Investigation into GI scope-related infections changes national guidelines

The research and updated disinfection technique will be shared Saturday in Philadelphia at ID Week 2014, an annual meeting of health professionals in infectious disease fields.

"Patient safety is our top priority," said senior author Carlene Muto, M.D., M.S., director of infection prevention at UPMC Presbyterian Hospital. "We are confident that the change from disinfection to sterilization of GI scopes is necessary in preventing serious infections and we are glad to share our findings with hospitals nationwide."

After tracking and monitoring an uptick in antibiotic-resistant infections in 2012 in patients who had undergone an Endoscopic Retrograde Cholangiopancreatography (ERCP) procedure with flexible endoscopy scopes, UPMC began investigating the devices, which are equipped with an "elevator channel" used to deflect accessories passed through the biopsy channel and assist clinicians in examining a patient's gastrointestinal tract. The elevator channel is most commonly found on ERCP and endoscopic ultrasound scopes.

UPMC took the scopes out of service, notified the manufacturer and began an investigation into the disinfecting process that takes place between each use. When it was ultimately determined that the normal process failed to eliminate all bacteria, UPMC switched to gas sterilization using ethylene oxide to ensure proper disinfection of the scopes.

"Throughout UPMC, no additional health care-associated infections have been linked to scopes since switching to sterilization," said Dr. Muto.

The move from high-level disinfection of endoscopes to sterilization of them was foreshadowed earlier this year at the Association for Professionals in Infection Control and Epidemiology annual conference in Anaheim, Calif., by Bill Rutala, Ph.D., M.P.H., author of the Centers for Disease Control and Prevention Guideline for Disinfection and Sterilization in Healthcare Facilities. He said he believed the transition would take place in the next five years.

Approximately 11 million gastrointestinal endoscopies are performed annually in the U.S. and contaminated scopes have been linked to more hospital-acquired infections than any other type of medical device.