Via the always interesting blog Controversies in Hospital Infection Prevention, Dr Dan Diekema writes: Drug resistant bacteria versus advanced medical technology: No contest. Excerpt:
The duodenoscope implicated now in several deadly outbreaks of carbapenem-resistant Enterobacteriaceae (CRE) is an otherwise terrific device for management of biliary or pancreatic duct disorders. Unfortunately, the same features that allow the scope to guide fine instruments into minuscule spaces also provide sanctuary for bacterial pathogens, protecting them from all standard approaches to disinfection. To quote yesterday’s FDA safety communication:
“…reports associate multidrug-resistant bacterial infections in patients who have undergone ERCP with reprocessed duodenoscopes, even when manufacturer reprocessing instructions are followed correctly. Meticulously cleaning duodenoscopes prior to high-level disinfection should reduce the risk of transmitting infection, but may not entirely eliminate it.”
Translation: you pays your money and you takes your chances.
There aren’t any great options for further reducing the (albeit small) risk for infection transmission from these devices. Some hospitals that have experienced outbreaks have switched to ethylene oxide gas, which is time-consuming and may still fail if organic debris remains in the tiny spaces that are so difficult to clean mechanically. Microbiological surveillance (culturing scopes after disinfection) is time-consuming, costly, and has unknown sensitivity for detection of transmission risk.