D0623 - Outcomes of a Duodenoscope Surveillance Culture Protocol in Response to a Carbapenem-resistant Enterobacteriacea Outbreak

Meghana Doniparthi, MD¹, Dean Silas, MD², Kenneth D. Chi, MD^3
1Advocate Lutheran General Hospital, Park Ridge, IL; ²Advocate Lutheran General Hospital, Niles, IL; ³Advocate Lutheran General Hospital, Glenview, IL

Introduction: In 2013, Advocate Lutheran General Hospital (ALGH) was one of many healthcare organizations worldwide that reported an outbreak of multi-drug resistant infections linked to duodenoscopes, specifically with carbapenem-resistant Enterobacteriacea (CRE). In 2016, our institution transitioned to manual cleaning of each duodenoscope (Olympus TJF-Q180) followed by use of the manufacturer automated endoscope reprocessor (OER-PRO). Culture of the scope channel for CRE after reprocessing followed by temporary quarantine of the scope has been performed since that time. The role of routine surveillance cultures in a non-outbreak setting is not well-defined. We proposed that routine culture of duodenoscopes for CRE in non-outbreak settings does not confer additional benefit following current duodenoscope reprocessing methods and results in excess cost.

Methods: We performed a retrospective review of culture reports from scopes used during patient cases at ALGH between January 4, 2021 to December 31, 2021. All scopes that underwent the standardized reprocessing method and culture of channel for CRE were included. Culture reports of scopes from outside institutions or those that did not undergo our current reprocessing method were excluded. An electronic spreadsheet of culture results was provided by ACL Laboratories and indexed by scope serial number. We also reviewed costs of implementing scope quarantine after culture.

Results: 482 ERCPs were performed during this time period. All scopes were cultured after reprocessing. There were 0/482 (0%) positive culture results (Table 1). Zero scopes required additional processing. The average time to receive the culture result was 48 hours. The cost of each culture was $28 for a total of $13,496 for the year. In order to implement the quarantine policy, we purchased 7 additional duodenoscopes to have 14 scopes in circulation. Each device cost $42,000 for a one time total of $294,000.

Discussion:
Based on our preliminary review of 1 year of culture results, following the manufacturer recommended process for disinfection of scopes has been successful at eliminating CRE, the organism identified during our initial outbreak. In a high volume ERCP center, the cost of implementing a culture and quarantine policy may be prohibitive. Our initial data support discontinuation of routine culture after reprocessing in a non-outbreak setting. Further investigation includes review of long-term data and benefit-cost analysis.



Disclosures:


Meghana Doniparthi, MD¹, Dean Silas, MD², Kenneth D. Chi, MD³. D0623 - Outcomes of a Duodenoscope Surveillance Culture Protocol in Response to a Carbapenem-resistant Enterobacteriacea Outbreak, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.