Annual Scientific Meeting
Introduction: The complex design of the elevator mechanism in duodenoscopes has been recognized as a challenge for disinfection and previously implicated as a source of clinically significant bacterial transmission. Our group has also determined the potential for harboring bacteria in elevator-containing linear echoendoscopes.1 Despite increased awareness, there continues to be a lack of definitive guidelines for routine bacterial culturing protocols for these endoscopes. Our study aims to provide a bacterial culture protocol that is cost-effective, efficient, and accurate.
Methods: Consecutive duodenoscopes and linear echoendoscopes (Olympus; Center Valley, PA) used at a tertiary care center were reprocessed following hospital and manufacturer protocol and dried using an automatic machine. The following morning, these endoscopes were sequentially cultured for surveillance using two different protocols. The brush protocol consisted of suctioning and dispensing sterile water through the endoscope multiple times prior to brushing eight different components of the endoscope, costs $53.40 per culture, and takes an average of 15 minutes. The swab protocol consisted of using a flocked swab to sample above, below, and around the elevator mechanism while it was in mid-position, costs $32.04 per culture and takes 1 minute to perform.
Results: A total of 292 primary cultures were collected from 17 duodenoscopes and 8 linear echoendoscopes. Of these, 146 cultures were gathered using the brush method and 146 cultures using the swab method. No endoscopes tested positive using the brush method. Two cultures (1.4%) tested positive for Enterobacter cloacae bacteria using the swab method (one duodenoscope and one linear echoendoscope).
Discussion: In our pilot study data, the swab method appeared to be superior to the brush method when evaluating the presence of residual bacteria found on duodenoscopes and linear echoendoscopes. The swab method not only detected two positive cultures not found on the brush method. Furthermore, the brush method poses a risk for environmental contamination due to the increased duration of sampling. Based on our prior published data, the swab method could potentially save our center $26,529 and 290 nursing hours annually, supporting the use of the flocked swab methods. Further prospective studies in larger sample sizes are needed to validate optimal surveillance protocols for elevator containing endoscopes.