Endoscopes Causing Infections, FDA Warns Providers

April 1, 2021
Frank Diamond

The FDA wants providers to know about “contamination issues associated with reprocessing urological endoscopes, including cystoscopes, ureteroscopes and cystourethroscopes—devices used to view and access the urinary tract.”

Experts interviewed by Infection Control Today® have been urging infection preventionists (IPs) for some time to get more involved in sterile processing, especially when it comes to endoscopes. Well, the Food and Drug Administration (FDA) just gave IPs more reason to jump in and help in the sterile processing effort.

The agency today warns health care providers that some medical devices have caused serious infections in patients. The information comes from numerous medical device reports (MDRs) focusing mainly on endoscope malfunctions. MDRs can be filed by providers, manufacturers, importers, or anybody else who spots a problem.

In a press release, the FDA says that the MDRs describe “patient infections and other possible contamination issues associated with reprocessing urological endoscopes, including cystoscopes, ureteroscopes and cystourethroscopes—devices used to view and access the urinary tract. Reprocessing these types of medical devices involves both cleaning and high-level disinfection or sterilization so the devices can be reused.”

The FDA received 450 MDRs from January 1, 2017 through February 20, 2021 that describe how patients were infected with devices post procedure, with the cause likely to be faulty decontamination. Olympus Corporation, a manufacturer of endoscopes, filed 3 MDRs in which patients died from a bacterial infection outside of the United States. (The FDA says that MDRs are not evidence that the infection was caused by a device malfunction.)

“Two of those reports were associated with a forceps/irrigation plug, an accessory component used to control water flow and enable access to the working channel of the endoscope,” the FDA press release states. “Lab tests confirmed the same infectious bacteria was present in both the forceps/irrigation plug and in the patient with the infection. The third patient death report involved a cystoscope that did not pass a leak test, indicating possible damage to the device, which could have been an underlying factor in the infection.”

In a recent interview with ICT®, Tanya Lewis, who is slated to become the president of the International Association of Healthcare Central Service Materiel Management (IAHCSMM) next month, said that sterile processing no longer solely involves the traditional surgical tools of knife and scalpel, and that it’s the more sophisticated modern devices—such as endoscopes—that really need attention. “They’re a challenge for us,” Lewis said. “And that’s why it’s so important for us to make sure that we get our instructions for use from the manufacturer. Because we can never just guess. We’re not ever going to guess on how we would clean an item, or a camera, or a scope, or anything of that sort. We have to have that information. And we have to be able to do it according to the manufacturer’s instructions because if we don’t, then we’re setting our patients up to fail.”

Jeff Shuren, MD, JD, the director of the FDA’s center for devices and radiological health, said in the press release that “while some reports indicate the potential causes could be inadequate reprocessing or device maintenance issues, we’re also evaluating other possibilities, including device design or the reprocessing instructions in the labeling. Although we believe that the risk of infection is low based on available data, we’re reminding health care providers how important it is to follow the labeling and reprocessing instructions to properly clean and reprocess the devices, including accessory components.”

Linda Spaulding RN, BC, CIC, CHEC, CHOP, a member of ICT®’s Editorial Advisory Board, warned in an interview with ICT® in January that a lot can go wrong in sterile processing. She told of a time when she was working for a hospital accreditation company and inspected hospitals “where they didn’t even track their scopes. They didn’t know what scope was used on what patient or…that a particular scope kept breaking down. And that’s the same one they kept sending out, because their tracking programs just aren’t there.”

There’s a solution though, Spaulding said. The Healthcare Infection Control Practices Advisory Committee (HICPAC), which is under the Centers for Disease Control and Prevention, published a document called “Essential Elements of a Reprocessing Program for Flexible Endoscopes—Recommendations of the Healthcare Infection Control Practices Advisory Committee.”

“Not only does it give you good information related to scopes and processing, but if you don’t have a strong program setup, it gives you everything to put that program in place,” Spaulding said. “It gives you a policy format [and] audit tools. It gives you a competency verification tool so you can make sure your people are competent, [and]…an inventory repair and maintenance log, so you can log every single time a scope breaks and when it goes out.”

The letter the FDA sent to providers today “provides recommendations for reprocessing and using these devices, including following the reprocessing instructions, not using a device that has failed a leak test, developing schedules for routine device inspection and maintenance, and discussing the potential benefits and risks associated with procedures involving reprocessed urological endoscopes with patients,” according to the FDA press release.

The FDA’s concern about contamination of medical devices has grown in recent years. In 2015, the FDA issued instructions about how to properly reprocess duodenoscopes and urges manufacturers to make all or parts of duodenoscopes disposable.