M A Y 2 0 1 5 O U T P A T I E N TS U R G E R Y. N E T 9
says. "At the same time, they're trying to push enhancements in scope care
while maintaining the benefits."
Duodenoscopes are arguably the
most complex, most challenging
reusable instrument to reprocess,
says Lawrence F. Muscarella, PhD, an
independent infection control
expert and president of LFM
Healthcare Solutions in
Montgomeryville, Pa.
A thin cable woven for durability
runs through an elevator channel to
a mechanism that lets physicians manipulate tools at the scope's distal tip. In older models, the channel
was open, meaning its entire length could be flushed during reprocessing. In recent years, scope manu-
facturers sealed the elevator channel with the hopes of reducing contamination risks, says Dr.
Muscarella.
There's speculation that bacteria is wicking up into the closed channel and being transmitted between
patients. Contamination hiding in the crevices around the elevator mechanism attached to the wire cable
at the scope's head could also be to blame for infection outbreaks.
When the elevator is manipulated up and down during use, fluids can get above and below it, says
Bret T. Petersen, MD, councilor with the American Society for Gastrointestinal Endoscopy and professor of
medicine at the Mayo Clinic in Rochester, Minn. Clusters of infection have been linked to scopes with
sealed channels and open channels accessible for flushing, so it's not necessarily the newer design that's
to blame, he adds. — Daniel Cook
REPROCESSING NIGHTMARE
Why Are Duodenoscopes
So Tough to Clean?
z HARD TO REACH Contaminated elevator channels are believed
to have caused outbreaks at facilities across the United States.
