P2129 - Novel High-Pressure Water Jet-Based System Effectively Decreases Bioburden in the Preprocessing of Duodenoscope’s Elevator Mechanism Immediately After an ERCP: Preliminary Findings of a Pilot Study

Award: Outstanding Research Award in the Biliary/Pancreas Category
Award: Presidential Poster Award

Award: Outstanding Research Award in the Biliary/Pancreas Category

Award: Presidential Poster Award

Kapil Gupta, MD, Yazan Abboud, MD, Kenneth Park, MD, Quin Liu, MD, Srinivas Gaddam, MD, Simon Lo, MD
Cedars-Sinai Medical Center, Los Angeles, CA

Introduction: Duodenoscopes play a role in the transmission of multi-drug resistant organisms. Inability to effectively clean the elevator mechanism has remained a challenge. In this study we prospectively assess the efficacy and reproducibility of a novel high-pressure water jet-based system (cleaning system) to preprocess the elevator mechanism of a duodenoscope.

Methods: 30 duodenoscopes were preprocessed immediately after an ERCP. The first 10 duodenoscopes underwent standard-of-care manual cleaning (control group) and the subsequent 10 were cleaned using the “cleaning system” (study group) at a pressure of 100 PSI with 1400 pulses/ minute. The cleaning system consists of an enclosure into which a duodenoscope tip can be inserted and a water-jet performs the cleaning. The third group of 10 consecutive duodenoscopes (cleaning agent test group) were preprocessed with varying cleaning fluids (150 mL of soap solution followed by 500 mL water in 5, and 1000 mL of water in 5). Relative light units (RLU) were used to assess bioburden, measured using a Clean-Trace NGi Luminometer (3M Company, Maplewood, MN) from the elevator and recesses in front of and behind the elevator. Mean RLU scores were compared using a two-tailed Mann-Whitney U test.

Results: The mean time spent in the control group was shorter than the study group (23 seconds, SD 10.85 vs. 45 seconds, p=0.0007). Baseline RLU scores in the two groups 171,177 RLU (control) and 240,431 RLU (study) were not statistically different (p=0.257). There was a statistically significant decrease in the absolute value, and percentage in bioburden in the study group when compared to the control group (584.5 RLU vs. 10425.7 RLU, p=0.001; 98.7% vs. 78.9%, p=0.001). When comparing cleaning solutions, no difference was found in the percentage decrease in RLU; 500 mL water vs 200 mL soap (98.75% vs 96.11%; p=0.06), 500 mL water vs. 200 mL soap followed by 500 mL water (98.7% vs 99.7%; p=0.624), 500 mL water vs 1000 mL water (98.7% vs. 99.6%; p=0.27).

Discussion: Our study shows that a high-pressure water jet-based system effectively decreases bioburden in the duodenoscope’s elevator mechanism. Compared to manual cleaning, the cleaning system provides low variability and improved precision in lowering the load of bioburden, although the requirement of < 200 RLU was not reached. Further improvement in the novel system and studies are needed.



Disclosures:


Kapil Gupta, MD, Yazan Abboud, MD, Kenneth Park, MD, Quin Liu, MD, Srinivas Gaddam, MD, Simon Lo, MD. P2129 - Novel High-Pressure Water Jet-Based System Effectively Decreases Bioburden in the Preprocessing of Duodenoscope’s Elevator Mechanism Immediately After an ERCP: Preliminary Findings of a Pilot Study, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.