Duodenoscope-Associated Infections beyond the Elevator Channel: Alternative Causes for Difficult Reprocessing

Gheorghe G Balan, Irina Rosca, Elena-Laura Ursu, Adrian Fifere, Cristian-Dragos Varganici, Florica Doroftei, Ioana-Andreea Turin-Moleavin, Vasile Sandru, Gabriel Constantinescu, Daniel Timofte, Gabriela Stefanescu, Anca Trifan, Catalin Victor Sfarti, Gheorghe G Balan, Irina Rosca, Elena-Laura Ursu, Adrian Fifere, Cristian-Dragos Varganici, Florica Doroftei, Ioana-Andreea Turin-Moleavin, Vasile Sandru, Gabriel Constantinescu, Daniel Timofte, Gabriela Stefanescu, Anca Trifan, Catalin Victor Sfarti

Abstract

Objectives: Duodenoscopes have been widely used for both diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP) procedures, but recently, numerous outbreaks of multidrug-resistant organisms (MDRO) infections have been reported which has led to extensive research for their possible causes. Consequently, the aim of this study is to search for possible duodenoscope surface damages that could provide an alternative and plausible source of infections.

Materials and methods: In order to assess both outer and inner surfaces, a duodenoscope was dismantled and samples were taken from the outer resin polymer and from the air/water, elevator, and working (biopsy) channels that were characterized by FTIR, DSC, TGA, AFM, SEM techniques and the antimicrobial activity were tested.

Results: Alterations were noticed on both the coating and working channel polymers, with external alterations increasing progressively from the proximal sample to the distal sample near the tip of the scope. However, the results showed that the coating surface was still efficient against bacterial adhesion. Changes in surface texture and also morphological changes were shown.

Conclusions: The study describes the impact of routine procedural use and reprocessing cycles on the duodenoscope, showing that these may possibly make it susceptible to bacterial contamination and MDRO biofilm formation due to difficult reprocessing of the altered surfaces.

Keywords: carbapenem-resistant enterobacteriaceae; endoscopic retrograde cholangiopancreatography; nosocomial infections; reprocessing.

Conflict of interest statement

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1
Figure 1
FTIR spectra of the studied samples 1–4.
Figure 2
Figure 2
DSC second scans of the studied samples.
Figure 3
Figure 3
(A) TGA and (B) DTG curves of the studied samples.
Figure 4
Figure 4
AFM topographic images for the duodenoscope samples: a—1st sample, b—2nd sample, c—3rd sample, d—4th sample.
Figure 5
Figure 5
AFM topographic images for the duodenoscope samples after incubation with Escherichia coli and Staphylococcus aureus: a—1st sample, b—2nd sample, c—3rd sample, d—4th sample.
Figure 6
Figure 6
SEM micrographs of duodenoscope samples. a—1st sample, b—2nd sample, c—3rd sample, d—4th sample.
Figure 7
Figure 7
SEM micrographs of elevator and channel samples: a—air/water channel; b—elevator channel; c—working channel; d,e,f—elevator recess side.

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