Rachael Snyders

Implementation of a Housewide Chlorhexidine Gluconate Bathing Program

BACKGROUND: The 2015 “superbug” outbreaks associated with duodenoscopes alerted the nation and made the public aware of the importance of proper cleaning and disinfection of these complex devices. In response, The Centers for Disease Control and Prevention (CDC) published an Interim Duodenoscope Surveillance Protocol for healthcare facilities. METHODS: In April 2015, a multi-disciplinary team examined all procedures and processes related to duodenoscopes at the three campuses of the health system. Utilizing the CDC protocol, all endoscopes were sampled to determine baseline results. Duodenoscope testing continued monthly, thereafter. Additionally, duodenoscopes used on patients with a multi-drug resistant gram negative bacilli (MDRGNB) were processed and then sampled, cultured, and quarantined until results were final. Infection Control, in collaboration with Endoscopy management, performed the sampling; the microbiology department performed the testing. RESULTS: Following an initial concern related to contamination of broth in the microbiology lab, baseline results of the 32 endoscopes sampledwere negative for high-concern bacteria. Subsequent monthly sampling of all duodenoscopes, and scopes used on MDRGNB patients was negative for high-concern bacteria. CONCLUSIONS: Procedural inconsistencies were discovered; consequently system-wide changes were implemented. A recommendation was made that all scopes go to Endoscopy for processing in the automated endoscope reprocessor (AER). Gloves are usedwhen handling clean scopes from the cabinet and the AER. Staff competencies are now conducted every six months. Manual flushes are performed prior to the scope being placed in the AER. Adenosine Triphosphate (ATP) testing is performed on duodenoscopes used on MDR-GNB patients (prior to placing in AER). A patient education sheet was created with the most frequently asked questions regarding duodenoscopes, and explains the cleaning process. Endoscopy has assumed the role of monthly sampling of the duodenoscopes. The recently reported outbreaks of duodenoscope related infections led to several pro-active process improvements as well as implementation of a comprehensive scope culturing program.