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Testing Reprocessed Duodenoscopes for Bacteria

Surveillance for Bacterial Contamination of Duodenoscopes after Reprocessing

EMSL provides microbiological testing services for reprocessed duodenoscopes at the Cinnaminson, NJ laboratory.

Outbreaks of bacterial infection associated with endoscopes are often attributed to improperly reprocessed
endoscopes. In the past few years, there have been multiple reports of patient exposure to multi-drug
resistant organisms, such as carbapenem-resistant Enterobacteriaceae (CRE), from contaminated

The complex design of the duodenoscope results in difficult to access parts and hard-to-clean areas. Debris
from previous patients may not be completely removed during cleaning, which allows for organisms to
survive the disinfection process. As demonstrated by recent outbreaks, multi-drug resistant organisms can
be transmitted from patient-to-patient by the contaminated duodenoscopes.

The CDC has provided an interim guidance for epidemiological and surveillance studies to find the root
cause. Rather than focus attention solely on the detection of CRE, the CDC recommends that labs look for
the presence of large numbers of bacteria and for "high-concern" organisms. The high-concern organisms
are not normal skin or environmental flora and represent potential pathogens, such as Pseudomonas, E. coli,
and Klebsiella spp.

Sampling Duodenoscopes for Bacteria Testing at EMSL

This method is used in the field to sample ‘ready-to-use’, fully reprocessed duodenoscopes (after drying) for
bacteria specifically located on the distal end. In addition, it’s also used for collecting samples from the
instrument channel (via the instrument port to the distal end). Ideally, two personnel familiar with the
instrument and who are capable of aseptic technique should perform this protocol. One will hold the
duodenoscope (facilitator) while the other person samples (sampler) accordingly. It is important to sample
gently, while thoroughly, in order for optimal sampling and maintaining the integrity of the duodenoscope.

In the area where the duodenoscope(s) will be sampled:

1. Contact John Passero at EMSL for FREE Sampling Swabs*.  He may be reached at or 1-800-220-3675 Ext. 3604.

2. Duodenoscopes should be sampled on a clean surface away from traffic, obvious airflow (e.g. vents)
and potential contamination with water. A sectioned-off area of a reprocessing room or a separate
room can be designated for duodenoscope sampling.

3. Clean and disinfect the counter where sampling of the duodenoscope(s) will be performed with an
EPA-approved disinfectant for hard, non-porous surfaces observing manufacturer’s instructions on
contact time and disinfection procedure.

4. Sampler and Facilitator: Don sterile gowns, face masks/shields, hair coverings and gloves.

5. Prepare the sampling materials by laying out the sterile diaper pad; placing respectively labeled
sampling containers, pre-moistening PBST tubes in a rack, as well as other needed items (e.g. 60-cc

6. Gather sterile brushes for sampling of the duodenoscopes.

7. Follow the CDC’s interim sampling method for the duodenoscope – distal end and instrument

8. Fill out a Sample Submital Form available at

9. Ship samples to: EMSL Analytical, Inc., 200 Route 130 North, Cinnaminson, NJ  08077

*EMSL recommends using a wetted swab for bacteria recovery on hard surfaces when sampling. Click here
to view the 1ML Butterfield Swabs in our product catalog. Each swab comes in an easy-to-use container for
sampling, transport and storage.

1 ML Butterfields Swab
Product ID: 8708935
Price: Free for EMSL Clients
Contact: John Passero, 1-800-220-3675 Ext. 3604


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Health care infections, hepatitis, antimicrobial resistance, health care worker protection. Slide presentations.
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Chapter 41Preventing Health Care–Associated Infections
Amy S. Collins, B.S., B.S.N., M.P.H., Centers for Disease Control and Prevention;

Full list of services provided for Duodenoscope Testing ( click for details )
Laboratories providing Duodenoscope Testing ( click for details )
Ann Arbor, MI - NVLAP Lab Code 101048-4Atlanta, GA - NVLAP Lab Code 101048-1Baton Rouge, LA - NVLAP Lab Code 200375-0Beltsville, MD - NVLAP Lab Code 200293-0Boston, MA - NVLAP Lab Code 101147-0Buffalo, NY - NVLAP Lab Code 200056-0Calgary, Alberta - NVLAP Lab Code 500100-0Carle Place, NY - NVLAP Lab Code 101048-10Charlotte, NC - NVLAP Lab Code 200841-0Chicago, IL - NVLAP Lab Code 200399-0Corporate - Cinnaminson, NJ - NVLAP Lab Code 101048-0Dallas, TX - NVLAP Lab Code 600111-0Denver, CO - NVLAP Lab Code 200828-0EMSL Canada - Montreal -- Quebec - NVLAP Lab Code 201052-0EMSL Canada -- Toronto - NVLAP Lab Code 200877-0EMSL Canada Inc. -- Ottawa - NVLAP Lab Code 201040-0Fort Lauderdale - NVLAP Lab Code 500085-0Houston, TX - NVLAP Lab Code 102106-0Huntington Beach, CA - NVLAP Lab Code 101384-0Indianapolis, IN - NVLAP Lab Code 200188-0Inland Empire, CA - NVLAP Lab Code 600239-0Kernersville, NC - NVLAP Lab Code 102104-0Las Vegas, NV - NVLAP Lab Code 600140-0Miami, FL - NVLAP Lab Code 200204-0Minneapolis, MN - NVLAP Lab Code 200019-0New York, NY - NVLAP Lab Code 101048-9Orlando, FL - NVLAP Lab Code 101151-0Pasadena, CA - NVLAP Lab Code 200232-0Phoenix, AZ - NVLAP Lab Code 200811-0Piscataway, NJ - NVLAP Lab Code 101048-2Plymouth Meeting, PA - NVLAP Lab Code 200699-0Raleigh, NC - NVLAP Lab Code 200671-0Rochester, NY - NVLAP Lab Code 600183-0S. Portland, ME - NVLAP Lab Code 500094-0Salem, NH - NVLAP Lab Code 201051-0San Diego, CA - NVLAP Lab Code 200855-0San Leandro, CA - NVLAP Lab Code 101048-3Seattle, WA - NVLAP Lab Code 200613-0St. Louis, MO - NVLAP Lab Code 200742-0Tampa, FL - NVLAP Lab Code 600215-0Vancouver, BC - NVLAP Lab Code 201068-0Wallingford, CT - NVLAP Lab Code 200700-0West Palm Beach, FL - NVLAP Lab Code 600206-0Weymouth, MA - NVLAP Lab Code 600217-0
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