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World J Gastrointest Endosc. Oct 16, 2014; 6(10): 457-474
Published online Oct 16, 2014. doi: 10.4253/wjge.v6.i10.457
Risk of transmission of carbapenem-resistant Enterobacteriaceae and related “superbugs” during gastrointestinal endoscopy
Lawrence F Muscarella
Lawrence F Muscarella, LFM Healthcare Solutions, LLC, Montgomeryville, PA 18936, United States
Author contributions: Muscarella LF contributed to this paper.
Supported by An educational grant provided by FUJIFILM Medical Systems, USA, Inc., Endoscopy Division (Wayne, NJ; United States)
Correspondence to: Lawrence F Muscarella, PhD, President, LFM Healthcare Solutions, LLC, PO Box 684, Montgomyerville, PA 18936, United States.
Telephone: +1-215-4124088 Fax: +1-215-4124088
Received: June 13, 2014
Revised: August 14, 2014
Accepted: September 4, 2014
Published online: October 16, 2014
Core Tip

Core tip: Gastrointestinal (GI) endoscopy, particularly ERCP, is an emerging risk factor for transmission of carbapenem-resistant Enterobacteriaceae (CRE) and their related superbugs, as well as of other certain bacteria and viruses. Several recent reports associate outbreaks of CRE following ERCP, with associated morbidity and mortality. If performed properly, however, current practices for reprocessing GI endoscopes, which include high-level disinfection, appear adequate to prevent disease transmission. Enhancing the quality and safety both of infection control in GI endoscopy departments and of the design of GI endoscopes to facilitate their thorough cleaning and reprocessing is recommended, as it is reasonable to conclude that these recent outbreaks of CRE causally linked to contaminated GI endoscopes may result in more robust and focused oversight and inspections both of manufacturers by regulatory agencies and of healthcare facilities by healthcare accrediting organizations and state health departments. Along with risk assessments, performing root cause analyses that identify the likely causes of CRE outbreaks and the actions required to prevent their recurrence is encouraged.