DUODENOSCOPES
DUODENOSCOPES TESTING SERVICES
Surveillance for Bacterial Contamination of Duodenoscopes after Reprocessing
Outbreaks of bacterial infection associated with endoscopes are often attributed to improperly reprocessed endoscopes. In the past few years there have been multiple reports of patient exposure to multi-drug resistant organisms, such as Carbapenem-resistant Enterobacteriaceae (CRE), from contaminated duodenoscopes.
The complex design of the duodenoscope results in difficult to access parts and hard to clean areas. Debris from previous patients may not be completely removed during cleaning, which allows for organisms to survive the disinfection process. As demonstrated by the recent outbreaks, multi-drug resistant organisms can be transmitted from patient to patient by the contaminated duodenoscopes.
The CDC has provided an interim guidance for epidemiological and surveillance studies to find the root cause. Rather than focus attention solely on the detection of CRE, the CDC recommends labs look for the presence of large numbers of bacteria and for "high concern" organisms. The high concern organisms are not normal skin or environmental flora and represent potential pathogens, such as Pseudomonas, E. coli, and Klebsiella spp.
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Sampling Duodenoscopes for Bacteria
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This method is for use in the field to sample ‘ready-to-use’, fully reprocessed duodenoscopes (after drying) for bacteria specifically located on the distal end; and for collecting samples from the instrument channel (via the instrument port to the distal end). Ideally, two personnel familiar with the instrument and who are capable of aseptic technique should perform this protocol. One will hold the duodenoscope (facilitator) while the other person samples (sampler) accordingly. It is important to sample gently, while thoroughly, in order for optimal sampling and maintaining the integrity of the duodenoscope.
In the area where the duodenoscope(s) will be sampled:
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Duodenoscopes should be sampled on a clean surface away from traffic, obvious airflow (e.g. vents) and potential contamination with water. A sectioned-off area of a reprocessing room or a separate room can be designated for duodenoscope sampling.
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Clean and disinfect the counter where sampling of the duodenoscope(s) will be performed with an EPA-approved disinfectant for hard, non-porous surfaces observing manufacturer’s instructions on contact time and disinfection procedure.
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Sampler and Facilitator: Don sterile gowns, face masks/shields, hair coverings and gloves.
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Prepare the sampling materials by laying out the sterile diaper pad; placing respectively labeled sampling containers, pre-moistening PBST tubes in a rack, as well as other needed items (e.g. 60-cc syringes).
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Gather sterile brushes for sampling of the duodenoscopes.
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Follow the CDC’s interim sampling method for the duodenoscope – distal end and instrument channel.
Sampling Product Available:
EMSL recommends using a wetted swab for bacteria recovery on hard surfaces when sampling. Click here to view the 1ML Butterfield Swabs in our product catalog. Each swab comes in an easy-to-use container for sampling, transport and storage.
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1 ML Butterfields Swab
Product ID: 8708935
Price: Free for EMSL Clients
FREE Sampling Swabs Available!
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References
Pronovost P, Needham D, Berenholtz S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med. 2006;355:2725-32.
Vital Signs: Estimated Effects of a Coordinated Approach for Action to Reduce Antibiotic-Resistant Infections in Health Care Facilities — United States; MMWR August 4, 2015; 64; 1-7
Scott RD. The direct medical costs of healthcare-associated infections in US hospitals and the benefits of prevention. Atlanta: Centers for Disease Control and Prevention; 2009.
The Lowbury Lecture. The economics of nosocomial infections. Wenzel RP J Hosp Infect. 1995 Oct; 31(2):79-87.
Centers for Disease Control and Prevention: CDC for Healthcare Providers Health care infections, hepatitis, antimicrobial resistance, health care worker protection. Slide presentations.
Fact sheets. http://www.cdc.gov/CDCForYou/healthcare_providers.html
Guidelines http://www.cdc.gov/ncidod/dhqp
Garner JS and the Hospital Infection Control Practices Advisory Committee. Guideline for isolation precautions in hospitals. Infect Control Hosp Epidemiol. 1996;17:53–80 http://www.cdc.gov/hai/organisms/organisms.html
Chapter 41Preventing Health Care–Associated Infections Amy S. Collins, B.S., B.S.N., M.P.H., Centers for DiseaseControl and Prevention; Atlanta, Georgia. http://www.cdc.gov/hai/settings/lab/lab-duodenoscope-sampling.html
