Randomized Comparison of 3 High-Level Disinfection and Sterilization Procedures for Duodenoscopes

Graham M. Snyder, Sharon B. Wright, Anne Smithey, Meir Mizrahi, Michelle Sheppard, Elizabeth B. Hirsch, Ram Chuttani, Riley Heroux, David S. Yassa, Lovisa B. Olafsdottir, Roger B. Davis, Jiannis Anastasiou, Vijay Bapat, Kiran Bidari, Douglas K. Pleskow, Daniel Leffler, Benjamin Lane, Alice Chen, Howard S. Gold, Anthony BartleyAleah D. King, Mandeep S. Sawhney

Research output: Contribution to journalArticlepeer-review

70 Scopus citations


Background and Aims Duodenoscopes have been implicated in the transmission of multidrug-resistant organisms (MDRO). We compared the frequency of duodenoscope contamination with MDRO or any other bacteria after disinfection or sterilization by 3 different methods. Methods We performed a single-center prospective randomized study in which duodenoscopes were randomly reprocessed by standard high-level disinfection (sHLD), double high-level disinfection (dHLD), or standard high-level disinfection followed by ethylene oxide gas sterilization (HLD/ETO). Samples were collected from the elevator mechanism and working channel of each duodenoscope and cultured before use. The primary outcome was the proportion of duodenoscopes with an elevator mechanism or working channel culture showing 1 or more MDRO; secondary outcomes included the frequency of duodenoscope contamination with more than 0 and 10 or more colony-forming units (CFU) of aerobic bacterial growth on either sampling location. Results After 3 months of enrollment, the study was closed because of the futility; we did not observe sufficient events to evaluate the primary outcome. Among 541 duodenoscope culture events, 516 were included in the final analysis. No duodenoscope culture in any group was positive for MDRO. Bacterial growth of more than 0 CFU was noted in 16.1% duodenoscopes in the sHLD group, 16.0% in the dHLD group, and 22.5% in the HLD/ETO group (P =.21). Bacterial growth or 10 or more CFU was noted in 2.3% of duodenoscopes in the sHLD group, 4.1% in the dHLD group, and 4.2% in the HLD/ETO group (P =.36). MRDOs were cultured from 3.2% of pre-procedure rectal swabs and 2.5% of duodenal aspirates. Conclusions In a comparison of duodenoscopes reprocessed by sHLD, dHLD, or HLD/ETO, we found no significant differences between groups for MDRO or bacteria contamination. Enhanced disinfection methods (dHLD or HLD/ETO) did not provide additional protection against contamination. However, insufficient events occurred to assess our primary study end-point. ClinicalTrials.gov no: NCT02611648.

Original languageEnglish (US)
Pages (from-to)1018-1025
Number of pages8
Issue number4
StatePublished - Oct 2017

Bibliographical note

Funding Information:
Portions of this data have been presented at the Society for Healthcare Epidemiology of America Spring 2016 Conference and at Digestive Disease Week 2017. This work was conducted with support from Harvard Catalyst (NIH Award UL1 TR001102).

Publisher Copyright:
© 2017 AGA Institute


  • Endoscopy
  • Non-outbreak Setting
  • Surveillance


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