Single-Use vs Reusable Duodenoscopes: How Infection Knowledge Gaps Are Driving Environmental Harm and What Can Be Done

This is the authors' abstract. We don't add key points for this paper.

Are Driving Environmental Harm and What Can Be Done M ore than 500,000 duodenos- copies are now performed annually in the United States. 1 Increased reports of duodenoscopeassociated infections (DAIs) after endoscopic retrograde cholangiopancreatography (ERCP) over the past decade have sparked discussions about how to reduce the incidence of DAIs and have propelled the adoption of single-use duodenoscopes (SUDs) as an infection mitigation strategy.Meanwhile, potential downsides to SUDs, including increased environmental and public health impacts, costs, and supply chain risks, also warrant discussion, especially because the true benefits of these devices remain unclear.A better understanding of DAI incidence is essential for the rational use of SUDs.To address key information gaps and potential next steps, this article highlights the environmental impact of SUDs and calls for the development of standard DAI case definitions and a reliable DAI data repository, similar to how case definitions have been developed to improve reporting and surveillance of ventilator-associated adverse events (VAEs). 2 An accurate reporting system and supporting an active surveillance infrastructure will enable evidence-informed discussions on how to weigh the risks and benefits of SUDs vs reusable duodenoscopes.Implementing value-based incentive programs, wherein health system reimbursement is linked to standardized DAI reporting, could advance measurement and quality improvement activities related to DAIs.