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State of California—Health and Human Services Agency
California Department of Public Health

AFL 15-05
February 25, 2015

General Acute Care Hospitals (GACHs)
Ambulatory Surgery Centers (ASCs)

Endoscopic Retrograde Cholangiopancreatography (ERCP) Duodenoscopes: Difficulty Cleaning and Association with Carbapenem-Resistant Enterobacteriaceae (CRE).

​This All Facilities Letter (AFL) notifies GACHs and ASCs that perform endoscopic retrograde cholangiopancreatography (ERCP), and health care personnel responsible for these procedures and for the reprocessing of ERCP endoscopes (also called duodenoscopes), that the complex design of the duodenoscopes may impede effective reprocessing and has been associated with a number of outbreaks of infections of carbapenem-resistant Enterobacteriaceae (CRE).

On February 19, 2015, the U.S. Food and Drug Administration (FDA) issued a safety communication on this issue. The California Department of Public Health (CDPH) encourages all personnel involved with ERCP and reprocessing endoscopes to carefully review the alert at:

FDA - ERCP: Safety Communication

Send questions regarding this issue to CDPH’s Healthcare-Associated Infections Program at



Original signed by Jean Iacino

Jean Iacino
Deputy Director

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