title: Residual contamination and bioburden after reprocessing of single-use endoscopic ultrasound needles: An ex vivo study.
abstract: OBJECTIVE
  Endoscopic ultrasound (EUS) aspiration needles are single-use devices. However, in many centers, because of cost-constraints, these devices are reused multiple times. We studied microbiological contamination and bioburden on reprocessed needles to evaluate whether these devices can be successfully sterilized.
  
  
  METHODS
  We studied 10 EUS needles each of 19 G, 22 G, and 25 G in size, and five 22-G ProCore needles. After initial use, each needle was reprocessed by a standardized protocol. We used standard microbiological cultures, as well as ATP bioluminescence technique to quantify bioburden as relative light units (RLU). We defined significant soil contamination by RLU values >200. We also used extractant fluid to disrupt cell membranes in an attempt to enhance ATP detection.
  
  
  RESULTS
  We found culture positivity in 3/34 (8.8%), and detectable bioburden on the exposed surface of 33/35 (94.3%), and inside lumen of 29 (82.9%) reprocessed FNA needles. Significant bioburden was found in three (8.6%) and two (5.7%) needles on the surface and lumen, respectively. We found that use of extractant fluid enhanced detection of bioburden. Larger (19 G) needles had higher surface contamination (P = 0.016), but there was no relation of luminal contamination with needle diameter (P = 0.138). Sheath design and presence of side bevel did not influence extent of contamination. There was significant correlation between the surface and intraluminal bioburden (P < 0.001).
  
  
  CONCLUSIONS
  There is significant bioburden in reprocessed EUS needles; standard microbiological cultures have low sensitivity for detection of needle contamination. We have provided objective evidence for the futility of reprocessing attempts, and practice of EUS needle reuse should be discontinued.
authors.affiliation: Department of Gastroenterology, Fortis Escorts Liver and Digestive Institute, Delhi, India.
authors.forename: Vikram
authors.initials: V
authors.lastname: Bhatia
authors.affiliation: Department of Microbiology, SRL Ltd, Fortis Escorts Heart Institute, Delhi, India.
authors.forename: Anu
authors.initials: A
authors.lastname: Gupta
authors.affiliation: Department of Microbiology, SRL Ltd, Fortis Escorts Heart Institute, Delhi, India.
authors.forename: Shweta
authors.initials: S
authors.lastname: Sharma
authors.affiliation: Department of Gastroenterology, Fortis Escorts Liver and Digestive Institute, Delhi, India.
authors.forename: Rajeev
authors.initials: R
authors.lastname: Shandil
authors.affiliation: Department of Gastroenterology, Fortis Escorts Liver and Digestive Institute, Delhi, India.
authors.forename: Manav
authors.initials: M
authors.lastname: Wadhawan
authors.affiliation: Department of Interventional Radiology, Fortis Escorts Liver and Digestive Institute, Delhi, India.
authors.forename: Nitesh
authors.initials: N
authors.lastname: Agrawal
authors.affiliation: Department of Gastroenterology, Fortis Escorts Liver and Digestive Institute, Delhi, India.
authors.forename: Ajay
authors.initials: A
authors.lastname: Kumar
mesh_terms: D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000295:instrumentation*; D004866:Equipment Contamination; D006801:Humans; D008163:Luminescent Measurements; D009339:Needles / Q000382:microbiology*; D010192:Pancreatic Pseudocyst / Q000473:pathology; D013242:Sterilization
keywords: ATP bioluminescence; bioburden; endoscopic ultrasound; fine-needle aspiration; relative light unit; reuse; sterilization