Whatshouldbedonetoensurethesafetyofthesecommonly
useddevices?Theenforcementofbestpracticesincludingequipment
maintenance and routine auditswith at least yearly competency
testing of staff who use the reprocessing equipment is
imperative.Butif adherence toregulation is lax,more outbreaks
will likely occur. Obtaining additional information on the frequencyandlevel
ofmicrobialcontamination ofendoscopesthat
have been cleaned and high-level disinfectedwith strict adherence
to current guidelineswill be helpful in defining the extent
of the problem.Ifendoscopesarefoundtobecontaminatedwith
potentialpathogens (eg,enteric gram-negative bacilli), the clinical
effects of such contamination need to be quantified.
In addition, better approaches to assess the effectiveness
of cleaning and high-level disinfection are needed. Although
microbiological cultures are the gold standard, they cannot be
used as a real-time monitoring process.However, based on the
study by Epstein et al, itwould be reasonable to perform periodicmicrobiological
surveillance of duodenoscopes to assess
microbial contamination, although many questions remain.
These include the following: (1)What cutoff should be used to
define proper disinfection (eg, 0 pathogens or a higher number,
such as