WGO Guideline—Endoscope Disinfection Update

T he WGO Guideline “Endoscope Disinfection” is intended for use by health providers and professionals who are involved in the use, cleaning, and maintenance of endoscopes and aims to support national societies, official bodies and individual endoscopy departments in developing local standards and protocols for reprocessing endoscopes. This updated Endoscope Disinfection Guideline addresses the recent outbreaks of multi-drug resistant organisms after endoscopy and proposes measures to reduce the risks of these outbreaks occurring. The recommendations are based on the consensus findings of an international multidisciplinary working group with expertise in microbiology, including biofilms, endoscope reprocessing, nursing, and gastroenterology, and with broad experience in developing national and international reprocessing guidelines.

[1]  Center for Devices and Radiological Health , 2020, Definitions.

[2]  A. Troelstra,et al.  Independent root cause analysis of contributing factors, including dismantling of 2 duodenoscopes, to an outbreak of multidrug-resistant Klebsiella pneumoniae. , 2019, Gastrointestinal endoscopy.

[3]  B. Petersen Other considerations: Perspective and obligations of our societies and governmental organizations , 2019, Techniques in Gastrointestinal Endoscopy.

[4]  M. Bruno,et al.  Endoscope-associated infections: A brief summary of the current state and views toward the future , 2019, Techniques in Gastrointestinal Endoscopy.

[5]  V. Muthusamy,et al.  Endoscope reprocessing: Comparison of drying effectiveness and microbial levels with an automated drying and storage cabinet with forced filtered air and a standard storage cabinet. , 2019, American journal of infection control.

[6]  P. Hoffman,et al.  Transmission of multi-drug resistant Pseudomonas aeruginosa between two flexible ureteroscopes and an outbreak of urinary tract infection: the fragility of endoscope decontamination. , 2019, The Journal of hospital infection.

[7]  L. Dwyer,et al.  What every endoscopist should know about decontamination , 2019, Frontline Gastroenterology.

[8]  Subhas Banerjee,et al.  Comparison of automated and manual drying in the elimination of residual endoscope working channel fluid after reprocessing (with video). , 2019, Gastrointestinal endoscopy.

[9]  K. Vickery,et al.  Determination of bacterial species present in biofilm contaminating the channels of clinical endoscopes , 2018, Infection, Disease & Health.

[10]  V. Muthusamy,et al.  Inspection of endoscope instrument channels after reprocessing using a prototype borescope. , 2018, Gastrointestinal endoscopy.

[11]  D. Hooper,et al.  Transmission of Mobile Colistin Resistance (mcr-1) by Duodenoscope , 2018, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[12]  H. Wetzler,et al.  Residual moisture and waterborne pathogens inside flexible endoscopes: Evidence from a multisite study of endoscope drying effectiveness , 2018, American journal of infection control.

[13]  B. Manns,et al.  Economic evaluations and their use in infection prevention and control: a narrative review , 2018, Antimicrobial Resistance & Infection Control.

[14]  D. Gommers,et al.  VIM-positive Pseudomonas aeruginosa in a large tertiary care hospital: matched case-control studies and a network analysis , 2018, Antimicrobial Resistance & Infection Control.

[15]  A. Ross,et al.  Optimizing duodenoscope reprocessing: rigorous assessment of a culture and quarantine protocol. , 2018, Gastrointestinal endoscopy.

[16]  A. Stewart,et al.  APSIC guidelines for disinfection and sterilization of instruments in health care facilities , 2018, Antimicrobial Resistance & Infection Control.

[17]  C. Deming,et al.  Genomic Analysis of Hospital Plumbing Reveals Diverse Reservoir of Bacterial Plasmids Conferring Carbapenem Resistance , 2018, mBio.

[18]  J. Rey,et al.  Prevention of multidrug-resistant infections from contaminated duodenoscopes: Position Statement of the European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastroenterology Nurses and Associates (ESGENA) , 2017, Endoscopy.

[19]  Roger B. Davis,et al.  Randomized Comparison of 3 High-Level Disinfection and Sterilization Procedures for Duodenoscopes. , 2017, Gastroenterology.

[20]  G. Ramage,et al.  Tolerance of Pseudomonas aeruginosa in in-vitro biofilms to high-level peracetic acid disinfection. , 2017, The Journal of hospital infection.

[21]  Harminder Singh,et al.  A novel polytetrafluoroethylene-channel model, which simulates low levels of culturable bacteria in buildup biofilm after repeated endoscope reprocessing. , 2017, Gastrointestinal endoscopy.

[22]  J. Kovaleva Endoscope drying and its pitfalls. , 2017, The Journal of hospital infection.

[23]  C. Kashork,et al.  A randomized trial of single versus double high-level disinfection of duodenoscopes and linear echoendoscopes using standard automated reprocessing. , 2017, Gastrointestinal endoscopy.

[24]  M. Kochman,et al.  Duodenoscope reprocessing practice patterns in U.S. endoscopy centers: a survey study. , 2017, Gastrointestinal endoscopy.

[25]  B. Petersen,et al.  Multisociety guideline on reprocessing flexible GI endoscopes: 2016 update. , 2017, Gastrointestinal endoscopy.

[26]  H. Tilg,et al.  European consensus conference on faecal microbiota transplantation in clinical practice , 2017, Gut.

[27]  J. Rey,et al.  WEO position statement on hygiene in digestive endoscopy: Focus on endoscopy units in Asia and the Middle East , 2017, Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society.

[28]  Z. Li Consensus of experts on the safe operation of digestive endoscopy centers in China , 2016, Journal of digestive diseases.

[29]  H. Wetzler,et al.  Assessing residual contamination and damage inside flexible endoscopes over time. , 2016, American journal of infection control.

[30]  P. Saliou,et al.  Evaluation of current cleaning and disinfection procedures of GI endoscopes. , 2016, Gastrointestinal endoscopy.

[31]  H. Wetzler,et al.  Simethicone residue remains inside gastrointestinal endoscopes despite reprocessing. , 2016, American journal of infection control.

[32]  G. Grunkemeier,et al.  Surveillance of guideline practices for duodenoscope and linear echoendoscope reprocessing in a large healthcare system. , 2016, Gastrointestinal endoscopy.

[33]  M. Zervos,et al.  Preventing Hospital-acquired Infections in Low-income and Middle-income Countries: Impact, Gaps, and Opportunities. , 2016, Infectious disease clinics of North America.

[34]  H. Wetzler,et al.  Practical toolkit for monitoring endoscope reprocessing effectiveness: Identification of viable bacteria on gastroscopes, colonoscopes, and bronchoscopes. , 2016, American journal of infection control.

[35]  P. Saliou,et al.  Measures to improve microbial quality surveillance of gastrointestinal endoscopes , 2016, Endoscopy.

[36]  M. Alfa Current issues result in a paradigm shift in reprocessing medical and surgical instruments. , 2016, American journal of infection control.

[37]  C. Keevil,et al.  Persistent residual contamination in endoscope channels; a fluorescence epimicroscopy study , 2016, Endoscopy.

[38]  M. Jung,et al.  Hygiene: The Looming Achilles Heel in Endoscopy , 2016, Visceral Medicine.

[39]  B. Petersen Duodenoscope reprocessing: risk and options coming into view. , 2015, Gastrointestinal endoscopy.

[40]  L. Laine,et al.  Update on Fecal Microbiota Transplantation 2015: Indications, Methodologies, Mechanisms, and Outlook. , 2015, Gastroenterology.

[41]  Andreas Voss,et al.  Infectious diseases linked to cross-contamination of flexible endoscopes , 2015, Antimicrobial Resistance and Infection Control.

[42]  A. Loeve,et al.  Withdrawal of a novel-design duodenoscope ends outbreak of a VIM-2-producing Pseudomonas aeruginosa , 2015, Endoscopy.

[43]  B. Wiedenmann,et al.  An outbreak of carbapenem-resistant OXA-48 – producing Klebsiella pneumonia associated to duodenoscopy , 2015, Antimicrobial Resistance and Infection Control.

[44]  Ren-pei Wu,et al.  Correlation between the growth of bacterial biofilm in flexible endoscopes and endoscope reprocessing methods. , 2014, American journal of infection control.

[45]  T. Baron,et al.  Reported gastrointestinal endoscope reprocessing lapses: the tip of the iceberg. , 2013, American journal of infection control.

[46]  C. Roberts The role of biofilms in reprocessing medical devices. , 2013, American journal of infection control.

[47]  G. Thiéfin,et al.  Gastroscopy-associated transmission of extended-spectrum beta-lactamase-producing Pseudomonas aeruginosa. , 2013, The Journal of hospital infection.

[48]  A. Carattoli,et al.  Patient risk factors for outer membrane permeability and KPC-producing carbapenem-resistant Klebsiella pneumoniae isolation: results of a double case–control study , 2013, Infection.

[49]  V. Koo,et al.  Multidrug‐resistant NDM‐1 Klebsiella outbreak and infection control in endoscopic urology , 2012, BJU international.

[50]  R. Briandet,et al.  Resistance of bacterial biofilms to disinfectants: a review , 2011, Biofouling.

[51]  A. Carattoli,et al.  Risk factors and clinical significance of ertapenem-resistant Klebsiella pneumoniae in hospitalised patients. , 2011, The Journal of hospital infection.

[52]  P. Nordmann,et al.  Endoscopy-associated transmission of carbapenem-resistant Klebsiella pneumoniae producing KPC-2 beta-lactamase. , 2010, The Journal of antimicrobial chemotherapy.

[53]  J. Degener,et al.  Is bacteriologic surveillance in endoscope reprocessing stringent enough? , 2009, Endoscopy.

[54]  I. Herrmann,et al.  Risques et dangers cachés de l’endoscopie, conduite à tenir , 2008, Acta Endoscopica.

[55]  N. Chotai,et al.  Pharmaceutical GMP: past, present, and future--a review. , 2008, Die Pharmazie.

[56]  W. Melchers,et al.  Endoscope disinfection and its pitfalls - requirement for retrograde surveillance cultures , 2008, Endoscopy.

[57]  J. Rey,et al.  ESGE-ESGENA guideline for quality assurance in reprocessing: microbiological surveillance testing in endoscopy. , 2007, Endoscopy.

[58]  Warwick Selby,et al.  A prospective study of the efficacy of routine decontamination for gastrointestinal endoscopes and the risk factors for failure. , 2006, American journal of infection control.

[59]  G. Fadda,et al.  Bloodstream Infections Caused by Extended-Spectrum-β-Lactamase-Producing Klebsiella pneumoniae: Risk Factors, Molecular Epidemiology, and Clinical Outcome , 2006, Antimicrobial Agents and Chemotherapy.

[60]  Y. Cossart,et al.  Is biofilm accumulation on endoscope tubing a contributor to the failure of cleaning and decontamination? , 2004, The Journal of hospital infection.

[61]  Yang K. Chen,et al.  High-level disinfection of gastrointestinal endoscopes: are current guidelines adequate? , 1999, American Journal of Gastroenterology.

[62]  Fred Silverstein,et al.  Transmission of Infection by Gastrointestinal Endoscopy and Bronchoscopy , 1993, Annals of Internal Medicine.

[63]  A. Detsky,et al.  Evidence-based medicine. A new approach to teaching the practice of medicine. , 1992, JAMA.

[64]  M. Alfa,et al.  In-hospital evaluation of contamination of duodenoscopes: a quantitative assessment of the effect of drying. , 1991, The Journal of hospital infection.

[65]  Allen Caldwell,et al.  Panel , 1991, 2021 IEEE International Conference on Pervasive Computing and Communications (PerCom).

[66]  Leslie E. Mueller,et al.  Potential economic burden of carbapenem-resistant Enterobacteriaceae (CRE) in the United States. , 2017, Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases.

[67]  R. Bleichrodt,et al.  Surgery and Obstetric Care are Highly Cost-Effective Interventions in a Sub-Saharan African District Hospital: A Three-Month Single-Institution Study of Surgical Costs and Outcomes , 2015, World Journal of Surgery.

[68]  J. A. Salkeld,et al.  Surface-attached cells, biofilms and biocide susceptibility: implications for hospital cleaning and disinfection. , 2015, The Journal of hospital infection.

[69]  Staðlaráð Íslands,et al.  Gæðastjórnunarkerfi : grunnatriði og íðorðasafn = Quality Management Systems : fundamentals and vocabulary. , 2006 .

[70]  R. F. S. C. G. J. D. N. C. Worsham,et al.  Bronchoscopy-related infections and pseudoinfections--New York, 1996 and 1998. , 1999, MMWR. Morbidity and mortality weekly report.

[71]  A. Troelstra,et al.  Independent root-cause analysis of contributing factors, including dismantling of 2 duodenoscopes, to investigate an outbreak of multidrug-resistant Klebsiella pneumoniae , 2022 .