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| 1 | Risk of transmission of carbapenem-resistant Enterobacteriaceae and related “superbugs” during gastrointestinal endoscopy显示文摘To evaluate the risk of transmission of carbapenem-resistant Enterobacteriaceae(CRE) and their related superbugs during gastrointestinal(GI) endoscopy. Reports of outbreaks linked to GI endoscopes contami-nated with different types of infectious agents, includ-ing CRE and their related superbugs, were reviewed. Published during the past 30 years, both prior to and since CRE's emergence, these reports were obtained by searching the peer-reviewed medical literature(via the United States National Library of Medicine's 'MEDLINE' database); the Food and Drug Administration's Manu-facturer and User Facility Device Experience database, or 'MAUDE'; and the Internet(via Google's search engine). This review focused on an outbreak of CRE in 2013 following the GI endoscopic procedure known as endoscopic retrograde cholangiopancreatography, or ERCP, performed at 'Hospital X' located in the sub-urbs of Chicago(IL; United States). Part of the largest outbreak of CRE in United States history, the infection and colonization of 10 and 28 of this hospital's patients, respectively, received considerable media attention and was also investigated by the Centers for Disease Con-trol and Prevention(CDC), which published a report about this outbreak in Morbidity and Mortality WeeklyReport(MMWR), in 2014. This report, along with the results of an independent inspection of Hospital X's in-fection control practices following this CRE outbreak, were also reviewed. While this article focuses primar-ily on the prevention of transmissions of CRE and their related superbugs in the GI endoscopic setting, some of its discussion and recommendations may also apply to other healthcare settings, to other types of flexible endoscopes, and to other types of transmissible infec-tious agents. This review found that GI endoscopy is an important risk factor for the transmission of CRE and their related superbugs, having been recently as-sociated with patient morbidity and mortality following ERCP. The CDC reported in MMWR that the type of GI endoscope, known as an ERCP endoscope, that Hospi-tal X used to perform ERCP in 2013 on the 38 patients who became infected or colonized with CRE might be particularly challenging to clean and disinfect, because of the complexity of its physical design. If performed in strict accordance with the endoscope manufacturer's labeling, supplemented as needed with professional organizations' published guidelines, however, current practices for reprocessing GI endoscopes, which include high-level disinfection, are reportedly adequate for the prevention of transmission of CRE and their related superbugs. Several recommendations are provided to prevent CRE transmissions in the healthcare setting. CRE transmissions are not limited to contaminated GI endoscopes and also have been linked to other reusable flexible endoscopic instrumentation, including broncho-scopes and cystoscopes. In conclusion, contaminated GI endoscopes, particularly those used during ERCP, have been causally linked to outbreaks of CRE and their related superbugs, with associated patient morbidity and mortality. Thorough reprocessing of these complex reusable instruments is necessary to prevent disease transmission and ensure patient safety during GI endos-copy. Enhanced training and monitoring of reprocessing staffers to verify the proper cleaning and brushing of GI endoscopes, especially the area around, behind andnear the forceps elevator located at the distal end othe ERCP endoscope, are recommended. If the ERCPendoscope features a narrow and exposed channel thathouses a wire connecting the GI endoscope's controhead to this forceps elevator, then this channel's com-plete reprocessing, including its flushing with a deter-gent using a procedure validated for effectiveness, is also emphasized. | Lawrence F Muscarella | 2014 | World Journal of Gastrointestinal Endoscopy2014，6，10： | 26 |
| 2 | Current issues in endoscope reprocessing and infection control during gastrointestinal endoscopy显示文摘这篇文章的目的是在胃肠的内视镜检查法,在内诊镜 reprocessing 重要的因素和感染控制期间关于感染的传播考察证据,集中于的区域在这域里改进依从,和最近的开发和进展。 | Douglas B Nelson Lawrence F Muscarella | 2006 | World Journal of Gastroenterology2006，12，25： | 19 |
| 3 | Natural-orifice transgastric endoscopic peritoneoscopy in humans: Initial clinical trial显示文摘 | Jeffrey W. Hazey Vimal K. Narula David B. Renton Kevin M. Reavis Christopher M. Paul Kristen E. Hinshaw Peter Muscarella E. Christopher Ellison W. Scott Melvin | 2008 | Surgical Endoscopy2008，，1： | 4 |
| 4 | Medical errors, infection-control breaches and the use of adulterated and misbranded medical devices显示文摘Several well-publicized cases of improper cleaning,disinfection or sterilization of contaminated reusable medical equipment that posed an increased risk of patientto-patient disease transmission were reported within the past few years,resulting in the notification of approximately 20 000 patients.These medical errors,the specific infection-control standards they breached,and assessments of the risk of infection associated with each are discussed.Other topics discussed include the Food and Drug Administration’s(FDA)regulation of medical devices and infection-control products;the use of adulterated,misbranded,and investigational devices;consent decrees and associated Certificates of Medical Necessity;and informed patient consent.Focus is placed on liquid chemical sterilization,its history,and the FDA’s recent censure and discontinuation of a medical device labeled with this claim,namely,the STERIS System 1 processor.Recommendations are provided for healthcare facilities,regulatory agencies,manufacturers of reusable medical devices,and professional healthcare organizations and administrations to improve public health and prevent healthcareassociated infections. | Lawrence F Muscarella | 2012 | World Journal of Clinical Infectious Diseases2012，2，2： | 3 |
| 5 | Corporate Capital Expenditure Decisions and the Market Value ofthe Firm 显示文摘 | Johrl J MeConnell Chris J Muscarella | 1985 | Journal of Financial Economics1985，，14： | 1 |
| 6 | Genetic alterations in gastrinomas and nonfunctioning pancreatic neuroendocrine tumors: an analysis of P16/MTS1 tumor suppressor gene inactivation显示文摘 | Melvin WS Fisher WE | 1998 | Cancer Res1998，58，： | 1 |
| 7 | The role of venture capital in the creation of public compa- nies: evidence from the going-public process显示文摘 | BARRY C C MUSCARELLA J PEAVY M VETSUYPENS | 1990 | Journal of Financial Economics1990，27，2： | 1 |
| 8 | Identification and sequeneing of the Syrian Golden hamster(Mesocricetusauratus) p16(INK4a) and p15 (INK4b) cDNA sand theirhomozy- gous gene delection in cheek pouch and pancreatic tumor cells 显示文摘 | Muscarella P Knobloch TJ Ulrich AB | 2001 | Gene2001，278，12： | 1 |
| 9 | Evaluation of the genotoxic and embryotoxic potential of chlorpyrifos and its metabolites in vivo and in vitro显示文摘 | Muscarella DE Keown JF Bloom SE | 1984 | Environ Mutagen1984，6，： | 1 |
| 10 | The Role of Venture Capital in the Creation of Public Companies: Evidence from the Going Public Process显示文摘 | Barry Muscarella Peavy Vetsuypens | 1990 | Journal of Financial Economics1990，27，2： | 1 |
| 11 | Outcome analysis of long-term survivors following pancreaticoduodenectomy显示文摘 | W. Scott Melvin M.D. Karl S. Buekers B.S. Peter Muscarella M.D. Jerome A. Johnson Ph.D. William J. Schirmer M.D. E. Christopher Ellison M.D | 1998 | Journal of Gastrointestinal Surgery1998，，1： | 1 |
| 12 | Differential induction of apoptosis and MAP kinase signaling by mitochondrial toxicants in drug - sensitive compared to drug - resistant B - lineage lymphoid cell lines 显示文摘 | OBrien KA Muscarella DE Bloom SE | 2001 | Toxicol Appl Pharmacol2001，174，3： | 1 |
| 13 | The Role of Venture Capitalists in the Creation of Public Companies:Evidence From the Going Public Process显示文摘 | Barry Chris Muscarella John Pcavy and Michael Vetsuypens | | Journal of Financial Economics0，27，： | 1 |
| 14 | The Role of Venture Capital in the Creation of Public Companies: Evidence from the Going-public Process显示文摘 | BARRY C B MUSCARELLA C J VETSUYPENS M R | 1990 | Journal of Financial Economics1990，，27： | 1 |
| 15 | Evaluation of the genotoxic and embryotoxic potential of chlorpyrifos and its metabolites in vivo and in vitro 显示文摘 | MUSCARELLA D E KEOWN J F BLOOM S E | 1984 | Environ Mutage1984，6，1： | 1 |
| 16 | The genetics of pancreatic cancer显示文摘 | Cowgill SM Muscarella P | 2003 | Am J Surg2003，186，3： | 1 |
| 17 | Investigation on thepresence of sulphites in fresh meat preparations:Estimation of an allowablemaximum limit显示文摘 | IAMMARINO M DI TARANTO A MUSCARELLA M | 2012 | Meat Science2012，90，2： | 1 |
| 18 | The role of venture capital in the creation of public companies: Evidence from the going-public process显示文摘 | Barry C B Muscarella C J Peavy III J W | 1990 | Journal of Financial economics1990，27，2： | 1 |
| 19 | Stock splits: signaling or liquidity? The case of ADR ' Solo-Splits' 显示文摘 | Muscarella C Vetsuypens M | 1996 | Journal of Financial Economics1996，42，： | 1 |
| 20 | Therole of venture capital in the creation of public compa-nies:Evidence from the going-public process显示文摘 | Barry C Muscarella C Peavy J Vetsuypens M R | 1990 | Jour-nal of Financial Economics1990，27，44： | 1 |
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