Testing after every duodenoscope reprocessing This algorithm describes the process for testing after every duodenoscope reprocessing. First, test duodenoscope and hold the instrument until culture results are available. Culture method options include: (A) Presence/Absence by Enrichment or (B) Quantitative. If negative, reprocess again to remove PBST and return to circulation. If positive and you choose not to identify organism, then reprocess again and re-culture. If negative, reprocess again to remove PBST and return to circulation. If positive again, identify organism. When you choose to identify organism, and if you find low-concern organisms, examples include: coagulase-negative staphylococci, micrococci, diptheroids, Bacillus spp. and other gram-positive rods, then if culture method is enrichment, 1. Reprocess and culture again and 2. Do not return to circulation until cultures are negative or are below acceptable levels of low-concern organisms† or OR if culture method is quantitative, 1.Quantify colonies, if ˂10 CFU/duodenoscope†, reprocess to remove PBST and return to circulation, 2. If ≥10CFU/duodenoscope, review facility-specific acceptable levels†, reprocess and culture again if not below acceptable levels, 3. Do not return to circulation until cultures are negative or are below acceptable levels of low-concern organisms†. When you choose to identify organism, and if you find high-concern organisms, examples include: Staphylococcus aureus, Enterococcus spp., Streptococcus sp. viridians group, Pseudomonas aeruginosa, Klebsiella spp., Salmonella spp., Shigella spp. and other enteric gram-negative bacilli, then 1. Reprocess and culture again, and 2. Do not return to circulation until cultures are negative or are below acceptable levels of low- concern organisms †. If cultures are repeatedly positive (3 times or more) for either any high-concern organisms or >10 CFU/duodenoscope of low-concern organisms, facilities should consider re-evaluating their culture technique and/or sending the duodenoscope to the manufacturer for evaluation. *This approach could be reserved specifically for patients known to be colonized or infected with or felt to be at high risk for multidrug-resistant organisms (e.g., carbapenem-resistant Enterobacteriaceae). †The levels of low-concern organisms on a duodenoscope may vary depending on the reprocessing, handling, and culturing practices in a facility. Therefore, the acceptable level of those organisms present after reprocessing can vary. Facilities can monitor the levels of low-concern organisms during the first month of surveillance testing to develop an appropriate baseline for those organisms. Typically, fewer than 10 CFU of these microbes does not require intervention; interpretation of culture results with ≥ 10 CFU of low-concern organisms should be considered in the context of expected culture results at the facility.