M A Y 2 0 1 5 O U T P A T I E N TS U R G E R Y. N E T 1 5
designs, and manufacturers are responding, says Dr. Allen.
In the meantime, Dr. Muscarella suggests you contact the manufacturer of
your scopes and have them send a rep to your facility to audit your reprocess-
ing processes and sign off that they're done correctly.
Review your reprocessing training protocols, re-educate staff about issues
specific to duodenoscope cleaning and document staff competency assessments
now and at regular intervals, advises Dr. Petersen. Meticulously clean the eleva-
tor mechanism and surrounding recesses by hand — raise and lower the mecha-
nism to allow for brushing of both sides — even when using an automatic endo-
scope reprocessor, he suggests. Also document individual scopes used for each
procedure to facilitate subsequent testing in the event a patient is found to have
a CRE infection.
Most of the public health surveillance focuses on catching CRE bugs
that have a specific type of resistance to carbapenem antibiotics, but the
outbreak at Virginia Mason involved AmpC–producing E. coli infections
resistant to third-generation cephalosporins and carbapenems. "Our
investigation uncovered a bug that is potentially more common than the
CRE-specific outbreaks people talk about," says Kristen Wendorf, MD,
epidemic intelligence service officer at the CDC. "From our perspective,
this could be happening anywhere."
To make sure it doesn't, the FDA has issued guidance for "periodic" surveil-
lance culturing of a duodenoscope's elevator channel and distal tip, but leaves
the frequency to the discretion of individual facilities that must decide what is
both practical and effective for their specific risk profiles. For example, Virginia
Mason now cultures and sequesters each scope for 2 days before they're used
on patients again.
Added precautions
Work with local infection control experts to assess the prevalence of CRE in
your facility and local patient population, says Dr. Petersen. For routine daily
