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An update on gastrointestinal endoscopy-associated infections and their contributing factors

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      Abstract

      Introduction

      During clinical use, gastrointestinal endoscopes are grossly contaminated with patient’s native flora. These endoscopes undergo reprocessing to prevent infectious transmission upon future use. Endoscopy-associated infections and outbreaks have been reported, with a recent focus on the transmission of multi-drug resistant organisms. This review aims to provide an update on endoscopy-associated infections, and the factors contributing to their occurrence.

      Methods

      PubMed, ScienceDirect, and CINAHL were searched for articles describing gastrointestinal endoscopy-associated infections and outbreaks published from 2008 to 2018. Factors contributing to their occurrence, and the outcomes of each outbreak were also examined.

      Results

      This review found 18 articles, 16 of which described duodenoscope-associated infections, and the remaining two described colonoscope- and gastroscope-associated infection respectively. Outbreaks were reported from the United States, France, China, Germany, the Netherlands and the United Kingdom. The causative organisms reported were Klebsiella pneumoniae, Pseudomonas aeruginosa, Escherichia coli and Salmonella enteritidis.

      Conclusions

      A number of factors, including lapses in reprocessing, biofilm formation, endoscope design issues and endoscope damage, contribute to gastrointestinal endoscopy associated infection. Methods of improving endoscope reprocessing, screening for contamination and evaluating endoscope damage may be vital to preventing future infections and outbreaks.

      Related collections

      Most cited references 43

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      New Delhi metallo-β-lactamase-producing carbapenem-resistant Escherichia coli associated with exposure to duodenoscopes.

      Carbapenem-resistant Enterobacteriaceae (CRE) producing the New Delhi metallo-β-lactamase (NDM) are rare in the United States, but have the potential to add to the increasing CRE burden. Previous NDM-producing CRE clusters have been attributed to person-to-person transmission in health care facilities.
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        Multisociety guideline on reprocessing flexible gastrointestinal endoscopes: 2011.

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          Disinfection and sterilization: an overview.

          All invasive procedures involve contact by a medical device or surgical instrument with a patient's sterile tissue or mucous membranes. The level of disinfection or sterilization is dependent on the intended use of the object: critical (items that contact sterile tissue such as surgical instruments), semicritical (items that contact mucous membrane such as endoscopes), and noncritical (devices that contact only intact skin such as stethoscopes) items require sterilization, high-level disinfection, and low-level disinfection, respectively. Cleaning must always precede high-level disinfection and sterilization. Copyright © 2013 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.
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            Author and article information

            Affiliations
            [1 ]GRID grid.429098.e, Ingham Institute for Applied Medical Research, ; 1 Campbell Street, Sydney, NSW 2560 Australia
            [2 ]ISNI 0000 0000 9939 5719, GRID grid.1029.a, Western Sydney University, School of Medicine, ; Sydney, 2560 Australia
            [3 ]ISNI 0000 0004 0527 9653, GRID grid.415994.4, Department of Gastroenterology and Hepatology, , Liverpool Hospital, ; Sydney, 2170 Australia
            [4 ]ISNI 0000 0004 4902 0432, GRID grid.1005.4, School of Medicine, , University of New South Wales, ; Sydney, 2033 Australia
            Contributors
            (+614) 99 777 181 , c.mccafferty@westernsydney.edu.au
            marra.aghajani1@gmail.com
            dr.david@abi-hanna.com
            i.gosbell@westernsydney.edu.au
            s.jensen@westernsydney.edu.au
            Journal
            Ann Clin Microbiol Antimicrob
            Ann. Clin. Microbiol. Antimicrob
            Annals of Clinical Microbiology and Antimicrobials
            BioMed Central (London )
            1476-0711
            10 October 2018
            10 October 2018
            2018
            : 17
            30314500
            6182826
            289
            10.1186/s12941-018-0289-2
            © The Author(s) 2018

            Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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            Review
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            © The Author(s) 2018

            Infectious disease & Microbiology

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