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Surveillance of endoscopes : comparison of different sampling techniques

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Abstract
OBJECTIVE: To compare different techniques of endoscope sampling to assess residual bacterial contamination. DESIGN: Diagnostic study. SETTING: The endoscopy unit of an 1,100-bed university hospital performing similar to 13,000 endoscopic procedures annually. METHODS: In total, 4 sampling techniques, combining flushing fluid with or without a commercial endoscope brush, were compared in an endoscope model. Based on these results, sterile physiological saline flushing with or without PULL THRU brush was selected for evaluation on 40 flexible endoscopes by adenosine triphosphate (ATP) measurement and bacterial culture. Acceptance criteria from the French National guideline (<25 colony-forming units [CFU] per endoscope and absence of indicator microorganisms) were used as part of the evaluation. RESULTS: On biofilm-coated PTFE tubes, physiological saline in combination with a PULL THRU brush generated higher mean ATP values (2,579 relative light units [RLU]) compared with saline alone (1,436 RLU; P=.047). In the endoscope samples, culture yield using saline plus the PULL THRU (mean, 43 CFU; range, 1-400 CFU) was significantly higher than that of saline alone (mean, 17 CFU; range, 0-500 CFU; P<.001). In samples obtained using the saline+PULL THRU brush method, ATP values of samples classified as unacceptable were significantly higher than those of samples classified as acceptable (P=.001). CONCLUSION: Physiological saline flushing combined with PULL THRU brush to sample endoscopes generated higher ATP values and increased the yield of microbial surveillance culture. Consequently, the acceptance rate of endoscopes based on a defined CFU limit was significantly lower when the saline+PULL THRU method was used instead of saline alone.
Keywords
FLEXIBLE GASTROINTESTINAL ENDOSCOPES, ADENOSINE-TRIPHOSPHATE, INFECTION, GUIDELINE, BIOFILMS, QUALITY, DISINFECTION, CULTURES

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Chicago
Cattoir, Lien, Thomas Vanzieleghem, Lisa Florin, Tania Helleputte, Martine De Vos, Bruno Verhasselt, Jerina Boelens, and Isabel Leroux-Roels. 2017. “Surveillance of Endoscopes : Comparison of Different Sampling Techniques.” Infection Control and Hospital Epidemiology 38 (9): 1062–1069.
APA
Cattoir, Lien, Vanzieleghem, T., Florin, L., Helleputte, T., De Vos, M., Verhasselt, B., Boelens, J., et al. (2017). Surveillance of endoscopes : comparison of different sampling techniques. INFECTION CONTROL AND HOSPITAL EPIDEMIOLOGY, 38(9), 1062–1069.
Vancouver
1.
Cattoir L, Vanzieleghem T, Florin L, Helleputte T, De Vos M, Verhasselt B, et al. Surveillance of endoscopes : comparison of different sampling techniques. INFECTION CONTROL AND HOSPITAL EPIDEMIOLOGY. 2017;38(9):1062–9.
MLA
Cattoir, Lien, Thomas Vanzieleghem, Lisa Florin, et al. “Surveillance of Endoscopes : Comparison of Different Sampling Techniques.” INFECTION CONTROL AND HOSPITAL EPIDEMIOLOGY 38.9 (2017): 1062–1069. Print.
@article{8551340,
  abstract     = {OBJECTIVE: To compare different techniques of endoscope sampling to assess residual bacterial contamination. 
DESIGN: Diagnostic study. 
SETTING: The endoscopy unit of an 1,100-bed university hospital performing similar to 13,000 endoscopic procedures annually. 
METHODS: In total, 4 sampling techniques, combining flushing fluid with or without a commercial endoscope brush, were compared in an endoscope model. Based on these results, sterile physiological saline flushing with or without PULL THRU brush was selected for evaluation on 40 flexible endoscopes by adenosine triphosphate (ATP) measurement and bacterial culture. Acceptance criteria from the French National guideline (<25 colony-forming units [CFU] per endoscope and absence of indicator microorganisms) were used as part of the evaluation. 
RESULTS: On biofilm-coated PTFE tubes, physiological saline in combination with a PULL THRU brush generated higher mean ATP values (2,579 relative light units [RLU]) compared with saline alone (1,436 RLU; P=.047). In the endoscope samples, culture yield using saline plus the PULL THRU (mean, 43 CFU; range, 1-400 CFU) was significantly higher than that of saline alone (mean, 17 CFU; range, 0-500 CFU; P<.001). In samples obtained using the saline+PULL THRU brush method, ATP values of samples classified as unacceptable were significantly higher than those of samples classified as acceptable (P=.001). 
CONCLUSION: Physiological saline flushing combined with PULL THRU brush to sample endoscopes generated higher ATP values and increased the yield of microbial surveillance culture. Consequently, the acceptance rate of endoscopes based on a defined CFU limit was significantly lower when the saline+PULL THRU method was used instead of saline alone.},
  author       = {Cattoir, Lien and Vanzieleghem, Thomas and Florin, Lisa and Helleputte, Tania and De Vos, Martine and Verhasselt, Bruno and Boelens, Jerina and Leroux-Roels, Isabel},
  issn         = {0899-823X},
  journal      = {INFECTION CONTROL AND HOSPITAL EPIDEMIOLOGY},
  keywords     = {FLEXIBLE GASTROINTESTINAL ENDOSCOPES,ADENOSINE-TRIPHOSPHATE,INFECTION,GUIDELINE,BIOFILMS,QUALITY,DISINFECTION,CULTURES},
  language     = {eng},
  number       = {9},
  pages        = {1062--1069},
  title        = {Surveillance of endoscopes : comparison of different sampling techniques},
  url          = {http://dx.doi.org/10.1017/ice.2017.115},
  volume       = {38},
  year         = {2017},
}

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