Su1509 PREVENTION OF BACTERIAL CONTAMINATION OF DUODENOSCOPES USING A DISPOSABLE ELEVATOR TIP

Abstract

Recent reports from USA and Europe have documented increasing incidence of sepsis with multidrug-resistant organisms (MDRO) caused by contaminated duodenoscopes. Reprocessing protocols in use seem to be inadequate in completely eradicating the microbial load in the duodenoscope. The elevator tip has been identified as a possible source for persistent contamination of the duodenoscope. In this study, we evaluated the role of a disposable elevator tip in the prevention of scope contamination. This was a case-control study conducted in a high volume tertiary center. To assess the impact of the elevator tip in bacterial contamination of the duodenoscope, two different scopes were used. In the first group, (control group) the standard duodenoscopes (Olympus TJFQ180V) was used, while in the second group(Test group) a duodenoscope with disposable elevator tip (Pentax ED3490TK) wherein the tip was replaced for every procedure, was used. Reprocessing was carried out by dedicated trained technicians in accordance with ESGE guidelines. Bacterial contamination was confirmed by performing surveillance cultures on the scopes as per CDC guidelines. The cultures for the test group were performed after disposal of the elevator tip. Contamination was defined as: (1) microbial growth more than 20 CFU of any type of microorganism(AM20) as used by the ESGE guidelines or (2) presence of microbial growth (more than 1 CFU/ 20mL of gastrointestinal and/or oral microorganisms(MGO). Patients were followed up after the procedure for cholangitis which was defined as 1) presence of fever (>38.0°C), abdominal pain, jaundice; 2) laboratory data suggestive of inflammation and biliary obstruction; and 3) no evidence of acute cholangtitis in the week prior to ERC. The prevalence of scope contamination, type of bacteria and procedure related cholangitis was compared between the two groups. A total of 88 cultures were taken of which, 55 cultures were from controls and 33 cultures were from test group. Overall, 39 (44%) and 21(24%) samples were contaminated as per AM20 criteria and MGO criteria respectively. A significantly higher proportion of contaminated scopes using both definitions were seen in controls as compared to the test group (Table 1). A total of 6 patients (10.5%) had cholangitis following procedure of which 4 patients were from the control group and two patients from the test group. Scope culture results correlated with post procedure cholangitis in the control group. Among the high priority organisms, pseudomonas aeruginosa and Klebsiella pneumoniae were the most common (10 positive samples each). The use of a disposable elevator tip resulted in significant reduction of bacterial contamination of the duodenoscope. Reduction in bacterial contamination of the duodenoscope resulted in reduced procedure related cholangitis.