The Healthcare Infection Control Practices Advisory Committee, or HICPAC, is a federal advisory committee which provides guidance to the Centers for Disease Control and Prevention (CDC) on infection control and similar topics. HICPAC meets several times a year to discuss relevant topics in the infection control community.
At the November 2019 meeting, a session titled “Reducing the Risk of Infection from Reprocessed Duodenoscopes” indicated that between 4 and 6 percent of endoscopes have organic matter on them after cleaning and high-level sterilization, according to over 500 studies. Duodenoscopes are a type of endoscope inserted through the mouth and used to diagnose, evaluate, and treat problems in the bile and pancreatic ducts.
Our key takeaways from the presentation:
1. The current reprocessing methods work – if they are carried out correctly
Endoscope manufacturers provide extensive instructions for use (IFUs) with their equipment. The IFUs include detailed instructions on how to reprocess endoscopes, for both manual and automated reprocessing. However, an FDA panel recognized that reprocessing is often incompletely or incorrectly carried out, leading to a recommendation that infection control personnel collaborate with endoscope manufacturers and relevant organizations to promote and oversee correct reprocessing.
2. Training is key
This is a natural follow-up to the first point. Studies indicate that duodenoscopes are improperly cleaned, therefore rendering high-level disinfection insufficient. Studies show that training is hugely effective in increasing compliance with various protocols (one study showed a 240% increase in hand-washing 10 months after a training program concluded). Systematic reviews of endoscopy-related infections consistently link those infections to non-compliance with guidelines. Further training and oversight could prevent those infections.
3. Reprocessing techniques can be improved
All of that said, reprocessing techniques can still be improved. Incremental improvements to endoscopes themselves, such as disposable endcaps, can yield significant health outcomes. Automatic endoscope reprocessors are not susceptible to human error. Newer endoscopes may be designed for easier cleaning.
The HICPAC session concluded that high-level disinfection is appropriate and sufficient for the reprocessing of endoscopes, assuming that the cleaning procedures in previous steps are carried out completely and correctly. Training is key to ensuring clean endoscopes. Further, qualified staff may find that devices such as automatic endoscope reprocessors can free time for other tasks, and methods of quantitatively verifying cleanliness measurements can provide extra assurance in process validation.