Risk of Flexible Endoscopes, Including Gastroscopes and Echoendoscopes, Transmitting “Superbugs” Infections: An Important Update


The infection prevention and healthcare epidemiology community has continued to sound the alarm about outbreaks of CRE infections related to therapeutic gastrointestinal endoscopy cases in which contaminated and improperly reprocessed duodenoscopes and echoendoscopes were used during clinical procedures.

“Superbug” infections linked to newer models of duodenoscopes featuring a sealed channel design were first recognized in 2012. This article provides a review of the published medical literature and of the FDA’s medical-device database to evaluate the potential for other types of flexible endoscopes to transmit multidrug-resistant bacteria, including carbapenem-resistant Enterobacteriaceae, or CRE. Several cases document the contamination of bronchoscopes, cystoscopes, curvilinear-array echoendoscopes, flexible laryngoscopes, gastroscopes and ureteroscopes with concerning bacteria, and in some cases these devices were linked to superbug infections or outbreaks. Public notices focusing on the potential for these other types of flexible endoscopes, too, to transmit superbugs are few, however, suggesting that these devices may pose an under-recognized risk of multidrug-resistant bacterial infections. Recommendations for preventing these devices from infecting patients with potentially untreatable bacteria are provided, including that users consider applying at least one enhanced practice, previously recommended by the FDA to mitigate the risk of duodenoscopes transmitting superbugs, to these other types of flexible endoscopes, as deemed appropriate, feasible and warranted, particularly to curvilinear-array echoendoscopes, which like duodenoscopes feature a forceps elevator mechanism. Efforts to increase public awareness about the potential for these devices to infect patients with superbugs is recommended.

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Ruhof is an innovator and leading manufacturer world renowned for offering reliable solutions and individualized service to help you meet and exceed your decontamination and materials management challenges. As the pioneer in instrument and scope care, Ruhof introduced the first enzymatic detergent to the market in 1976. Since then we have dedicated ourselves to research, development and manufacturing state-of-the-art products to ensure the complete cleaning and reprocessing of all surgical instruments and scopes. As a global leader in our ISO certified facilities, a certification that we meet and exceed worldwide standards of quality assurance in production and customer service, Ruhof brand products also bear the CE mark, which guarantees that our products comply with the European Medical Devices Directive 93-742-EEC. www.ruhof.com

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