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Review
. 2017 Nov;49(11):1098-1106.
doi: 10.1055/s-0043-120523. Epub 2017 Oct 16.

Prevention of Multidrug-Resistant Infections From Contaminated Duodenoscopes: Position Statement of the European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastroenterology Nurses and Associates (ESGENA)

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Prevention of Multidrug-Resistant Infections From Contaminated Duodenoscopes: Position Statement of the European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastroenterology Nurses and Associates (ESGENA)

Ulrike Beilenhoff et al. Endoscopy. .
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Abstract

Patients should be informed about the benefits and risks of endoscopic retrograde cholangiopancreatography (ERCP)Only specially trained and competent personnel should carry out endoscope reprocessing.Manufacturers of duodenoscopes should provide detailed instructions on how to use and reprocess their equipment.In the case of modifications to their equipment, manufacturers should provide updated instructions for use.Detailed reprocessing protocols based on the manufacturer's instructions for use should clearly lay out the different reprocessing steps necessary for each endoscope model.Appropriate cleaning equipment should be used for duodenoscopes in compliance with the manufacturer's instructions for use. Only purpose-designed, endoscope type-specific, single-use cleaning brushes should be used, to ensure optimal cleaning. As soon as the endoscope is withdrawn from the patient, bedside cleaning should be performed, followed by leak testing, thorough manual cleaning steps, and automated reprocessing, in order to: · Remove debris from external and internal surfaces;. · Prevent any drying of body fluids, blood, or debris;. · Prevent any formation of biofilms.. In addition to the leak test, visual inspection of the distal end as well as regular maintenance of duodenoscopes should be performed according to the manufacturer's instructions for use, in order to detect any damage at an early stage.The entire reprocessing procedure in endoscope washer-disinfectors (EWDs) should be validated according to the European and International Standard, EN ISO 15883. Routine technical tests of EWDs should be performed according to the validation reports.Microbiological surveillance of a proportion of the department's endoscopes should be performed every 3 months, with the requirement that all endoscopes used in the unit are tested at least once a year.In the case of suspected endoscopy-related infection, the relevant device (e. g., endoscope, EWD) should be taken out of service until adequate corrective actions have been taken. Outbreaks should be managed by a multidisciplinary team, including endoscopy, hygiene, and microbiology experts, manufacturers, and regulatory bodies, according to national standards and/or laws. In the case of suspected multidrug-resistant organism (MDRO) outbreaks, close cooperation between the endoscopy unit and the clinical health provider is essential (including infection control departments and hospital hygienists).

Conflict of interest statement

Competing interests: U. Beilenhoff has provided consultancy to Boston Scientific since July 2017. H. Biering has done customer presentations and trainings, moderated workshops, and provided consultancy to Richard Wolf GmbH, Olympus Europa, Dr. Weigert, and Ecolab. Reinhard Blum is employed by Olympus Europa, who hold patents on endoscopes in general; he is a member of the DIN/CEN/ISO TC/198/WG13 standards group for safe reprocessing of endoscopes. M. Cimbro has been employed by CBC Europe since 2002; she has been a consultant since 2011 to ANOTE-ANIGEA (Italian Association of Gastroenterology and Endoscopy Nurses). M. Jung's hospital has received sponsorship from Olympus Optical and other companies for an EUS/endoscopy course (22nd September 2017). M. Pietsch's department has received third-party funding from Olympus for a research project, from 2015 to 2017. L. Pineau has provided training on hygiene and medical device evaluation for Pentax, Olympus, and Fujifilm, from 1999 to 2017. T. Ponchon has served on an Advisory board for Fujifilm (January 2015 to October 2017). J. Brljak, J.-M. Dumonceau, C. Hassan, C. Neumann, S. Rejchrt, J.-F. Rey, V. Schmidt, J. Tillett, and J. van Hooft have no competing interests.

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