250. Implementation and Outcomes of an Enhanced Duodenoscope Reprocessing and Culturing Program
Session: Poster Abstract Session: HAI: Environment and Device Cleaning
Thursday, October 27, 2016
Room: Poster Hall
Posters
  • Implementation and Outcomes of an Enhanced Duodenoscope Reprocessing and Culturing Program .pdf (626.3 kB)
  • Background: In February 2015, the FDA issued a safety alert regarding post-ERCP CRE transmission despite adherence to high level disinfection (HLD) of duodenoscopes.

    Methods: In response to the alert, our high volume center (approx. 2200 ERCPs/yr) evaluated current process, reviewed literature, contacted peer institutions, developed and implemented an enhanced duodenoscope reprocessing and culturing protocol. All duodenoscopes were EtO sterilized and additional scopes were purchased to allow implementation of a culture-and-sequester program. The most frequently used scopes were selected for culturing. Phase 1: single reprocessing and scope culturing; brushings were obtained from both the elevator mechanism, sent as one sample, and the three working channels, sent together as a second sample.  The brushes were placed in 10 ml of tryptic soy broth, vortexed and incubated. The samples were checked at 24 and 48 hours and if turbid, the broth was subcultured to solid media. Phase 2: double reprocessing (2 cycles of manual cleaning and HLD) and scope culturing with targeted sequestration and EtO sterilization after any known CRE case. Phase 3: double reprocessing and culturing the elevator only; growth was noted from the elevator mechanism but not the working channels. 

    Results: From April 2015 through May 2016, each scope was cultured between 1 to 23 times. 989 cultures (28% of the total ERCP volume) were obtained from 62 individual duodenoscopes with varying rates of positivity.

    See Table 1:

     

    Number of cultures

    % positive cultures (potential pathogens)

    % positive cultures (unlikely pathogens)

    Phase 1   4/9/15

    40

    1/40        2.5%

    2/40        5%

    Phase 2   5/15/15

    240

    1/240     0.4%

    6/240      2.5%

          Elevator

    120

    1/120     0.8%

    6/120      5%

          Channels

    120

    0/120         0%

    0/120       0%

    Phase 3  8/26/15  Elevator only

    510

    4/510    0. 8%

    49/510   9.6%

        With change in detergent

    - Elevator only 2/29 to 5/4/16

    199

    2/199       1%

    8/199      4%

    Conclusion: A resource-intensive intervention of double reprocessing, culture and sequestration reduced but did not completely eliminate pathogenic bacterial contamination of the duodenoscope elevator. This process sampled only 25% of the ERCP volume. Culture and sequestration of every duodenoscope in use is not sustainable with current resources and a new method for scope sterilization is needed.

    Douglas Webb, MD, FIDSA, FSHEA1, Amy B. Kressel, MD, MS, FIDSA, FSHEA2, Marnie Sieber, RN, BSN1, Kristen Kelley, MPH, CIC, CLC1 and Bryan Schmitt, DO3, (1)IU Health, Indianapolis, IN, (2)Indiana Univ. Sch. of Med., Indianapolis, IN, (3)Pathology and Laboratory Medicine, Indiana University, Indianapolis, IN

    Disclosures:

    D. Webb, None

    A. B. Kressel, None

    M. Sieber, None

    K. Kelley, None

    B. Schmitt, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.