High Level Disinfection Failure in Gastrointestinal Scopes with Elevator channels – Is it time to switch to Ethylene oxide (ETO) Sterilization?
Background: CRE infections are a challenge in health-care. Carbapenem-resistant (CR) Klebsiella pneumoniae (KP) is the species most commonly encountered in the US and resistant to most antimicrobials. Infections have been associated with high rates of morbidity and mortality. In 2012, CRKP incidence increased from 0.24 to 0.33; many patients had an Endoscopic Retrograde Cholangiopancreatography (ERCP) prior to (+) clinical culture. An investigation indicated that after high level disinfection the 5/31 (16%) ERCP scopes were positive for organisms consistent with GI flora. 1 ERCP grew both Carbapenem susceptible (CS) and CRKP, 1 Endoscope (EUS) grew Carbapenem sensitive Klebsiella Pneumoniae (CSKP). A decision to routinely disinfect scopes with an elevator channel with High level Disinfection (HLD) followed by Ethylene oxide (ETO) was made. The scope washer was changed as per scope manufacturer recommendation. The objective of this study was to determine if the new scope washer would be able to successfully achieve HLD.
Methods: A new scope washer was introduced in 2012. A maximum of 30 scopes were to undergo culture post HLD and prior to ETO. Initially targeted scopes were for patients who had undergone an ERCP and had a history of CRKP colonization/infection. The study would terminate if a positive culture was identified as this would show that the new scope washer could not consistently HLD scopes.
Over 2 months 6 scopes were cultured. 4/6 grew commensals, 1 scope was negative and 1 scope grew and ESBL KP.
· GI pathogens can be recovered post HLD even after a switch to the manufacture recommended scope washer.
· To ensure adequate disinfection, ETO should be considered for use with scopes with elevator channels (ERCP/EUS) scopes will be Ethylene oxide gas sterilized (ETO) after every patient use
· Routine scope culturing should occur to ensure proper cleaning and HLD
· No additional healthcare associated infections noted since cleaning/HLD has been combined with ETO.
C. Muto, None