Electronic and Microbiological Detection, Investigation, and Surveillance for Potential Hospital- Acquired Device Associated Infections at ERCP.

BACKGROUND: Duodenoscopy, done 700,000 times annually, is potentially life saving in biliary and pancreatic disease. ERCP is prone to device associated infections due to a complex elevator mechanism and slim margin of safety in scope reprocessing with a high microbial burden. Nosocomial infections are difficult to detect without a marker organism or antibiotic phenotype. A cluster of ESBL infections was detected by electronic surveillance in 2014 in a large 865 bed facility. METHODS: Utilizing electronic surveillance, a line listing of ESBLs from the prior year was made, and antibiotic phenotypes examined. After chart review, one phenotype Pattern A clustered with ERCP. Scopes were quarantined and cultured; isolates were sent out for pulsed-field gel electropheresis, and gene sequencing;patients and providers were notified; patients were offered rectal screening; additional scopes and new AERs purchased; double scope AER reprocessing with peracetic acid was centralized for five hospitals in the healthcare system; centralized weekly scope microbial sampling and monitoring after reprocessing was implemented 10/2015 using CDC guidance of March 2015; and prospective electronic surveillance of ERCP procedures was begun. RESULTS: Twenty-two phenotypes of ESBLs were found. Scope, environmental, and AER cultures were negative. Pattern A organisms were clonal. 235 patients of 274 exposed underwent screening with no additional pattern A isolated. Prevalence of ESBL colonization in this exposed cohort in New England was 11%. Scope post-reprocessing sampling and cultures were positive in 2015 for low concern organisms 5% of cultures, and one positive culture for an organism of high concern. Currently culture positivity is 1.3%, with 0% organisms of high concern for 18 months. Contamination of the culture media did occur rarely initially, and was detected by controls. Prospective electronic surveillance has identified no additional clusters. CONCLUSION: Electronic infection control surveillance will detect device associated infections, aid the investigation, and monitor procedures prospectively. The CDC guidance for weekly sampling and culturing after ERCP is easily implemented after an initial investment of training, additional scopes, and lab support; expected positivity will be < 2 %. DISCLOSURES: All authors: No reported disclosures.