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      Accreditation program for gastrointestinal endoscopes reprocessing in Italy: An on-site survey

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          Abstract

          Background and study aims  Endoscope reprocessing has been associated with a variable failure rate. Our aim was to present an overview on current practices for reprocessing in Italian facilities and discuss the principle critical points.

          Methods  In 2014 the Italian Society for Digestive Diseases implemented an accreditation program in collaboration with an independent organization for certification and with the Italian Association for Endoscopy Technical Operators. During a 1-day site visit of the endoscopy center, two endoscopists, one nurse, and the representative of the certification body evaluated the endoscope reprocessing.

          Results  As of July 1, 2020, 28 endoscopy centers had been accredited. Ten centers are completing the measures to correct deficiencies found at the visit. Three centers withdrew from the program. The accreditation program has found variations between the various centers, confirming the poor compliance with guidelines. Major deviations from the standards, established by the model before the site visit according to national and international guidelines, concerned instrument cleaning (44.7 % of the centers), instrument storage (23.7 %), and microbiological tests (31.6 %).

          Conclusions  Our overview demonstrated the lack of many reprocessing phases, which are important to prevent endoscopy-associated infections. Accreditation can achieve a transformation in quality and safety of reprocessing with the Italian centrally-led approach.

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          Most cited references24

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          Reprocessing of flexible endoscopes and endoscopic accessories used in gastrointestinal endoscopy: Position Statement of the European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastroenterology Nurses and Associates (ESGENA) – Update 2018

          This Position Statement from the European Society of Gastrointestinal Endoscopy (ESGE) and the European Society of Gastroenterology Nurses and Associates (ESGENA) sets standards for the reprocessing of flexible endoscopes and endoscopic devices used in gastroenterology. An expert working group of gastroenterologists, endoscopy nurses, chemists, microbiologists, and industry representatives provides updated recommendations on all aspects of reprocessing in order to maintain hygiene and infection control.
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            Multisociety guideline on reprocessing flexible GI endoscopes: 2016 update

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              Multidrug-resistant Klebsiella pneumoniae outbreak after endoscopic retrograde cholangiopancreatography.

              Infection is a recognized complication of endoscopic retrograde cholangiopancreatography (ERCP). We describe the epidemiologic and molecular investigations of an outbreak of ERCP-related severe nosocomial infection due to KLEBSIELLA PNEUMONIAE producing extended-spectrum beta-lactamase (ESBL). We conducted epidemiologic and molecular investigations to identify the source of the outbreak in patients undergoing ERCP. We carried out reviews of the medical and endoscopic charts and microbiological data, practice audits, surveillance cultures of duodenoscopes and environmental sites, and molecular typing of clinical and environmental isolates. Between December 2008 and August 2009, 16 patients were identified post-ERCP with KLEBSIELLA PNEUMONIAE that produced extended-spectrum beta-lactamase type CTX-M-15. There were 8 bloodstream infections, 4 biliary tract infections, and 4 cases of fecal carriage. The microorganism was isolated only from patients who had undergone ERCP. Environmental investigations found no contamination of the washer-disinfectors or the surfaces of the endoscopy rooms. Routine surveillance cultures of endoscopes were repeatedly negative during the outbreak but the epidemic strain was finally isolated from one duodenoscope by flushing and brushing the channels. Molecular typing confirmed the identity of the clinical and environmental strains. Practice audits showed that manual cleaning and drying before storage were insufficient. Strict adherence to reprocessing procedures ended the outbreak. The endoscopes used for ERCP can act as a reservoir for the emerging ESBL-producing K. PNEUMONIAE. Regular audits to ensure rigorous application of cleaning, high-level disinfection, and drying steps are crucial to avoid contamination. © Georg Thieme Verlag KG Stuttgart · New York.
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                Author and article information

                Journal
                Endosc Int Open
                Endosc Int Open
                10.1055/s-00025476
                Endoscopy International Open
                Georg Thieme Verlag KG (Rüdigerstraße 14, 70469 Stuttgart, Germany )
                2364-3722
                2196-9736
                November 2021
                12 November 2021
                1 November 2021
                : 9
                : 11
                : E1627-E1632
                Affiliations
                [1 ]Gasastroenterology and Endoscopy Department, Valduce Hospital, Como – Italy
                [2 ]Gastroenterology and Endoscopy Department, Chieti University, Chieti – Italy
                [3 ]Gastroenterology and Endoscopy Department, Pordenone Hospital, Pordenone – Italy
                [4 ]Gastroenterology and Endoscopy Department, Pistoia Hospital, Pistoia – Italy
                [5 ]Gastroenterology and Endoscopy Department, Firenze Hospital, Firenze – Italy
                [6 ]Gastroenterology and Endoscopy Department, Ferrara Hospital, Ferrara – Italy
                [7 ]Gastroenterology and Endoscopy Department, Perugia Hospital, Perugia – Italy
                [8 ]Gastroenterology and Endoscopy Department, Bologna University, Bologna – Italy
                [9 ]Kiwa-Cermet Statistical Department, Bologna-Italy
                Author notes
                Corresponding author Giancarlo Spinzi, MD Valduce Hospital Via Dante 1122100 ComoItaly+39031308047 gispinz@ 123456tin.it
                Article
                10.1055/a-1535-1238
                8589566
                6add8f0e-8829-4934-8351-9610fe75b927
                The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

                This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License, which permits unrestricted reproduction and distribution, for non-commercial purposes only; and use and reproduction, but not distribution, of adapted material for non-commercial purposes only, provided the original work is properly cited.

                History
                : 26 December 2020
                : 10 June 2021
                Categories
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