Endoscope-Cleaning Techniques Prove Extremely Costly

When an endoscope-associated outbreak occurred at Virginia Mason Medical Center in Seattle, Washington, officials implemented new practices to avoid it from happening again.

The devices caused more than 250 patients in 10 states and four countries become infected with antibiotic-resistant superbugs between 2012 and 2015. One of the outbreaks was caused by the spread of E. coli through duodenoscopes in November 2012. Clinicians began to take an in-depth look at guidelines for cleaning the scopes according to the manufacturer. They went on to publish research that states many times that the guidelines don’t work.

Andrew Ross, MD, section head of gastroenterology at Virginia Madison Medical Center, said that the defect rate for the devices was 1.9% - which is unacceptable. The medical center implemented a new cleaning and disinfecting process by March 2014, however, the process takes a lot more time to complete than previous methods.

“I think the most important part to recognize is by doing this we’ve extended the endoscope reprocessing procedure from an hour-long process to something that takes over two days,” Ross told Becker’s Hospital Review.

The high-level disinfection process for the Olympus scopes starts with following the guidelines provided and then the devices are thoroughly dried and cultured. From there, liquid culture media is used for culturing and the devices go through automated endoscope reprocessor for one cycle. The devices are held for 48 hours until the culture results are available and if there is any evidence of bacteria, the devices go through the entire process again.

This in-depth process isn’t for every hospital, Ross explained. Not only is it time-consuming, but it is expensive.

“The costs incurred are astronomical; to add the culture and quarantine process we had to purchase 20 additional scopes in order to accommodate our clinical volume,” Ross continued. “That’s a huge burden, and the reality is why should we have to buy three endoscopes to make one work the way that it was sold to us, that it was supposed to work and be reprocessed?”

Although officials made this decision in the midst of an antibiotic-resistant outbreak, the Food and Drug Association has made disinfection recommendations that go beyond standard processing that do not have the added cost burden.