Duodenoscope Investigation

Duodenoscope reprocessing at MGH was conducted using the manufacturer’s updated instructions for use [26] and also included: a second HLD step in the automatic endoscope reprocessor (Medivators, Inc, Minneapolis, Minnesota), testing for residual bioburden after manual cleaning and before first HLD (Channel Check, Healthmark, Fraser, Michigan), and periodic culturing and sequestering of duodenoscopes. The duodenoscope used for ERCP in C1 and E4/C2 was a closed-elevator wire channel duodenoscope in service since October 2014 and leased from the manufacturer. It was sequestered on day 16; surveillance samples to assess for bacterial contamination were collected by MGH staff following CDC guidance [27] and sent to a third-party laboratory for culture-based analysis (Aerobiology Laboratory Associates, Denver, Colorado). Additional sampling was performed at the CDC 86 days after last use of the duodenoscope [27, 28]. The duodenoscope was then returned to the manufacturer (PENTAX Medical, Montvale, New Jersey) for evaluation for mechanical defects.