Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.
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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