Abstract

Anesthesiologists provide anesthesia for numerous endoscopy procedures. They also perform bronchoscopy and other endoscopies. There are recent developments in mitigating endoscopy-associated infections.

Carbapenem-resistant Enterobacteriaceae (CRE) infections, which are resistant to multiple antibiotics, have been traced to duodenal endoscopy, cystoscopy, and ureteroscopy (Am J Infect Control 2016;44:1032-6). These cases had all followed standard disinfection protocols. The outbreaks were traced to difficulty sterilizing complex shapes or materials, such as the hinge of side-viewing duodenoscopes.

As a result of these outbreaks, new sterilization standards have been published by the American National Standards Institute (ANSI)/Association for the Advancement of Medical Instrumentation (AAMI) (ANSI/AAMI ST91:2021; asamonitor.pub/3DEYQnI). Additionally, the FDA and the CDC published new surveillance antimicrobial surveillance guidelines (asamonitor.pub/3Qgqiwq).

The FDA recommends transitioning to fully disposable duodenoscopes (Clin Gastroenterol Hepatol 2020;18:2108-2117) or using endoscopes with disposable components.

Why it matters

This guidance includes developing schedules for routine inspection and periodic maintenance, and steps to transition toward newer models of duodenoscopes with disposable components or those that are fully disposable. The FDA recommends developing a quality control program that includes sampling, microbiological culturing, and other monitoring methods.