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This award-winning blog supplements the articles in Hospital Infection Control & Prevention.

CDC designs new protocol to culture scopes for CRE

Responding to a series of outbreaks of CRE (carbapenem-resistant Enterobacteriaceae) linked to duodenoscopes, the Centers for Disease Control and Prevention has developed an interim protocol for culturing the devices before use to create a greater of margin of safety for patients. But as others have noted, the approach is not foolproof and could be costly if facilities determine that they must purchase more scopes to adopt the protocol.

Duodenoscopes are priced in the $40,000 range, according to researchers who came up with a similar protocol at the ECRI Institute.

The CDC protocol provides a plan to determine how scopes may be sampled and how to test the samples in a lab.

“Like other proposed solutions to the problem of duodenoscope-related CRE infections, we recognize that there are both pros and cons associated with using screening cultures,”Michael Bell, MD, Deputy Director of CDCs Division of Healthcare Quality Promotion, said in a blog post..

“There can be concerns about cost, as using this method will mean that the duodenoscopes will not be available for use while waiting for the results of the cultures,” he noted. “This could mean that a facility would need to buy additional scopes in order to be sure they have the equipment, available when needed. Additionally, the failure to grow bacteria from the areas sampled may not guarantee that there are no bacteria present anywhere on the scope.”

The CDC continues to work with the Food and Drug Administration, medical specialty societies, and other endoscope experts to develop a more long-range solution. The various partners are working to determine which duodenoscope models are potentially affected; evaluate duodenoscope cleaning, drying, and disinfection; and assess the feasibility of using microbiologic sampling cultures to evaluate a facility’s duodenoscope cleaning methods and identify if bacterial contamination remains after disinfection, Bell said.