title: A novel adjunctive cleansing method to reduce colony-forming units on duodenoscopes.
abstract: Background and study aims:Endoscopic retrograde cholangiopancreatography-related infections are of increasing global concern due to the emergence of multidrug-resistant bacteria such as carbapenem-resistant enterobacteriaceae (CRE), with bacterial biofilm production postulated as one cause of persistent infection from such virulent organisms. Because N-acetylcysteine (NAC) has been shown to possess antibacterial and biofilm-disruption properties, we aimed to evaluate if NAC would demonstrate clinical utility in reducing the colony forming units (CFU) at the elevator end of a duodenoscope, one of the hardest areas to clean.Patients and methods:This was a pilot study of 16 procedures involving the use of a duodenoscope. After use, the elevator tip of a duodenoscope was cultured and submerged for 30 minutes, either in 20 % NAC (200 mg/mL, intervention) or in sterile water (control). After 30 minutes, the elevator tip was re-cultured.Results:Submersion of the distal end of a duodenoscope in 20 % NAC (200 mg/mL) for 30 minutes resulted in a statistically significant reduction in bacterial colony forming units compared to control (average reduction 41.6 % vs 8.8 %,P= 0.001). There was no visible damage and no optical distortion to the duodenoscope after submersion in NAC.Conclusions:In summary, NAC may be a safe, simple, and useful adjunct to currently available methods of duodenoscope reprocessing. Further research may better define NAC's role in duodenoscope reprocessing, either broadly or specifically after procedures suspected to produce a high risk of bacterial contamination (e. g. choledocholithiasis).
authors.affiliation: Kaiser Permanente, Los Angeles Medical Center - Medicine/Gastroenterology, Los Angeles, California, United States.
authors.forename: Karl
authors.initials: K
authors.lastname: Kwok
authors.affiliation: Kaiser Permanente, Los Angeles Medical Center - Pharmacy, Los Angeles, California, United States.
authors.forename: Joseph
authors.initials: J
authors.lastname: Chang
authors.affiliation: Cedars-Sinai Medical Center - Gastroenterology, Los Angeles, California, United States.
authors.forename: Simon
authors.initials: S
authors.lastname: Lo
authors.affiliation: Kaiser Permanente, Anaheim Medical Center - Medicine/Gastroenterology, Anaheim, California, United States.
authors.forename: Andrew
authors.initials: A
authors.lastname: Giap
authors.affiliation: Kaiser Permanente, Riverside Medical Center - Medicine/Gastroenterology, Los Angeles, California, United States.
authors.forename: Brian
authors.initials: B
authors.lastname: Lim
authors.affiliation: Kaiser Permanente, Los Angeles Medical Center - Medicine/Gastroenterology, Los Angeles, California, United States.
authors.forename: Bechien
authors.initials: B
authors.lastname: Wu