--- title: CRE, ERCP, OMG! description: CRE, ERCP, OMG! --- # [CRE, ERCP, OMG!](https://www.viroxanimalhealth.com/resources/talkcleantome/2015/03/cre-ercp-omg.html) Written by [Nicole Kenny](https://www.viroxanimalhealth.com/resources/author/nicole-kenny) | Mar 6, 2015 9:04:00 PM It's likely that you've seen at least [one news article](https://www.google.ca/webhp?sourceid=chrome-instant&ion=1&espv=2&ie=UTF-8#q=cre%20outbreak%20with%20duodenoscopes) to do with the spate of recent [CRE](http://www.cdc.gov/vitalsigns/pdf/2013-03-vitalsigns.pdf) (Carbapenem-Resistant Enterobacteriaceae) outbreaks across several states and facilities that have been linked to Endoscopic retrograde cholangiopancreatography ([ERCP](http://www.niddk.nih.gov/health-information/health-topics/diagnostic-tests/ercp/Pages/diagnostic-test.aspx)) procedures using duodenoscopes.  ERCP is a relatively common diagnostic procedure that examines diseases of the liver, bile ducts and pancreas.   [Duodenoscopes](http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm434922.htm) are long, flexible, viewing instruments that are inserted through the mouth and fed down into the top of the small intestine (duodenum). They contain a hollow channel that allows the injection of contrast dye or the insertion of other instruments to obtain tissue samples for biopsy or treat certain abnormalities. Unlike most other endoscopes, duodenoscopes also have a movable “elevator” mechanism at the tip. The elevator mechanism changes the angle of the tip of the duodenoscope, which allows the instrument to access the ducts to treat problems with fluid drainage as a result it is a complex instrument than other endoscopes and unsurprisingly can be more difficult to clean and disinfect. Reprocessing is a detailed, multi-step process to clean and disinfect or sterilize reusable devices.  First, meticulous cleaning must occur which requires the removal of adherent visible soil, blood, protein substances, and other debris from the surfaces, crevices, serrations, joints, and lumens of instruments, devices, and equipment by a manual or mechanical process that prepares the items for safe handling and/or further decontamination using a detergent and water.  As a semi-critical device, duodenoscopes require [high-level disinfection](http://www.cdc.gov/hicpac/Disinfection_Sterilization/2_approach.html) which is intended to reduce the risk of transmitting infection, but may not entirely eliminate it.  High-Level disinfection is generally completed using a germicide that inactivates all microbial pathogens, except large numbers of bacterial endospores, when used according to labeling. The FDA and Health Canada further define a high level disinfectant as a sterilant used under the same contact conditions except, for a longer contact time. The complex design of duodenoscopes allows for improved patient outcomes for diagnosis and treatment; however, it does cause challenges for cleaning and disinfection as some parts of the scope can be extremely difficult to access.  For example, the moving parts of the elevator mechanism contain microscopic crevices that may not be reached with a brush allowing residual body fluids and organic debris to remain in these crevices after cleaning and disinfection.  This remaining soil can lead to transmission of disease causing organisms and can be transmitted to subsequent patients. While the prevalence of such pathogens is increasing in hospitals, it is important to understand that antibiotic resistance does not translate to chemical resistance.  It is also important to remember that disinfectants have been used for well over 100 years without loss of effectiveness. While there is a hierarchy with respect to some bacteria such as spore-formers or *Mycobacteria *spp. being less susceptible to chemicals than their gram negative or gram positive cousins.  In fact, as shown by numerous studies, antibiotic resistant pathogens are not more resistant to disinfectants than antibiotic sensitive pathogens. In accordance to [recent communications from the FDA](http://www.asge.org/publications/publications.aspx?id=17913) with respect to the best practices for cleaning and disinfection of duodenoscopes while they acknowledge that duodenoscopes are inherently difficult to reprocess, strict adherence to the manufacturer’s reprocessing instructions will minimize the risk of infection.  Facilities should have processes in place to ensure staff that are responsible for reprocessing do not deviate from the manufacturer's instructions for reprocessing as this may contribute to contamination. The long and the short of it is....meticulous cleaning is paramount to patient safety, and similar to baking, cutting corners or skipping ingredients is bound to lead to disaster! *Bugging Off! * Nicole [View full post](https://www.viroxanimalhealth.com/resources/talkcleantome/2015/03/cre-ercp-omg.html) ```json { "@context" : "http://schema.org", "@type" : "BlogPosting", "author" : { "@type" : "Person", "name" : "Nicole Kenny" }, "dateModified" : "2019-03-04T15:23:19.369Z", "datePublished" : "2015-03-06T21:04:00Z", "headline" : "CRE, ERCP, OMG!", "image" : { "@type" : "ImageObject", "height" : 60, "url" : "/hs/hsstatic/content_shared_assets/static-1.4092/img/default-amp-logo.png", "width" : 60 }, "mainEntityOfPage" : "https://www.viroxanimalhealth.com/resources/talkcleantome/2015/03/cre-ercp-omg.html", "publisher" : { "@type" : "Organization", "logo" : { "@type" : "ImageObject", "height" : 60, "url" : "/hs/hsstatic/content_shared_assets/static-1.4092/img/default-amp-logo.png", "width" : 60 }, "name" : "Virox-Animal-Health-Resources" } } ```