108. Evaluation of Bacterial Contamination on Endoscopic Retrograde Cholangiopancreatography Duodenoscopes Before and After Cleaning and High Level Disinfection
Session: Oral Abstract Session: Duodenoscope-Related CRE Infections
Thursday, October 8, 2015: 11:15 AM
Room: 5--AB
Background: The FDA reported 135 cases of microbial transmission linked to endoscopic retrograde cholangiopancreatography (ERCP) from 2013- 2014. After investigation, many of these outbreaks were attributed to the duodenoscope's elevator mechanism which made adequate reprocessing difficult, despite adherence to manufacturers’ recommendations. We examined duodenoscope contamination before and after reprocessing to determine the efficacy of procedures in our system. 

Methods: Twelve duodenoscopes from two Intermountain Healthcare (IHC) endoscopy departments were cultured immediately following ERCP, and then again following reprocessing. An additional 12 unused duodenoscopes from other IHC facilities were also cultured. Sterile saline (5 mL) was flushed through the elevator channel followed by brushing of the cantilevered elevator mechanism in both the up and down positions and rapid swirling of the brush in the flush saline. Quantitative colony counts were obtained by serial dilution of collected saline. Additionally, a sterile swab was passed over and under the elevator mechanism and inoculated into 5 mL TSB. Any broth growth was sub-cultured for bacterial identification.

Results: Before reprocessing 6/12 (50%) scopes cultured high concern organisms including Enterobacteriaceae, Enterococcus, and Pseudomonas aeruginosa. Carbapenem-sensitive Klebsiella pneumonia was isolated before, but not after, reprocessing. Post-reprocessing only 1/24 (4.2%) scopes showed higher than desired quantitative growth of oral-pharyngeal bacteria. High concern organisms were cultured from 2/24 (8.3%) scopes by broth enrichment, however neither scope was positive by quantitative culture. There were statistically fewer organisms (p=0.0054) after reprocessing (mean= 5.6 CFU/scope CI +/- 8.0) than before (mean = 1.7e105 CFU/scope CI +/- 2x10e5).

Conclusion: The presence of high concern organisms on 50% of duodenoscopes before reprocessing highlights the risks from inadequate cleaning and high level disinfection. We conclude that our reprocessing procedures are effective based on post-reprocessing quantitative counts. However, given the complex design of the duodenoscopes, and increasing number of outbreaks, regular surveillance will ensure the quality of reprocessing protocols.

Michaela A. Gazdik, PhD1, Jana Coombs, BS1, Kristin Dascomb, MD, PhD1,2, Carrie W. Taylor, RN, CIC1, Jeannette Prochazka, MSN, ACNS-BC3, Michael Sossenheimer, MD4 and Bert K. Lopansri, MD1,5, (1)Clinical Epidemiology and Infectious Diseases, Intermountain Medical Center, Murray, UT, (2)Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, (3)Surgical Services Clinical Program, Intermountain Medical Center, Murray, UT, (4)Gastroenterology, Mountain West Endoscopy Center, Salt Lake City, UT, (5)Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City, UT

Disclosures:

M. A. Gazdik, None

J. Coombs, None

K. Dascomb, None

C. W. Taylor, None

J. Prochazka, None

M. Sossenheimer, None

B. K. Lopansri, None

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