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Patel J, Gimeno Ruiz de Porras D, Mitchell LE, Carson A, Whitehead LW, Han I, Pompeii L, Conway S, Zock JP, Henneberger PK, Patel R, De Los Reyes J, Delclos GL. Cleaning Tasks and Products and Asthma Among Health Care Professionals. J Occup Environ Med 2024; 66:28-34. [PMID: 37801602 PMCID: PMC10841035 DOI: 10.1097/jom.0000000000002990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/08/2023]
Abstract
OBJECTIVE Health care workers are at risk for work-related asthma, which may be affected by changes in cleaning practices. We examined associations of cleaning tasks and products with work-related asthma in health care workers in 2016, comparing them with prior results from 2003. METHODS We estimated asthma prevalence by professional group and explored associations of self-reported asthma with job-exposure matrix-based cleaning tasks/products in a representative Texas sample of 9914 physicians, nurses, respiratory/occupational therapists, and nurse aides. RESULTS Response rate was 34.8% (n = 2421). The weighted prevalence rates of physician-diagnosed (15.3%), work-exacerbated (4.1%), and new-onset asthma (6.7%) and bronchial hyperresponsiveness symptoms (31.1%) were similar to 2003. New-onset asthma was associated with building surface cleaning (odds ratio [OR], 1.91; 95% confidence interval [CI], 1.10-3.33), use of ortho-phthalaldehyde (OR, 1.77; 95% CI, 1.15-2.72), bleach/quaternary compounds (OR, 1.91; 95% CI, 1.10-3.33), and sprays (OR, 1.97; 95% CI, 1.12-3.47). CONCLUSION Prevalence of asthma/bronchial hyperresponsiveness seems unchanged, whereas associations of new-onset asthma with exposures to surface cleaning remained, and decreased for instrument cleaning.
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Affiliation(s)
- Jenil Patel
- Southwest Center for Occupational and Environmental Health, Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth Houston) School of Public Health, Houston, TX, USA
- Center for Pediatric Population Health, Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth Houston), Dallas, TX, USA
| | - David Gimeno Ruiz de Porras
- Southwest Center for Occupational and Environmental Health, Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health in San Antonio, The University of Texas Health Science Center at Houston (UTHealth Houston), San Antonio, TX, USA
- Center for Research in Occupational Health, Universitat Pompeu Fabra, Barcelona, Spain
- CIBER Epidemiología y Salud Pública, Madrid, Spain
| | - Laura E. Mitchell
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth Houston) School of Public Health, Houston, TX, USA
| | - Arch Carson
- Southwest Center for Occupational and Environmental Health, Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth Houston) School of Public Health, Houston, TX, USA
| | - Lawrence W. Whitehead
- Southwest Center for Occupational and Environmental Health, Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth Houston) School of Public Health, Houston, TX, USA
| | - Inkyu Han
- Department of Epidemiology and Biostatistics, Temple University College of Public Health, Philadelphia, PA, USA
| | - Lisa Pompeii
- Research in Patient Services, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | | | - Jan-Paul Zock
- Center for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
| | - Paul K. Henneberger
- Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
| | - Riddhi Patel
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth Houston) School of Public Health, Houston, TX, USA
| | - Joy De Los Reyes
- Department of Biostatistics and Data Science, The University of Texas Health Science Center at Houston (UTHealth Houston) School of Public Health, Houston, TX, USA
| | - George L. Delclos
- Southwest Center for Occupational and Environmental Health, Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth Houston) School of Public Health, Houston, TX, USA
- Center for Research in Occupational Health, Universitat Pompeu Fabra, Barcelona, Spain
- CIBER Epidemiología y Salud Pública, Madrid, Spain
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2
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Shahid HM, Bareket R, Tyberg A, Sarkar A, Simon A, Gurram K, Gress FG, Bhenswala P, Chalikonda D, Loren DE, Kowalski TE, Kumar A, Vareedayah AA, Abhyankar PR, Parker K, Gabr MM, Nieto J, De Latour R, Zolotarevsky M, Barber J, Zolotarevsky E, Vazquez-Sequeiros E, Gaidhane M, Andalib I, Kahaleh M. Comparing the Safety and Efficacy of Two Commercially Available Single-Use Duodenoscopes: A Multicenter Study. J Clin Gastroenterol 2023; 57:798-803. [PMID: 35997700 DOI: 10.1097/mcg.0000000000001752] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 07/07/2022] [Indexed: 12/10/2022]
Abstract
INTRODUCTION Single-use disposable duodenoscopes (SDD) have been developed to mitigate infectious risks related to reusable duodenoscopes. The aim of this study is to compare the safety and efficacy of the two available SDDs in the United States. METHODS We conducted a comparative study of 2 SDD in consecutive ERCP procedures performed by expert endoscopists from 9 academic centers. Performance ratings, procedure details, and adverse events were collected. RESULTS A total of 201 patients were included: 129 patients underwent ERCP with Exalt (mean age 63, Males- 66 (51%), 72 with aScope Duodeno (mean age 65, males=30 (42%). A majority of endoscopists had performed >2000 ERCPs in both groups (71% Exalt, 93% aScope Duodeno). Technical success was 92% in both groups (n=119 Exalt-group, n=66 aScope-Duodeno-group). The procedural complexity for the ERCP cases performed were: Grade 1: 35 cases (18%), Grade 2: 83 cases (41%), Grade 3: 65 cases (32%), and Grade 4: 18 cases (9%). Thirteen patients (10%) from the Exalt group and 16 patients (22%) from the aScope Duodeno group required conversion to a reusable duodenoscope. On a scale of 1 to 5, Exalt and aScope Duodeno, respectively, were rated: 2.31 versus 2.60 for location and visualization quality, 1.38 versus 1.57 for maneuverability based on papillary orientation, 1.48 versus 1.15 for suction/air control, and 2.31 versus 2.34 for elevator efficiency. None of the adverse events were related to the SDDs. CONCLUSIONS The 2 SDDs were comparable. Further ongoing enhancements to these devices will improve maneuverability and clinical effectiveness.
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Affiliation(s)
- Haroon M Shahid
- Endoscopy, Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Romy Bareket
- Endoscopy, Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Amy Tyberg
- Endoscopy, Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Avik Sarkar
- Endoscopy, Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Alexa Simon
- Endoscopy, Robert Wood Johnson Medical School, New Brunswick, NJ
| | | | | | | | | | | | | | - Anand Kumar
- Thomas Jefferson University, Philadelphia, PA
| | | | | | | | | | - Jose Nieto
- Borland Groover Clinic, Jacksonville, FL
| | | | | | | | | | | | - Monica Gaidhane
- Endoscopy, Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Iman Andalib
- Elmhurst Mount Sinai, Icahn School of Medicine New York
| | - Michel Kahaleh
- Endoscopy, Robert Wood Johnson Medical School, New Brunswick, NJ
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3
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Shang R, Liu J, Luo Z, Huang X, Zhang C, Chen D, Wu L, Yao L, Wang X, Wang Q, Wu Y, Zhang L, Yu H. Effect of an automated flexible endoscope channel brushing system on improving reprocessing quality: a randomized controlled study. Endoscopy 2023. [PMID: 36623838 DOI: 10.1055/a-2009-4735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Qualified reprocessing, of which meticulous channel brushing is the most crucial step, is essential for prevention and control of endoscopy-associated infections. However, channel brushing is often omitted in practice. This study aimed to evaluate the effect of an automated flexible endoscope channel brushing system (AECBS) on improving the quality of endoscope reprocessing. METHODS This prospective, randomized controlled study was conducted between 24 November 2021 and 22 January 2022 at Renmin Hospital of Wuhan University, China. Eligible endoscopes were randomly allocated to the auto group (channels brushed by AECBS) or the manual group (channels brushed manually), with sampling and culturing after high-level disinfection and drying. The primary end point was the proportion of endoscopes with positive cultures. RESULTS 204 endoscopes in the auto group and 205 in the manual group were analyzed. The proportion of endoscopes with positive cultures was significantly lower in the auto group (15.2 % [95 %CI 10.7 %-21.0 %]) than in the manual group (23.4 % [95 %CI 17.9 %-29.9 %]). CONCLUSIONS AECBS could effectively reduce bioburden and improve reprocessing quality of gastroscopes and colonoscopes. AECBS has the potential to replace manual brushing and lower the risk of endoscopy-associated infections, providing a new option for the optimization of reprocessing.
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Affiliation(s)
- Renduo Shang
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China.,Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China.,Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jun Liu
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China.,Department of Nursing, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zi Luo
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xingmin Huang
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Caiqing Zhang
- Department of Laboratory Science, Renmin Hospital of Wuhan University, Wuhan, China
| | - Di Chen
- Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China
| | - Lianlian Wu
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Liwen Yao
- Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xianglan Wang
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Qing Wang
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yunxing Wu
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Lili Zhang
- Department of Nursing, Renmin Hospital of Wuhan University, Wuhan, China
| | - Honggang Yu
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China.,Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China.,Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China
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Abstract
Over the past 2 decades, in hospital centers worldwide, there have been numerous outbreaks of multidrug-resistant organisms that have since been attributed to endoscopic transmission of the infections between patients, primarily from duodenoscopes. These outbreaks have focused the attention of endoscope manufacturers, professional societies, and regulatory agencies on improving the reprocessing of these devices. The key steps in this process are point-of-use precleaning, leak testing, manual cleaning, high-level disinfection, and finally drying and storage. The promise of these initial efforts suggest that the aim of minimizing and ultimately eliminating events of endoscope-/duodenoscope-associated transmission of infectious organisms between patients can be achieved.
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Affiliation(s)
- Neil B Marya
- Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at UCLA, 200 UCLA Medical Plaza, Suite 214, Los Angeles, CA 90095, USA
| | - Raman V Muthusamy
- Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at UCLA, 200 UCLA Medical Plaza, Suite 214, Los Angeles, CA 90095, USA.
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6
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Shin JE, Jung Y, Lee JH, Son BK, Jang JY, Kim HK, Jang BI. Updates on the Disinfection and Infection Control Process of the Accredited Endoscopy Unit. Clin Endosc 2019; 52:443-450. [PMID: 31591281 PMCID: PMC6785420 DOI: 10.5946/ce.2019.173] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 09/23/2019] [Indexed: 11/16/2022] Open
Abstract
A thorough disinfection and infection control process associated with gastrointestinal endoscopy is highly important for the health and safety of the examinee and the medical staff involved in the procedure. Endoscopic reprocessing and disinfection are two of the most important steps in quality control of endoscopy. In 2019, the Korean Society of Gastrointestinal Endoscopy updated the Accreditation of Qualified Endoscopy Unit assessment items for these quality indicators. Assessment of disinfection and infection control comprises 28 mandatory items in the categories of disinfection education, pre-cleaning, cleaning, disinfection, rinsing, drying, reprocessing, storage, endoscopic accessories, water bottle and connectors, space/facilities, personal protective equipment, disinfection ledger, and regulations regarding infection control and disinfection. The updated Accreditation of Qualified Endoscopy Unit assessment items are useful for improving the quality of endoscopy by ensuring thorough inspection of endoscopic disinfection and infection control.
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Affiliation(s)
- Jeong Eun Shin
- Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Yunho Jung
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Jeong Hoon Lee
- Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Byoung Kwan Son
- Department of Internal Medicine, Eulji University College of Medicine, Seoul, Korea
| | - Jae-Young Jang
- Department of Internal Medicine, Kyung Hee University College of Medicine, Seoul, Korea
| | - Hyung-Keun Kim
- Division of Gastroenterology, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Byung Ik Jang
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
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8
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Bhatt S, Mehta P, Chen C, Schneider CL, White LN, Chen HL, Kong MG. Efficacy of low-temperature plasma-activated gas disinfection against biofilm on contaminated GI endoscope channels. Gastrointest Endosc 2019; 89:105-114. [PMID: 30120959 DOI: 10.1016/j.gie.2018.08.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 08/02/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS It has been increasingly recognized that the safety of GI endoscopes needs to be improved by addressing the small margin of safety of high-level disinfectants (HLDs) and the failure of HLDs to clear multidrug-resistant organisms and biofilms. There is also an unmet need for effective low-temperature sterilization techniques that have a clear pathway for U.S. Food and Drug Administration clearance. Here, we report the results of our investigation of a novel argon plasma-activated gas (PAG) for disinfection and potentially sterilization of biofilm-contaminated endoscopic channels. METHODS Test polytetrafluoroethylene channel segments were contaminated with 4-, 24- and 48-hour luminal biofilms of methicillin-resistant Staphylococcus aureus, Pseudomonas aeruginosa, or Escherichia coli and were treated by PAG flowing for up to 9 minutes. After PAG treatment, inactivation and dispersal of luminal bacterial biofilms and their regrowth in 48 hours were evaluated. Reactive species induced by PAG were measured with colorimetric probes and electron spin resonance spectrometry. Surface morphology and elemental composition of PAG-treated channel material were analyzed with scanning electron microscopy. RESULTS PAG treatment for 9 minutes led to more than 8 log reduction of viable cells and dispersal of 24- and 48-hour luminal biofilms of all 3 bacteria and to suppression of their regrowth, whereas it resulted in little morphologic abnormalities in channel material. Ozone concentration of PAG fell to below .01 ppm within 30 seconds of switching off the plasma. PAG-treated deionized water was acidified with numerous types of reactive species, each with a concentration some 3 orders of magnitude or more below its bacterial inhibition concentration. CONCLUSIONS PAG is capable of effectively and rapidly disinfecting luminal bacterial biofilms and offers an alternative to the step of HLDs and/or ethylene oxide in the endoscope reprocessing procedure with safety to personnel and environment.
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Affiliation(s)
- Sudhir Bhatt
- Center for Bioelectrics, Old Dominion University, Norfolk, Virginia, USA
| | - Poonam Mehta
- Center for Bioelectrics, Old Dominion University, Norfolk, Virginia, USA
| | - Chen Chen
- State Key Lab of Electrical Insulation and Power Equipment, Center for Plasma Biomedicine, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | | | - Lauren N White
- Center for Bioelectrics, Old Dominion University, Norfolk, Virginia, USA
| | - Hai-Lan Chen
- Center for Bioelectrics, Old Dominion University, Norfolk, Virginia, USA
| | - Michael G Kong
- Center for Bioelectrics, Old Dominion University, Norfolk, Virginia, USA; Department of Electrical and Computer Engineering, Norfolk, Virginia, USA
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Grein JD, Murthy RK. New Developments in the Prevention of Gastrointestinal Scope-Related Infections. Infect Dis Clin North Am 2018; 32:899-913. [PMID: 30241713 DOI: 10.1016/j.idc.2018.06.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Gastrointestinal endoscopes are used for diagnostic and therapeutic purposes and are the most common medical device implicated in health care-associated outbreaks. Infections can be divided into endogenous or exogenous. Exogenous infections were associated with lapses in reprocessing. Recent outbreaks have occurred despite compliance with reprocessing guidelines and highlight the challenges with clearance of all organisms from the duodenoscopes and the potential role of biofilms in hindering adequate reprocessing. This review provides an overview of recent developments and the current understanding of the key contributing factors related to gastrointestinal endoscope-related infections and current approaches to identify and prevent these complications.
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Affiliation(s)
- Jonathan D Grein
- Department of Hospital Epidemiology, Division of Infectious Diseases, Cedars-Sinai Medical Center, 8635 W 3rd Street, Suite 1150W, Los Angeles, CA, USA
| | - Rekha K Murthy
- Department of Hospital Epidemiology, Division of Infectious Diseases, Cedars-Sinai Medical Center, 8635 W 3rd Street, Suite 1150W, Los Angeles, CA, USA; Department of Medical Affairs, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Suite 2211, Los Angeles, CA 90048, USA.
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10
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Erratum. Gastrointest Endosc 2017; 85:871-872. [PMID: 28317699 DOI: 10.1016/j.gie.2017.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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