背景:多重感染暴发与世界范围内的十二指肠镜污染有关。然而,在已发表的测试该主题的研究中,患者就绪型十二指肠镜的污染率差异很大.我们旨在根据现有数据估计内镜逆行胰胆管造影术(ERCP)的再处理十二指肠镜的污染率。
方法:我们在PubMed和Embase数据库中搜索了2010年1月1日至2020年3月10日的引用,这些数据库调查了重新处理的患者准备十二指肠镜的污染率。分析中排除了未评估十二指肠镜以外的其他类型内窥镜的研究。研究资格和数据提取由三名评审员独立评估。基于比例分布的随机效应模型(REM)用于计算重新处理的患者准备十二指肠镜的合并总污染率。通过比较单一高水平消毒(HLD)与双重HLD和环氧乙烷(EtO)气体灭菌,进行了亚组分析以评估使用不同后处理方法时的污染率。此外,我们调查了爆发后进行的研究与非爆发开始的研究之间的污染率.
结果:我们确定了15项符合纳入的研究,其中包括来自13112个样本的925个受污染的十二指肠镜。计算的总加权污染率为15.25%±0.018(95%置信区间[Cl]:11.74%-18.75%)。仅使用HLD后的污染率为16.14%±0.019(95%Cl:12.43%-19.85%),使用dHLD或EtO后,污染率降至9.20%±0.025(95%Cl:4.30%-14.10%)。爆发后进行的研究(n=4)显示5.72%±0.034(95%Cl:0.00%-12.43%)的污染率,非暴发开始的研究(n=11)显示污染率为21.50%±0.031(95%Cl:15.35%-27.64%)。
结论:这是第一个评估用于ERCP的患者准备十二指肠镜污染率的荟萃分析。根据现有文献,我们的分析表明,再处理的患者就绪型十二指肠镜的污染率为15.25%.此外,分析表明,dHLD和EtO后处理方法优于单一HLD,但在正确清洁十二指肠镜方面仍然效率不高。此外,与未开始爆发的研究相比,在爆发后进行的研究并未导致更高的污染率.
背景:作者没有获得资助,作者身份,和/或本文的出版。
BACKGROUND: Multiple infection outbreaks have been linked to contaminated duodenoscopes worldwide. However, the contamination rate of patient-ready duodenoscopes varies highly amongst published studies testing this subject. We aimed to estimate the contamination rate of reprocessed patient-ready duodenoscopes for endoscopic retrograde cholangio-pancreatography (ERCP) based on currently available data.
METHODS: We searched the PubMed and Embase databases from January 1, 2010 until March 10, 2020, for citations investigating contamination rates of reprocessed patient-ready duodenoscopes. Studies not assessing other types of endoscopes than duodenoscopes were excluded from the analysis. Study eligibility and data extraction was evaluated by three reviewers independently. A random-effects model (REM) based on the proportion distribution was used to calculate the pooled total contamination rate of reprocessed patient-ready duodenoscopes. Subgroup analyses were carried out to assess contamination rates when using different reprocessing methods by comparing single high-level disinfection (HLD) with double HLD and ethylene oxide (EtO) gas sterilization. Additionally, we investigated the contamination rate between studies conducted following an outbreak compared to non-outbreak-initiated studies.
RESULTS: We identified 15 studies that fulfilled the inclusion, which included 925 contaminated duodenoscopes from 13,112 samples. The calculated total weighted contamination rate was 15.25% ± 0.018 (95% confidence interval [Cl]: 11.74% - 18.75%). The contamination rate after only using HLD was 16.14% ± 0.019 (95% Cl: 12.43% - 19.85%) and after using either dHLD or EtO the contamination rate decreased to 9.20% ± 0.025 (95% Cl: 4.30% - 14.10%). Studies conducted following an outbreak (n=4) showed a 5.72% ± 0.034 (95% Cl: 0.00% - 12.43%) contamination rate, and non-outbreak-initiated studies (n=11) revealed a contamination rate of 21.50% ± 0.031 (95% Cl: 15.35% - 27.64%).
CONCLUSIONS: This is the first meta-analysis to estimate the contamination rate of patient-ready duodenoscopes used for ERCP. Based on the available literature, our analysis demonstrates that there is a 15.25% contamination rate of reprocessed patient-ready duodenoscopes. Additionally, the analysis indicates that dHLD and EtO reprocessing methods are superior to single HLD but still not efficient in regards to cleaning the duodenoscopes properly. Furthermore, studies conducted following an outbreak did not entail a higher contamination rate compared to non-outbreak-initiated studies.
BACKGROUND: The authors received no financial support for the research, authorship, and/or publication of this article.