APIC and SHEA Issue Statement on Infections Associated with Duodenoscope Procedures

In light of recent reports of infections with carbapenem-resistant Enterobacteriaceae (CRE), a highly resistant form of bacteria, linked to endoscopic retrograde cholangiopancreatography (ERCP) procedures, the Association for Professionals in Infection Control and Epidemiology (APIC) and the Society for Healthcare Epidemiology of America (SHEA) issued the following statement:

APIC and SHEA are concerned about recent reports of carbapenem-resistant Enterobacteriaceae (CRE) infections related to endoscopic retrograde cholangiopancreatography (ERCP) duodenoscopes. Most recently, the Ronald Reagan UCLA Medical Center notified 179 patients who underwent ERCP that they may have been exposed to CRE from contaminated duodenoscopes. As of Feb. 24, a total of seven UCLA patients were infected and two have died.

APIC and SHEA strive for healthcare without infections. We believe that any number of preventable infections is unacceptable and that every infection should be thoroughly investigated. The Centers for Disease Control and Prevention (CDC) and the U.S. Food and Drug Administration (FDA) are working together to explore optimal protocols for duodenoscope reprocessing (cleaning and disinfecting/sterilizing before reusing on other patients). Read frequently asked questions for consumers. Because duodenoscopes are more complex than other endoscope instruments, it requires meticulous attention to detail and step-by-step precision to render them safe for re-use.

Infection preventionists (IPs) and healthcare epidemiologists (HEs) are experts in tracking down the sources of infection and limiting their spread in healthcare facilities and can play a significant role in the endoscopy department’s quality improvement program as it relates to scope processing. After observing the cleaning and disinfecting processes and asking questions so that each step of the process is understood, the IP or HE may visit the department regularly to observe scope cleaning practices and reinforce the importance of the work being done.

The IP or HE will evaluate human factors, including ensuring that the cleaning area is set up with a bright light and magnification so all sections of the scope being cleaned can be well visualized. Other factors that could negatively impact the cleaning process include distractions, interruptions in the process, or demands for rapid scope turn-around.

Some departments with many patients coming in and out for these procedures may pressure staff to turn scopes around quickly. IPs and HEs must lend their support to conscientious endoscopy staff who understand the importance of taking the time needed to do a thorough job. IPs and HEs must help promote a culture in which healthcare workers are empowered to speak up if they believe there is an issue that could impact patient safety.
 
Source: APIC, SHEA