Pre-use ureteroscope contamination after high level disinfection: Reprocessing effectiveness and the relation with cumulative ureteroscope use
AuthorLegemate, Jaap D.
Kamphuis, Guido Maarten
Freund, Jan Erik
Oussoren, Harry W.
Spijkerman, Ingrid J.B.
de la Rosette, Jean J. M. C. H.
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CitationLegemate, J. D., Kamphuis, G. M., Freund, J. E., Baard, J., Oussoren, H. W., Spijkerman, I. J. B. ... de la Rosette, J. J. M. C. H. (2019). Pre-use ureteroscope contamination after high level disinfection: Reprocessing effectiveness and the relation with cumulative ureteroscope use. Journal of Urology, 201(6), 1144-1150. http://doi.org/10.1097/JU.0000000000000108
Purpose: We assessed the frequency of preoperative and persistent microbial contamination of flexible ureteroscopes after reprocessing and the relation of contamination to cumulative ureteroscope use. Materials and Methods: We evaluated the effectiveness of high level disinfection with peracetic acid as well as data on ureteroscope use for 20 new flexible ureteroscopes from December 2015 to December 2017 at a single center. In the operating room pre-use and postuse microbial samples of the ureteroscope shaft and working channel were collected to evaluate microbial contamination after reprocessing. Positive cultures were defined as 30 cfu/ml or greater of skin flora, or 10 cfu/ml or greater of uropathogenic microorganisms. A generalized estimating equation model was used to analyze whether cumulative ureteroscope use was associated with positive pre-use cultures. Results: Microbial samples were collected during 389 procedures. Pre-use ureteroscope cultures were positive in 47 of 389 procedures (12.1%), of which uropathogens were found in 9 of 389 (2.3%) and skin flora in 38 of 389 (9.8%). Urinary tract infection symptoms did not develop in any of the patients who underwent surgery with a uropathogen contaminated ureteroscope. In 1 case the pre-use culture contained the same bacteria type as the prior postuse culture. Cumulative ureteroscope use was not associated with a higher probability of positive cultures. Conclusions: Microbial contamination of reprocessed ureteroscopes was found in an eighth of all procedures. Notably uropathogenic microorganisms were discovered in a small proportion of all procedures. Persistent ureteroscope contamination with uropathogens was only rarely encountered. Cumulative ureteroscope use was not associated with a higher probability of microbial contamination.