iLearning Recorded Webinar

Duodenoscope Processing: A Way Forward

Overview

General

The current data on the rate of duodenoscope contamination has focused attention on the potential infection risk from procedures performed with duodenoscopes. This one-hour CNE activity will examine the data on the efficacy of duodenoscope processing, the impact on the risk of infection, and evaluation of new technologies designed to address the issue. Participants will receive information enabling them to be proactive in their infection prevention strategies for endoscopes as they choose solutions related to the handling of these complicated endoscopes. 

Target Audience

This faculty directed education activity is intended primarily for RNs with a responsibility for or an interest in infection prevention for endoscopy. The presentation will also be of interest to allied healthcare personnel and MDs involved in endoscopic procedures.

Learner Objectives

Upon completion of this presentation, participants will be able to:
1) Review the factors that impact duodenoscope contamination and risk of endoscope-associated infections
2) Discuss the current data on the effectiveness of duodenoscope processing.
3) Describe new technologies designed to address the limitations of duodenoscope processing

Teaching Methodology

Participants will complete the recorded webinar learning activity. They will view the presentation, then register to complete the evaluation and take the post-test on the website. They will submit the documentation as directed. A bibliographic reference is included for those wishing additional information.

Contact Hours

Upon successful completion of the entire online program and submission of required documentation, participants will be granted 1 contact hour. No partial credit will be granted.

Accreditation

Provider approved by the California Board of Registered Nursing, Provider Number 08747, the District of Columbia Board of Nursing, Provider Number 50-574, the Florida Board of Registered Nursing, Provider Number 50-574 and the Georgia Board of Nursing, Provider Number 50-574.

According to the criteria of the American Board of Certification for Gastroenterology Nurses (ABCGN), contact hours earned in this activity are considered GI Specific for the purpose of recertification through the ABCGN.

This program has been pre-approved by the Certification Board for Sterile Processing and Distribution (CBSPD).

This program has been approved by the International Association of Healthcare Central Service Material Management (IAHCSMM).

This program is acceptable for surgical technologist recertification by the National Center for Competency Testing.

Disclosures

Successful completion: Participants must complete the entire program, register, achieve a score of 80% on the post-test and submit required documentation.

  1. Conflict of interest: Planners disclose no conflict of interest. The speakers disclose salary or honorarium from the commercial support entity; they have signed a statement agreeing to present material fairly and without bias.
  2. Commercial company support: Fees are underwritten by education funding provided by Cantel Medical.
  3. Non-commercial company support: None.
  4. Alternative/Complementary therapy: None.
Certificate Issue / Replacement

Participants successfully completing the activity and submitting required documentation will be permitted to print a certificate of completion. Participants are advised to retain the certificate for eight years following activity completion.
Replacement of misplaced certificate is available from Educational Dimensions. There is a fee for this service. Request a replacement by contacting us.

Guide to Study

Detailed instructions for completing this eLearning activity

The following steps will assist you in your successful completion of this eLearning Activity.

  1. Read the content or view the recorded presentation. If you want contact hours at the completion of studying the eLearning material, you will be required to register, complete an evaluation and take a post-test prior to printing your Certificate of Completion. We urge you to complete the eLearning activity once you have started. However, if you do need to come back later, you can sign in with your email and eLearning ID.
  2. First Time Visitors will be asked to register using an email address as your User Name. Make a note which email address you have used. Then you will create an eLearning ID using a combination of at least 6-10 letters or numbers. Please make a note of your eLearning ID and if for some reason you forget, you may request that your eLearning ID be sent to you. The web site is secured by Trustwave.
  3. Return Visitors: If you have registered already you do not need to register again. Just Sign In using your email and eLearning ID.
  4. Evaluation Form: Once you have registered or signed in you will be asked to complete an evaluation form and submit it. This is required to obtain the Certificate of Completion.
  5. Post-test: A post-test, based on the content of the eLearning activity, will need to be taken. A passing score of 80% is required. This is required to obtain the Certificate of Completion.
  6. Printing Your Certificate of Completion: Once you have successfully passed the post-test you will be able to print your Certificate of Completion. You will be given an opportunity to verify the information that will be printed on your certificate. Please make sure your printer is ready to print. You will not have access to the certificate page on later visits unless you contact us. Once you choose to print the Certificate of Completion, it will not be possible to make corrections. To obtain a corrected certificate you will need to contact Educational Dimensions. Fees may apply.
  7. Browser recommendations: We require using an up-to-date browser with JavaScript enabled. You must enable cookies from this site in order to access the secure areas.
  8. If you encounter any technical problems during this eLearning activity, please contact us.

Recorded Webinar Video

Suggested Readings

Aumeran C, Poincloux L, Souweine B, et al. Multidrug-resistant Klebsiella pneumonia outbreak after endoscopic retrograde cholangiopancreatography. Endoscopy 2010; 42: 895–99.

Bourigault C, Le Gallou F, Bodet N, Musquer N, Juvin M-E, Corvec S, et al. Duodenoscopy: an amplifier of cross-transmission during a carbapenemase-producing Enterobacteriaceae outbreak in a gastroenterology pathway. Journal of Hospital Infection. 2018;99:422-6.

CDC. Antibiotic Resistance Threats in the United States, 2019. Atlanta, Georgia2019.

Epstein L, Hunter J, Arwady A, Tsai V, Stein L, Gribogiannis M, et al. New Dehli Metallo-B-Lactamase-Producing Carbapenem-Resistant Escherichia coli Associated with Exposure to Duodenoscopes. New England Journal of Medicine. 2014;312(14):1447

Fraser TG, Reiner S, Malczynski M, Yarnold PR, Warren J, Noskin GA. MULTIDRUG-RESISTANT PSEUDOMONAS AERUGINOSA CHOLANGITIS AFTER ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY: FAILURE OF ROUTINE ENDOSCOPE CULTURES TO PREVENT AN OUTBREAK. Infection Control and Hospital Epidemiology. 2004;25:856-9.

Gromski MA, Sieber M, Sherman S, Rex DK. Double high-level disinfection versus liquid chemical sterilization for reprocessing of duodenoscopes used for ERCP: a prospective randomized study. Gastrointestinal Endoscopy. 2020;In Press.

Humphries RM, Yang S, Kim S, Muthusamy VR, Russell D, Trout AM, et al. Duodenoscope-Related Outbreak of a Carbapenem-Resistant Klebsiella pneumoniae Identified Using Advanced Molecular Diagnostics. Clinical Infectious Diseases. 2017;65:1159-66.

Kim S, Russell D, Mohamadnejad M, Makker J, Sedarat A, Watson RR, et al. Risk factors associated with the transmission of carbapenem-resistant Enterobacteriaceae via contaminated duodenoscopes. Gastrointestinal Endoscopy. 2016;83:1121-9.​

Kola A, Piening B, Pape U-F, Veltzke-Schlieker W, Kaase M, Geffers C, et al. An outbreak of carbapenem-resistant OXA-48 –producing Klebsiella pneumoniae associated to duodenoscopy. Antimicrobial Resistance and Infection Control. 2015;4.

Marsh JW, Krauland MG, Nelson JS, et al. Genomic epidemiology of an endoscope associated outbreak of Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae. PLoS One 2015; 10: e0144310

Ofstead CL, Langlay AMD, Mueller NJ, Tosh PK, Wetzler HP. Re-evaluating endoscopy-associated infection risk estimates and their implications. American Journal of Infection Control. 2013(41):734-6.​

Ofstead CL, Buro BL, Hopkins KM, Eiland JE, P.Wetzler H, Lichtenstein DR. Duodenoscope-associated infection prevention: A call for evidence-based decision making. Endoscopy International Open. 2020;08:E1769-E81

Potron A, Bernbeu S, Cuzon G, Ponties V, Blanchard H, Seringe E, et al. Analysis of OXA-204 carbapenemase-producing Enterobacteriaceae reveals possible endoscopy-associated transmission, France, 2012-2014. Euro Surveillance. 2017;22(49):pii=17-00048.​

Rex DK, Sieber M, Lehman GA, Webb D, Schmitt B, Kressel AB, et al. A double-reprocessing high-level disinfection protocol does not eliminate positive cultures from the elevators of duodenoscopes. Endoscopy. 2018;50:588-96.

Shenoy E, Pierce V, Walters M, Moulton-Meissner H, Lawsin A, Lonsway D, et al. Transmission of Mobile Colistin Resistance (mcr-1) by Duodenoscope. Clinical Infectious Diseases. 2019;68:1327-34.

Smith ZL, Oh YS, Saeian K, Edmiston CE, Khan AH, Massey BT, et al. Transmission of carbapenem-resistant Enterobacteriaceae during ERCP: time to revisit the current reprocessing guidelines. Gastrointestinal Endoscopy. 2015;81:1041-5.

Snyder GM, Wright SB, Smithey A, Mizrahi M, Sheppard M, Hirsch EB, et al. Randomized Comparison of 3 High-Level Disinfection and Sterilization Procedures for Duodenoscopes. Gastroenterology. 2017;153:1018-25.

Thornhill G, David M. Endoscope-associated infections: A microbiologist’s perspective on current technologies. Techniques in Gastrointestinal Endoscopy. 2019;21(4):1-12.​

US Senate. Senate health, education, labor and pensions committee minority staff report: preventable tragedies: superbugs and how ineffective monitoring of medical device safety fails patients. Jan 13, 2016. https://www.help.senate.gov/imo/media/doc/ Duodenoscope%20Investigation%20FINAL%20ReRepo.pdf (accessed March 5, 2018).

Verfaillie C, Bruno MJ, Voor in ‘t Holt AF, et al. Withdrawal of a novel-design duodenoscope ends outbreak of a VIM-2-producing Pseudomonas aeruginosa. Endoscopy 2015; 47: 493–502.

Visrodia K, Hanada Y, Pennington KM, Tosh PK, Topazian MD, Petersen BT. Duodenoscope reprocessing surveillance with adenosine triphosphate testing and terminal cultures: a clinical pilot study. Gastrointestinal Endoscopy. 2017;86(1):180-6.

Wendorf K, Kay M, Baliga C, Weissman S, Gluck M, Verma P, et al. Endoscopic Retrograde Cholangiopancreatography - Associated AmpC Escherichia coli Outbreak. Infection Control and Hospital Epidemiology. 2015;36(6):634-42

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