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S U P P L E M E N T T O O U T P AT I E N T S U R G E R Y M A G A Z I N E O N L I N E | M AY 2 0 1 4
complex instruments that are difficult to clean and reprocess effectively, and
note that colonoscopes were more contaminated than gastroscopes in their
study. Interestingly, the researchers say the number of culture-positive samples
obtained from colonoscopes was two times higher than those obtained from
E N D O S C O P E R E P R O C E S S I N G
E
ndoscope reprocessing is a fragile
process in how intensely it relies
on frontline staff to properly com-
plete multiple steps, says Bret T. Petersen,
MD, professor of medicine at the Mayo
Clinic in Rochester, Minn., and a national
expert on high-level disinfection.
"It's subject to lapses, depending on the
pace of given units, a given day or a given
staff member," he adds. "We're all highly
attuned to that reality being a bit of an
Achilles' heel in the process of infection
control."
There have been a couple clusters that
have received increased
scrutiny in recent months, par-
ticularly related to endoscopic
retrograde cholangiopancre-
atography (ERCP). Last
January, the CDC issued a
report (
tinyurl.com/pusk92q
)
about the 9 patients who were
infected by a new strain of New
Delhi metallo-β-lactamase after undergoing
endoscopic retrograde cholangiopancre-
atography. Cultures taken from the flexible
endoscope used on 5 of the patients after it
underwent high-level disinfection turned up
NDM-producing E. coli in the scope's eleva-
tor channel, the strain that was linked to the
outbreak. The CDC says the ERCP endo-
scope's complex design makes cleaning and
disinfection a challenge.
"The outbreaks in the ECRP arena have
come to our attention almost fortuitously,
because they happen to involve a bug that
gets reported up the chain of awareness to
STANDARDIZED APPROACH
The 'Achilles' Heel' of Infection Prevention
Pamela
Bevelhymer,
RN,
BSN
KEY QUESTION Should GI
reprocessing staffs be cre-
dentialed? Many experts are
pushing for it.
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