Just published: The 2021 “Multisociety guideline on reprocessing flexible GI endoscopes and accessories.“
- Below is an excerpt from this guideline discussing Dr. Muscarella’s research focusing on potential “superbug” exposures by a duodenoscope or bronchoscope:
“A systematic review by Muscarella examined all reported carbapenem-resistant Enterobacteriaceae– and multidrug-resistant organisms–related infections in the United States and Europe attributed to duodenoscope exposure and assessed the adequacy of reprocessing in these outbreaks. Factors such as endoscope design, lapses in reprocessing guidelines, damage to the endoscope, or a lack of servicing, maintenance, and repair of the endoscope were hypothesized to be contributors to these outbreaks. In this review, 6 of 17 studies implemented EtO sterilization as an intervention during infectious outbreaks; in at least 3 and possibly 6 studies this intervention yielded an absence of culture positivity from duodenoscopes at all sites, thereby stopping the outbreaks.6,7,54-57 Similar data exist for EtO sterilization ceasing outbreaks attributed to bronchoscopes.[58,59] Therefore, the implementation of EtO sterilization appears to be an effective tool for terminating carbapenem-resistant Enterobacteriaceae and multidrug-resistant organism outbreaks associated with duodenoscopes.”
Endoscope recalls, removals in the news:
- Ultrasound endoscopes recalled — November 27, 2020
- A bronchoscope model removal — August 31, 2020
- Bronchoscope models recalled — September 29, 2018
“Los Angeles Times:
- “The accuracy of death certificates has never been more important.” October 22, 2020.
As quoted in USA Today:
- “As COVID-19 spread, the feds relaxed rules, and hospitals tried to contain the outbreak. Other infections may have risen” (August 5, 2020)
Dr. Muscarella’s 7 most recent postings:
- Comparison of New COVID-19 Federal Guidance for Certifying Deaths to Assessments of Superbug-Related Deaths
- Can Bronchoscopes Transmit a ‘Superbug’?
- Sterilization of Duodenoscopes Found to Terminate ‘Superbug’ Outbreaks Other effective measures include returning the endoscope to the manufacturer for servicing.
- New Guidance for Hospitals Considering the Sterilization of Flexible Endoscopes A newly developed 3-tiered classification scheme based on the infection risk is discussed.
- A Colonoscope is Linked to Two Infections of the Nightmarish ‘CRE’ Superbug. Colonoscopy could now also be a risk factor for infection, in addition to ERCP and bronchoscopy.
- A Bronchoscope is Linked Again in the U.S. to an Outbreak of the Feared ‘CRE’ Superbug Is enough being done to improve safety? The recall of several bronchoscope models is also discussed.
- Are Enzymatic Detergents the Primary Cause of The Inflammatory Eye Reaction Called TASS? A recently published article investigates risk factors for TASS.
Expert Consulting, Quality Reviews, Forensic Services: LFM-Healthcare Solutions, LLC provides medical expertise and solutions for healthcare facilities, device manufacturers and patients, specializing in the causes and prevention of healthcare-associated infections (HAIs) linked to contaminated medical equipment. Years of experience, reasonably priced services. Click here.
- Muscarella LF. Use of ethylene-oxide gas sterilisation to terminate multidrug-resistant bacterial outbreaks linked to duodenoscopes. BMJ Open Gastro August 2019.
- Mehta AC, Muscarella LF. Bronchoscope-Related “Superbug” Infections. CHEST August 2019.
- Muscarella LF. Risk of transmission of carbapenem-resistant Enterobacteriaceae and related “superbugs” during gastrointestinal endoscopy. World J Gastrointest Endosc October 2014.
Dr. Muscarella’s proposed paradigm for disinfecting or sterilizing flexible endoscopes:
Gastroenterology & Endoscopy News: “Which Flexible Scopes Really Need Sterilization?” (Oct. 23, 2019)
- Running Out of Runway — A Podcast: Dr. Lawrence Muscarella’s talks about “Building a Case for a Paradigm Shift in Endoscope Reprocessing” (Produced by Beyond Clean; Oct. 28, 2019)
Some of Dr. Muscarella’s other relevant peer-reviewed articles:
- Muscarella LF. Infection control and its application to the administration of intravenous medications during gastrointestinal endoscopy. Am J Infect Control 2004 Aug;32(5):282-6.
- Muscarella LF. The study of a contaminated colonoscope. Clin Gastroenterol Hepatol 2010 Jul;8(7):577-80.e1.
- Nelson DB, Muscarella LF. Current issues in endoscope reprocessing and infection control during gastrointestinal endoscopy. World J Gastroenterol 2006 Jul 7;12(25):3953-64.
- Muscarella LF. Other Possible Causes of a Well-Publicized Outbreak of Pseudomonas aeruginosa Following Arthroscopy in Texas. Advances in Infectious Diseases 2013;3(2):134-145.
- Muscarella LF. Inconsistencies in endoscope-reprocessing and infection-control guidelines. The importance of endoscope drying. Am J Gastroenterol 2006 Sep; 101(9):2147-54.
- Click here for a listing of more of Dr. Muscarella’s peer-reviewed articles
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Dr. Muscarella’s expert guidance provided on the following TV news programs: CNN | NBC’s The Today Show | NBC’s Nightly News with Lester Holt | ABC World News Tonight | CBS Evening News with Scott Pelley | Wall Street Journal Live | WWL-TV News (New Orleans, LA) | CNC-TV News (NBC, Charlotte, NC)
Some of Dr. Muscarella’s radio interviews and quotes in the press: USA TODAY | New York Times | CNN | The Washington Post | Wall Street Journal | CBS News Radio (Los Angeles, CA) | Philadelphia Inquirer | Los Angeles Times | Bloomberg Business | NPR Radio (Los Angeles) | The Los Angeles Times | Scientific America | The Seattle Times | Reuters | Highlands Today | The Palm Beach Post | MassLive! | Los Angeles Times | Bloomberg Business | Newsweek | Al Jazeera America | KNX-1070 NewsRadio | CBS News 3 | CBS News 2 | ABC6 On-Your-Side | The Associated Press | The San Francisco Chronicle | WSOC-TV Eyewitness News | Reuters | The Los Angeles Times | USA TODAY | The Seattle Times | The Iowa City Gazette | NJ.com | The Philadelphia Inquirer | Winston-Salem Journal | Wall Street Journal | San Juan Weekly
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Disclaimer: Lawrence F Muscarella PhD is the owner of LFM Healthcare Solutions, LLC, a Pennsylvania-based quality improvement and consulting company that has provides safety services for hospitals, manufacturers and the public since 2013.
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