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Another Published Paper Demonstrates Inadequacy of AER's

[echo2]

Another paper published in American Journal of Infection Control (in-press) shows AER's inadequate to properly disinfect and decontaminate duodenoscopes, continuing to build the scientific case for mandating sterilization of these scopes (by the VP4):

Improper positioning of the elevator lever of duodenoscopes may lead to sequestered bacteria that survive disinfection by automated endoscope reprocessors

Michelle J. Alfa, PhDCorrespondence information about the author PhD Michelle J. AlfaEmail the author PhD Michelle J. Alfa

, 

Harminder Singh, MD

, 

Donald R. Duerksen, MD

, 

Gale Schultz, BN, RN

, 

Carol Reidy, RN, CGN

, 

Pat DeGagne, RT

, 

Nancy Olson, BSc, RT

 

Highlights

 

• •Simulated-use testing showed that bacteria in the presence of organic material may survive liquid chemical sterilization and HLD after one round of reprocessing if the duodenoscope elevator lever is in the horizontal position.
• •The expected 6 Log10 kill of vegetative Enterococcus faecalis and Escherichia colimay not be achieved when bacteria were sequestered under the horizontal duodenoscope lever in the presence of organic material.
• •There may be a very low margin of safety if bacteria and organic material become sequestered under the duodenoscope elevator lever in the horizontal position.

Background

Some outbreaks associated with contaminated duodenoscopes have been attributed to biofilm formation. The objective of this study was to determine whether bacteria within an organic matrix could survive if the elevator lever was improperly positioned in the automated endoscope reprocessor (AER) after 1 round of reprocessing.

Methods

Duodenoscope lever cavities with an open or sealed elevator wire channel were inoculated with 6-7 Log10 of both Escherichia coli and Enterococcus faecalis in ATS2015 (Healthmark Industries, Fraser, MI) and dried for 2 hours. The duodenoscopes with the lever in the horizontal position were processed through 2 makes of AERs. The cavity was sampled using a flush-brush-flush method to determine the quantity of surviving bacteria.

Results

E faecalis (range, 21-6 Log10 CFU) and E coli (range, 0-3 Log10 CFU) survived disinfection of sealed or unsealed elevator wire channel duodenoscopes in 2 different AERs with and without cleaning cycles.

Conclusion

If bacteria in organic residue are under the improperly positioned lever, then just 1 round of use is sufficient for bacteria to survive both liquid chemical sterilization and liquid chemical HLD regardless of whether or not the AER had a cleaning cycle.

https://www.ajicjournal.org/article/S0196-6553(17)30908-2/fulltext