title: Surveillance of guideline practices for duodenoscope and linear echoendoscope reprocessing in a large healthcare system.
abstract: OBJECTIVE
  To assess the adequacy of currently recommended duodenoscope and linear echoendoscope (DLE) automatic endoscope reprocessing (AER) and high-level disinfection (HLD), we collected daily post-reprocessing surveillance cultures of 106 DLEs in 21 Providence and Affiliate Hospitals.
  
  
  METHODS
  Daily qualitative surveillance of dried, post-HLD DLEs was conducted for a minimum of 30 days at each facility. Positivity rates for any microbial growth and growth of high-concern pathogens were reported. Potential effects of DLE manufacturer, age, and AER processor on culture-positivity rate were assessed.
  
  
  RESULTS
  Microbial growth was recovered from 201 of 4032 specimens (5%) or 189 of 2238 encounters (8.4%), including 23 specimens (.6%) or 21 encounters (.9%) for a high-concern pathogen. Wide variations in culture-positivity rate were observed across facilities. No striking difference in culture-positivity rate was seen among 8 DLE models, 3 DLE manufacturers, DLE age, manual or bedside cleanser, or automatic flushing system use. However, there was suggestive evidence that Custom Ultrasonics AER (Warminster, Pa, USA) had a lower culture-positivity rate than Medivators AER (Cantel Medical Corp., Little Falls, NJ, USA) for high-concern pathogen growth (0/1079 vs 21/2735 specimens or 0/547 vs 20/1582 encounters). Two endoscopes grew intestinal flora on several occasions despite multiple HLD. No multidrug-resistant organism was detected.
  
  
  CONCLUSIONS
  In this multicenter DLE surveillance study, microbial growth was recovered in 5.0% of specimens (8.4% of encounters), with most being environmental microbes. Enteric bacterial flora was recovered in .6% of specimens (.9% of encounters), despite compliance with 2014 U.S. guidelines and manufacturers' recommendations for cleaning and HLD process. The observed better performance of Custom Ultrasonics AER deserves further investigation.
authors.affiliation: Providence Health & Services, Renton, Washington, USA.
authors.forename: Jack J
authors.initials: JJ
authors.lastname: Brandabur
authors.affiliation: Providence Health & Services, Renton, Washington, USA.
authors.forename: James E
authors.initials: JE
authors.lastname: Leggett
authors.affiliation: Providence Health & Services, Renton, Washington, USA.
authors.forename: Lian
authors.initials: L
authors.lastname: Wang
authors.affiliation: Providence Health & Services, Renton, Washington, USA.
authors.forename: Rebecca L
authors.initials: RL
authors.lastname: Bartles
authors.affiliation: Providence Health & Services, Renton, Washington, USA.
authors.forename: Lynda
authors.initials: L
authors.lastname: Baxter
authors.affiliation: Providence Health & Services, Renton, Washington, USA.
authors.forename: George A
authors.initials: GA
authors.lastname: Diaz
authors.affiliation: Providence Health & Services, Renton, Washington, USA.
authors.forename: Gary L
authors.initials: GL
authors.lastname: Grunkemeier
authors.affiliation: Providence Health & Services, Renton, Washington, USA.
authors.forename: Shannan
authors.initials: S
authors.lastname: Hove
authors.affiliation: Providence Health & Services, Renton, Washington, USA.
authors.forename: Margret
authors.initials: M
authors.lastname: Oethinger
mesh_terms: D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000295:instrumentation*; D003428:Cross Infection / Q000517:prevention & control*; D004203:Disinfection / Q000592:standards*; D020698:Duodenoscopes / Q000382:microbiology*; D019160:Endosonography / Q000295:instrumentation*; D004866:Equipment Contamination; D000069196:Gastrointestinal Microbiome; D019983:Guideline Adherence; D006761:Hospitals; D006801:Humans; D017053:Infection Control; D017410:Practice Guidelines as Topic