Disclosures: Gromski reports serving as a consultant for Boston Scientific. Please see the full study for all other authors’ relevant financial disclosures.
August 04, 2020
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Double disinfection, liquid sterilization both produce low culture rate for duodenoscopes

Disclosures: Gromski reports serving as a consultant for Boston Scientific. Please see the full study for all other authors’ relevant financial disclosures.
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Double high-level disinfection and liquid chemical sterilization of duodenoscopes both produced low rates of positives cultures, according to the results of a randomized trial.

Mark Andrew Gromski, MD, of the division of gastroenterology and hepatology at Indiana University School of Medicine, and colleagues wrote that liquid chemical sterilization (LCS) has been seen as a potential alternative to traditional disinfection that could be easier on sensitive equipment like duodenoscopes.

“Although unknown, there are suggestions that LCS may lead to less wear on endoscopes than standard sterilization procedures (ie, ethylene oxide sterilization),” they wrote. “Presently, there are no prospective studies comparing LCS with double high-level disinfection (DHLD) for duodenoscope reprocessing.”

Researchers compared the efficacy of LCS and DHLD in a prospective, randomized trial. Between October 2017, and September 2018, they randomly assigned duodenoscopes to be reprocessed by either modality, and randomly cultured scopes after reprocessing for surveillance based on an internal protocol.

Of 878 postreprocessing cultures (DLHD n = 453; LCS n = 425), 17 tested positive for any organism (1.9%). There was no difference in positive cultures between the DHLD or LCS groups (1.8% vs. 2.1%). Each group had two cultures that grew high-concern organisms.

During the course of the study, investigators did not detect any multi-drug resistant organisms.

Despite the FDA-guided move toward duodenoscopes with disposable components, Gromski and colleagues suggested that finding better ways to reprocess scopes will remain an important area of study.

“These new devices have many variables including price, availability and performance that are unknown,” they wrote. “New developments in reusable scope reprocessing and sterilization are warranted. Optimally reprocessing reusable duodenoscopes will likely continue to be a necessity and priority for the foreseeable future. Based on our study, we do not endorse any comparative advantage of either (DHLD or LCS) enhanced reprocessing strategy over the other.”