Endoscopes and ERCP

There has been significant media coverage about a potential connection between endoscopes and ERCP procedures and patients infected with a drug-resistant bacteria. Please see the following for answers to important questions related to this issue:

What is the issue about specialized scopes and ERCP?
Virginia Mason discovered and addressed a likely connection between specialized scopes (duodenoscopes) used in procedures such as endoscopic retrograde cholangiopancreatography (ERCP) and patients infected with a drug-resistant bacteria in 2012 and 2013. The potential for these scopes to harbor bacteria, even following appropriate cleaning, is experienced by hospitals around the world.

What is endoscopic retrograde cholangiopancreatography (ERCP)?
It is a technique that combines the use of endoscopy and fluoroscopy to diagnose and treat certain problems of the biliary or pancreatic ductal systems.

Should I be concerned about having a colonoscopy?
No. Routine screening procedures such as colonoscopies and upper endoscopies do not utilize the specialized scopes necessary for ERCPs.

How did Virginia Mason address the issue?
Virginia Mason launched an exhaustive internal review to determine whether patients had come into contact with the bacteria while in our care and, if so, when and how the contact occurred. We worked closely with epidemiologists at Public Health – Seattle & King County and representatives of the Centers for Disease Control and Prevention (CDC).

What did the internal review consist of?
We conducted a thorough evaluation of our internal processes, including how we clean and process duodenoscopes. This process included inviting the scope manufacturer, in addition to the health department and CDC, to monitor our cleaning and disinfection processes. Our facility met the standard for cleaning and disinfection.

If the cleaning process met the standard, how can patients be infected?
It was determined that the manufacturer’s recommended guidelines for processing the scopes, as well as those from the Food and Drug Administration, did not ensure an optimal cleaning process in every case. Virginia Mason developed and implemented a better cleaning process. This new process is influencing national standards to ensure these specialized scopes are safe.

Were patients affected by the bacteria notified?
All patients are notified of the infection risks of endoscopy procedures ahead of time and they are given the opportunity to discuss this with their doctor before they have the procedure. The small number of patients who were identified as having a specific multi-drug resistant infection linked to their procedure at Virginia Mason received timely and appropriate treatment, and have been notified.

What is Virginia Mason doing to ensure this issue is resolved?
Over the past year, Virginia Mason physicians have been discussing the topic and presenting data at local and national professional society meetings. Our teams determined the manufacturer’s recommended guidelines for processing the scopes were less than optimal so we developed and implemented a much more rigorous cleaning process that is influencing the national standards. This process includes culturing every scope for harmful bacteria, putting each device in quarantine for 48 hours, and regularly sending scopes to the manufacturer for proactive safety inspections and maintenance.