Properly sterilizing scopes still a challenge, experts say
Maybe you're getting a gallstone removed or maybe your doctor says there's a new way to remove a painful kidney stone. There's a medical device to pluck them out,
Properly sterilizing scopes still a challenge, experts say
Maybe you're getting a gallstone removed or maybe your doctor says there's a new way to remove a painful kidney stone. There's a medical device to pluck them out, but how clean is it?
Years after rising concerns about infections caused by hard-to-clean reusable endoscopes, infection-control experts say it's an ongoing effort to properly sterilize the flexible lighted tubes used by doctors to look and work inside patients' bodies.
Two studies published this year found contamination even after cleaning in gastroscopes, used for upper GI procedures; endoscopes used for colonoscopies; and ureteroscopes, used to find and remove kidney stones.
Infection outbreaks have been linked to contaminated duodenoscopes (which pass into the small intestine), gastroscopes (stomach), bronchoscopes (airways) and cystoscopes (bladder).
Because they are usually reused in other patients, the scopes require extensive cleaning to prevent harmful germs from being passed from one patient to another.
"Some scopes are more difficult to clean and sterilize than other scopes," said Raymond Pontzer, director of infection prevention at UPMC. "As they get more intricate... (there's) more difficulty."
A key concern is the transmission of drug-resistant microbes, he said.
Fewer than 10 years ago infections started to show up in patients after they had undergone the procedure known as endoscopic retrograde cholangiopancreatography, or ERCP. It's used to diagnose and treat problems in the bile and pancreatic ducts, primarily the removal of gallstones, Pontzer said.
A flexible lighted scope is inserted through the mouth, down the esophagus, the stomach and to the point where the ducts from the pancreas and gallbladder drain into the duodenum. X-rays are then taken. During the test, the doctor can insert small tools through the scope to take a sample of tissue for a biopsy, remove a gallstone from a bile duct or open a narrowed bile duct by inserting a small stent.
After an outbreak of antibiotic-resistant infections in 2012 in patients who had the procedure, UPMC investigated the disinfecting process for the scopes. The cleaning didn't eliminate all the bacteria, so UPMC switched to a sterilization process, which is the basis of current recommendations from the U.S. Food and Drug Administrat