Testing Reprocessed Duodenoscopes for Bacteria

Surveillance for Bacterial Contamination of Duodenoscopes after Reprocessing

EMSL provides microbiological testing services for reprocessed duodenoscopes at the Cinnaminson, NJ laboratory.

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 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 that 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.

Sampling Duodenoscopes for Bacteria Testing at EMSL

This method is used in the field to sample ‘ready-to-use’, fully reprocessed duodenoscopes (after drying) for
bacteria specifically located on the distal end. In addition, it’s also used 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:

1. Contact John Passero at EMSL for FREE Sampling Swabs*.  He may be reached at JPassero@EMSL.com or 1-800-220-3675 Ext. 3604.

2. 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.

3. 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.

4. Sampler and Facilitator: Don sterile gowns, face masks/shields, hair coverings and gloves.

5. 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).

6. Gather sterile brushes for sampling of the duodenoscopes.

7. Follow the CDC’s interim sampling method for the duodenoscope – distal end and instrument
channel.

8. Fill out a Sample Submital Form available at www.EMSL.com.

9. Ship samples to: EMSL Analytical, Inc., 200 Route 130 North, Cinnaminson, NJ  08077


*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.

1 ML Butterfields Swab
Product ID: 8708935
Price: Free for EMSL Clients
Contact: John Passero, 1-800-220-3675 Ext. 3604

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 Disease Control and Prevention; http://www.cdc.gov/hai/settings/lab/lab-duodenoscope-sampling.html

Duodenoscope Testing Services Overview