TheEcoli isolatewashighly related(>92%)toall casepatient
isolatesbypulsed-fieldgelelectrophoresis.Endoscopereprocessingprocedureswerereviewedandnolapseswereidentified.
Further,
the automatedendoscopereprocessor(AER)wasfunctioning
correctly and the duodenoscopes were not damaged. The
facility notified the 226 patientswhohad potential exposure to
a culture-positive endoscope.Twenty-sevenadditional case patientswere
identifiedbyactive surveillancewhowere colonized
and had been exposed to a duodenoscope. No additional cases
were identified after the hospital changed its endoscope reprocessing
from automated high-level disinfection with orthophthalaldehyde
to gas sterilizationwith ethylene oxide.