Whatshouldbedonetoensurethesafetyofthesecommonlyuseddevices?Theenforcementofbestpracticesincludingequipmentmaintenance and routine auditswith at least yearly competencytesting of staff who use the reprocessing equipment isimperative.Butif adherence toregulation is lax,more outbreakswill likely occur. Obtaining additional information on the frequencyandlevelofmicrobialcontamination ofendoscopesthathave been cleaned and high-level disinfectedwith strict adherenceto current guidelineswill be helpful in defining the extentof the problem.Ifendoscopesarefoundtobecontaminatedwithpotentialpathogens (eg,enteric gram-negative bacilli), the clinicaleffects of such contamination need to be quantified.In addition, better approaches to assess the effectivenessof cleaning and high-level disinfection are needed. Althoughmicrobiological cultures are the gold standard, they cannot beused as a real-time monitoring process.However, based on thestudy by Epstein et al, itwould be reasonable to perform periodicmicrobiologicalsurveillance of duodenoscopes to assessmicrobial contamination, although many questions remain.These include the following: (1)What cutoff should be used todefine proper disinfection (eg, 0 pathogens or a higher number,such as <10 colony-forming units of enteric pathogens perchannel)? (2) What sampling scheme should be used to evaluategastrointestinal endoscopes (eg, all or a sample of endoscopes)?(3) Is the trigger for further action based on the levelor the frequency of contamination (ie, percent of endoscopescontaminated)? (4) What actions should an endoscopy unitundertake if a positive trigger is reached based upon the levelor frequency of contamination (ie, patient notificationwith anoffer of blood-borne pathogen testing, ethylene oxide sterilizationof positive endoscopes, or ethylene oxide sterilizationof all endoscopes)? Real-time monitoring methods need to bedeveloped and validated to assess the risk of infection.
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