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      Evaluation of an overnight non-culture test for detection of viable Gram-negative bacteria in endoscope channels

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          Background and study aims  Prevention of infection transmission from contaminated endoscopes would benefit from a rapid test that could detect low levels of viable bacteria after high level disinfection. The aim of this study was to evaluate the rapid NOW! (RN) test’s ability to detect endoscope contamination.

          Materials and methods  The RN test kit and the accompanying fluorometer were evaluated. The manufacturer states that a fluorometer signal > 300 units is indicative of viable Gram-negative bacteria. Suspension testing of varying concentrations of Escherichia coli, Pseudomonas aeruginosa and Enterococcus faecalis were used to determine the RN test limit of detection. Simulated-use testing was done using a duodenoscope inoculated with 10 % blood containing approximately 35 CFU E. coli per channel. Samples were extracted from the duodenoscope instrument channel and tested using the manufacturer’s instructions.

          Results  The RN test could consistently detect 10 CFU of E. coli and P. aeruginosa (fluorescent signal of 9,000 to 11,000 units) but not E. faecalis. Sensitivity and specificity for Gram-negative bacteria were 93 % and 90 %, respectively, using all of the suspensions in the study. Extraction of E. coli from an inoculated duodenoscope instrument channel repeatedly provided a positive signal (i. e. > 2,000 units).

          Conclusions  The RN test can reliably detect low levels of Gram-negative bacteria in suspension as well as from samples extracted from endoscope channels. These preliminary findings are encouraging but further assessment of extraction efficacy, impact of organic residuals and clinical workflow are still needed.

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          Most cited references 28

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          Transmission of infection by flexible gastrointestinal endoscopy and bronchoscopy.

          Flexible endoscopy is a widely used diagnostic and therapeutic procedure. Contaminated endoscopes are the medical devices frequently associated with outbreaks of health care-associated infections. Accurate reprocessing of flexible endoscopes involves cleaning and high-level disinfection followed by rinsing and drying before storage. Most contemporary flexible endoscopes cannot be heat sterilized and are designed with multiple channels, which are difficult to clean and disinfect. The ability of bacteria to form biofilms on the inner channel surfaces can contribute to failure of the decontamination process. Implementation of microbiological surveillance of endoscope reprocessing is appropriate to detect early colonization and biofilm formation in the endoscope and to prevent contamination and infection in patients after endoscopic procedures. This review presents an overview of the infections and cross-contaminations related to flexible gastrointestinal endoscopy and bronchoscopy and illustrates the impact of biofilm on endoscope reprocessing and postendoscopic infection.
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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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              ESGE-ESGENA guideline for quality assurance in reprocessing: microbiological surveillance testing in endoscopy.

               ,  R R Blum,  Bernhard Schmidt (2007)

                Author and article information

                Endosc Int Open
                Endosc Int Open
                Endoscopy International Open
                © Georg Thieme Verlag KG (Stuttgart · New York )
                February 2019
                30 January 2019
                : 7
                : 2
                : E268-E273
                [1 ]Dept of Internal Medicine, University of Manitoba, Winnipeg MB, Canada
                [2 ]Winnipeg Regional Health Authority, Winnipeg MB, Canada
                [3 ]St. Boniface Hospital, Winnipeg MB, Canada
                [4 ]St. Boniface Research Centre, Winnipeg, MB, Canada
                [5 ]Dept of Medical Microbiology, University of Manitoba, Winnipeg, MB, Canada
                Author notes
                Corresponding author Dr. Michelle Alfa, Ph.D., FCCM, Professor Dept of Medical MicrobiologyUniversity of ManitobaWinnipeg, MBCANADA R3E 0J9+1-204-789-3926 michellealfa001@

                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.

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