always reassemble it properly.
The challenges are great, but I believe the technology to make them
much safer can be developed. Until it happens, the responsibility will
fall on hospitals and surgery centers to find ways to continue offering
patients a life-saving procedure while ensuring that the risk of infec-
tion is reduced to where it becomes essentially negligible.
The first step is to examine how you're handling reprocessing of
duodenoscopes (as well as all flexible endoscopes), and to develop a
9 6 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • J A N U A R Y 2 0 1 6
When the various carbapenem-resistant
Enterobacteriaceae (CRE) bacteria outbreaks
became widely publicized, some surgical facili-
ties responded by instituting sterilization
instead of high-level disinfection — with the
rationale being that CRE is a very difficult bug
to kill. They turned to ethylene oxide (EtO),
which is powerful, but which also has the
potential to expose staff to toxic gas. EtO does
work, but I'm not convinced that it does so because it's a more powerful weapon. Some theorize
that there may be other factors involved. For example, when you use EtO, the process thoroughly
dries all surfaces of the duodenoscopes, including the internal channels, which makes it very
unlikely that bacteria will proliferate if any escape sterilization.
I believe the big-gun mentality was based on a misunderstanding, and that the jury is still out
as to whether we need to resort to sterilants, or whether we can still use conventional liquid
chemical germicide for high-level disinfection. CRE are susceptible to all the high-level disinfec-
tants currently being used for endoscope reprocessing, and regardless of what you use, if you
don't properly clean the scope before you disinfect or sterilize it, the soil that's left behind can
shield the bacteria. — Chris Lavanchy
"The jury is still out as to
whether we need to resort
to sterilants, or whether we
can still use conventional
liquid chemical germicide
for high-level disinfection."
HIGH-LEVEL DISINFECTION
Big-Gun Mentality Misses the Mark
