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Inspections reveal bacterial growth on reprocessed ureteroscopes
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Researchers detected bacterial growth on reprocessed flexible ureteroscopes days after the devices were sterilized, underscoring the need to actively monitor reprocessing outcomes, according to data presented at the Association for Professionals in Infection Control and Epidemiology annual conference.
The findings are the latest to demonstrate potential flaws with endoscopic cleaning procedures. According to a press release, multiple outbreaks have been linked to contaminated duodenoscopes, gastroscopes, bronchoscopes and cystoscopes.
“APIC is concerned that the techniques used in the field are insufficient, and that current methods in place are introducing more contamination with the reprocessing of each scope,” 2017 APIC President Linda Greene, RN, MPS, CIC, FAPIC, said in the release. “The results of this study are concerning and should prompt hospitals to ensure that proper cleaning verification and visual inspections are being performed.”
For the study, conducted by Ofstead & Associates, Inc., researchers sampled 16 sterilized ureteroscopes, which are commonly used to look for and remove kidney stones from a patient’s urinary tract. Because there are currently no reprocessing benchmarks indicating permissible levels of contamination for ureteroscopes, the researchers used published benchmarks for gastrointestinal endoscopes to assess the efficacy of sterilization techniques, even though the level of contamination on ureteroscopes should be much lower than the amount allowed for gastrointestinal endoscopes, the release said.
Cori Ofstead, MSPH, lead researcher and president and CEO of Ofstead & Associates, and colleagues reported at the conference that all 16 ureteroscopes exceeded benchmarks for clean endoscopes despite undergoing sterilization with hydrogen peroxide gas. They found that every scope exceeded the 6.4 g/mL protein benchmark (range, 9 g/mL to 32 g/mL). In addition, hemoglobin was identified on 63% of the devices, and 44% had higher levels of adenosine triphosphate than expected, according to the release. The researchers also tested two new, unused devices and observed an increase in hemoglobin and protein levels after initial reprocessing.
Further investigations revealed microbial growth on two ureteroscopes on day 3 (Micrococcus luteus) and day 4 (Corynebacterium glaucum). Through visual inspections, Ofstead and colleagues identified debris protruding from channels, oily deposits, white lint and foamy residue.
According to the researchers, suboptimal reprocessing and surface damage may have contributed to contamination.
“Sterilization failures were unexpected and are deeply concerning,” Ofstead said in the release. “Every scope should be inspected, every time — and there must be accountability measures set in place.
“Additional evidence is needed so the guideline-issuing bodies can make informed decisions about what standards to set in place.”
Reference:
Ofstead C, et al. Evaluation of reprocessing effectiveness for flexible ureteroscopes . Presented at: Association for Professionals in Infection Control and Epidemiology Annual Conference; June 14-16, 2017; Portland, Oregon.
Disclosure: Ofstead is president and CEO of Ofstead & Associates.