CDC Issues Duodenoscope Surveillance Protocol

March 26, 2015 — The Centers for Disease Control (CDC) has issued an interim protocol for facilities that want to test their duodenoscopes for contamination with antibiotic-resistant “superbug” bacteria after the cleaning and disinfection process.

The CDC made the following recommendations to reduce the risk of disease outbreaks, including:

• Inspection and manual cleaning: Ensure that the elevator mechanism located at the distal tip of the duodenoscope is thoroughly cleaned and free of all visible debris.
• Drying: Ensure that the channels of the duodenoscope and elevator mechanism are thoroughly dried prior to storage. … If channels and the elevator mechanism are not completely dry, bacterial growth can occur, forming a biofilm that is difficult to remove and could result in persistent contamination.
• Surveillance: Cultures should be obtained after the duodenoscope has been reprocessed (after drying) and should include at least the instrument channel and the distal end of the duodenoscope.
• And more:

The CDC recommended informing patients about the risk of patient-to-patient disease transmission before they undergo procedures involving duodenoscopes, including the transmission of antibiotic-resistant “superbugs.”

However, the CDC left it up to hospitals to decide whether to inform patients who were exposed to “superbugs” on contaminated scopes after undergoing the procedure.

The problem of infection on duodenoscopes is the complex design of the “elevator” channel in the tip of the scope. Even when hospitals follow the manufacturers instructions for cleaning the scope, bacteria can remain embedded in the scope.

In recent years, hundreds of people have been exposed to antibiotic-resistant bacteria on contaminated scopes. At least a dozen people have died in outbreaks at hospitals in California, Washington, Illinois, and more.