News of patient deaths caused by outbreaks of carbapenem-resistant Enterobacteriaceae (CRE) infections is fueling media attention and putting the healthcare community on high alert regarding appropriate disinfection practices for duodenoscopes. The hard-to-clean scopes are used to diagnose and treat a variety of conditions of the gall bladder and pancreas with Endoscopic Retrograde Cholangiopancreatography (ERCP) procedures.
ECRI Institute, a nonprofit that researches the best approaches to improving patient care, has issued a High Priority Hazard Report with recommendations to help reduce the risk of ERCP endoscope-related patient infections. Scope culturing is a key step in reducing the risk of CRE infections, according to the report. The Hazard Report is free to the healthcare professional community at www.ecri.org/CRE.
“Our recommendations call for timely action and executive level attention,” says Jeffrey C. Lerner, PhD, president and chief executive officer, ECRI Institute. “They will likely require additional costs and changes in workflow and processes.”
The report details ECRI’s recommendations on baseline and surveillance culturing. It recommends that hospitals consider instituting regular CRE surveillance through duodenoscope culturing regardless of which reprocessing method they use (e.g., high-level disinfection using a liquid chemical germicide or sterilization using ethylene oxide). Implementing surveillance culturing properly will not be trivial, but will provide a means to monitor duodenoscopes for CRE, say ECRI’s experts.
“Minimizing the risk of infections associated with ERCP scopes is extremely difficult and it will take multiple approaches to reduce the likelihood of contamination,” says James P. Keller, MS, vice president of health technology evaluation and safety, ECRI Institute.
ECRI’s new recommendations build upon the organization’s decades of experience investigating a variety of endoscope-related infections. The Hazard Report was developed by an ECRI Institute team of physicians, clinical specialists, infection control practitioners, biomedical engineers, and others who intensively researched and reviewed the best approaches to address this issue. Problems with reprocessing of endoscopes has appeared on ECRI Institute’s annual Top 10 Health Technology Hazards list for the past six years. It is number four on the 2015 list.
“We believe that despite their infection risks, ERCP endoscopy procedures are vital and discontinuing them because of this risk would be more harmful to patients,” says Lerner.
ECRI Institute continues to investigate this problem and will update its guidance and recommendations as new information becomes available. The Hazard Report and other technology management, patient safety, and risk management guidance articles and recommendations are publicly available in ECRI Institute’s new CRE and Duodenoscope Resource Center, located at www.ecri.org/CRE.
Source: ECRI Institute