Table 3. Publications related to reprocessing failures where the disinfection step was carried out by an AER.
| Reference | Origin | Micro-organism(s) (resistance) |
Problem | No. of patients exposed (positive cultures) | No. of infections (type(s)) | Action taken |
| 25 | Endoscope |
Pseudomonas aeruginosa
(ESBL) |
Deviations from the agreed processes (pre-cleaning and drying process) | 182 (4) | 3 | Strict adherence to reprocessing procedures; quarterly microbiological testing |
| 29 | Duodenoscope |
Klebsiella pneumoniae
(CRE) |
No optimal drying process | 17 (7) | 2 (bloodstream) | Revision of disinfection processes; monthly microbiological controls |
| 30 | Duodenoscope |
Klebsiella pneumonia
(ESBL) |
Insufficient manual cleaning and drying before storage | Not mentioned (16) | 12 (bloodstream, biliary tract) | Strict adherence to reprocessing procedures; regular auditing |
| 26 | Ureteroscope | Pseudomonas aeruginosa | Contaminated water due to failure in ultraviolet disinfection system | Not mentioned (10) | 10 (urinary tract) | New water disinfection system |
| 27 | Bronchoscope | Pseudomonas aeruginosa | No procedure for cleaning and disinfecting bronchoscope; no instruction for use of AER | Not mentioned (11) | Not mentioned | New reprocessing procedure; sustained education |
| 34 | Bronchoscope | Mycobacterium chelonae and Methylobacterium mesophilicum | Bronchoscope not adapted to connection for final alcohol flush; improper execution of 8-hour disinfection cycle | Not mentioned (20) | 0 | Replacement of automated washer and disinfection unit; quarterly maintenance and surveillance cultures |
| 35 | Bronchoscope | Mycobacterium tuberculosis | Inadequate high-level disinfection; use of AER was not approved for this bronchoscope. | 11 (2) | 0 | Education and training for health care providers, staff and laboratory workers |
| 32 | Duodenoscope |
Escherichia coli
(NDM-1) |
Recommended reprocessing process inadequate. | 156 (35) | 6 | Gas sterilization |
| 33 | Duodenoscope | Methylobacterium mesophillicum | Contaminated water used to rinse inner channel. | Not mentioned (1) | 1 (bloodstream) | Replacement of inner channel sheath |
| 31 | Duodenoscope | Klebsiella pneumoniae (CRE) | Inadequate cleaning technique | 53 (10) | 7 (bloodstream, pneumonia, urinary tract) | New reprocessing procedure |
| 28 | Bronchoscope | Pseudomonas aeruginosa | Detergent tank of AER Contaminated; inappropriate disinfection procedure |
Not mentioned (7) | 7 (pneumonia, bronchitis) | Cleaning and remodelling of the AER; disinfection of bronchoscopes |
Abbreviations: AER; automatic endoscope reprocessor; ESBL; Extended-Spectrum Beta-Lactamase; CRE; Carbapenem-resistant enterobacteriaceae; NDM-1; New Delhi-metallo-bèta-lactamase