.lastname: Payan
authors.affiliation: Department of Microbiology, Brest Teaching Hospital, Brest, France.
authors.forename: Valérie
authors.initials: V
authors.lastname: Narbonne
authors.affiliation: Department of Gastrointestinal Endoscopy, Brest Teaching Hospital, Brest, France.
authors.forename: Franck
authors.initials: F
authors.lastname: Cholet
authors.affiliation: Department of Gastrointestinal Endoscopy, Brest Teaching Hospital, Brest, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Jézéquel
authors.affiliation: Inserm U1078 Génétique, Génomique et Biotechnologies, Brest Teaching Hospital, Brest, France.
authors.forename: Virginie
authors.initials: V
authors.lastname: Scotet
authors.affiliation: Université de Bretagne Occidentale, Brest, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Robaszkiewicz
authors.affiliation: Université de Bretagne Occidentale, Brest, France.
authors.forename: Divi
authors.initials: D
authors.lastname: Cornec
authors.affiliation: Department of Microbiology, Brest Teaching Hospital, Brest, France.
authors.forename: Geneviève
authors.initials: G
authors.lastname: Héry-Arnaud
authors.affiliation: Infection Control Unit, Brest Teaching Hospital, Brest, France.
authors.forename: Raoul
authors.initials: R
authors.lastname: Baron
mesh_terms: D001419:Bacteria / Q000302:isolation & purification; D002175:Candida / Q000302:isolation & purification; D003428:Cross Infection / Q000517:prevention & control; D004203:Disinfection / Q000592:standards*; D020776:Endoscopes, Gastrointestinal / Q000382:microbiology*; D004866:Equipment Contamination; D017743:Equipment Reuse / Q000592:standards; D006801:Humans; D008828:Microbiological Techniques; D011785:Quality Assurance, Health Care; D013997:Time Factors