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Double high-level disinfection, sterilization do not eliminate positive duodenoscope cultures

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SAN ANTONIO — Reprocessing duodenoscopes with double high-level disinfection and liquid chemical sterilization helped produce lower rates of positive cultures from the scopes, but was not able to eliminate them entirely, according to study results presented at the American College of Gastroenterology Annual Meeting.

Mark A. Gromski, MD, from the Indiana University School of Medicine, said the design of current duodenoscopes brings an inherent potential for transmission of pathogenic organisms. Double high-level disinfection (DHLD) and liquid chemical sterilization have been suggested as two potential measures to better preprocess duodenoscopes.

“This is a prospective, randomized study evaluating reprocessing with either double-high level disinfection, in our case using the Medivator system, or liquid chemical sterilization, in our case using the Steris 1E platform,” Gromski said in his presentation.

Between October 2017 and September 2018, researchers took all of their operable duodenoscopes and segregated them for reprocessing by either DHLD or sterilization. They randomly cultured the scopes after processing based on internal protocol.

Of 878 total surveillance cultures, 453 came from the DHLD group and 425 came from the sterilization group. Investigators identified 17 positive cultures (1.9%). There was no significant difference of positive cultures between the DHLD and sterilization groups (1.8% vs. 2.1%).

Of those positive cultures, Gromski said each group had two that grew “high-concern” organisms. In the DHLD group it was Klebsiella pneumoniae and Enterobacter cloacae, and in the sterilization group it was Streptococcus viridans and Enterococcus spp. However, researchers did not detect any multi-drug resistant organisms.

Gromski said their findings showed that both of these reprocessing techniques produce low rates of positive cultures and pathogenic organism growth.

“There was no difference in the rate of growth of surveillance cultures between these two strategies,” Gromski said. “Nevertheless, despite the lower rates of positive cultures, neither reprocessing strategy entirely eliminated the growth of high-concern organisms.” – by Alex Young

Reference:

Gromski MA, et al. Abstract 10. Presented at: American College of Gastroenterology Annual Meeting; Oct. 25-30, 2019; San Antonio.

Disclosure s: The authors report no relevant financial disclosures.