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Digestive Diseases and Sciences

, Volume 49, Issue 11–12, pp 1791–1797 | Cite as

Current GI Endoscope Disinfection and QA Practices

  • Frank M. MosesEmail author
  • Jennifer S. Lee
Article

Abstract

High-level disinfection (HLD) of GI endoscopes is readily achieved when published guidelines are observed. Contamination is linked to breakdowns in accepted procedure. However, there is no recognized method of verifying adequacy of endoscope reprocessing in routine practice and no data regarding current quality assurance (QA) practice. Prior reports have demonstrated a wide variation in routine clinical practice of GI endoscopy HLD. The goal of this study was to determine current practice at regional endoscopy centers with regard to endoscope cleaning and HLD, maintenance, and QA practice. An anonymous multiple-choice questionnaire was mailed to 367 SGNA members in Pennsylvania, Delaware, Virginia, Maryland, and District of Columbia and completed by 230 (63%). The majority of responders were hospital-based and 59% of the units performed over 3000 procedures per year. After use the endoscope was hand-carried or transported in a dry container (97%) to a separate cleaning room (85%) for HLD by technicians (40%). Wide variations existed in manual step procedures including use of disposable (50%) brushes and number of times channel brushed: once (21%), twice (35%), or three to five times (37%). Soaking duration in disinfectant (70% gluteraldehyde) was for ≤10 min (8%), 10–20 min (35%), 20–30 min (38%), 30–40 min (7%), and >40 min (3%). Sixty-seven percent had an active unit infection control (IC) service and 98% had a QA program. Monitoring of cleaning effectiveness was by visual inspection (50%) and culturing endoscopes (17%). Culture was done weekly (1%) and ≤ biannually (6.5%) and performed by swabing the endoscope end (5%) or rinsing the biopsy channel (8%). If culture positive, most would remove the instrument from clinical use and reevaluate the protocol and personnel for technique lapses. Two respondents were aware of a procedure-related infection. Wide practice variations were noted in manual cleaning and in soaking time during automated HLD in this community. Fewer variations were noted in cleaning personnel and training, location and methods of cleaning, and presence of IC services and QA programs. Endoscope culturing was infrequently done and positive cultures were rare. While most units claim to have ongoing QA programs, few use objective criteria to monitor effective disinfection or lapses in technique. Iatrogenic infection is uncommonly recognized following GI endoscope procedures.

endoscope disinfection quality assurance practices 

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References

  1. 1.
    Technology Assessment Position Paper: Transmission of Infection by Gastrointestinal Endoscopy. Manchester, MA, ASGE, 1993Google Scholar
  2. 2.
    Lewis DL: A sterilization standard for endoscopes and other difficult to clean medical devices. Pract Gastroenterol 23:28–56, 1999Google Scholar
  3. 3.
    Davis R: Medicine’s dirty little secret. Hard-to-clean endoscopes can transmit infection. USA Today Feb 18, 1999 Sect D, pp 1, 2Google Scholar
  4. 4.
    Underwood A: Do scopes spread sickness? Newsweek Mar 1, 1999, p 72Google Scholar
  5. 5.
    Spach DH, Silverstein FE, Stamm WE: Transmission of infection by gastrointestinal endoscopy and bronchoscopy. Ann Intern Med 118:117–128, 1993CrossRefGoogle Scholar
  6. 6.
    Walker SB: Guideline for the use of high-level disinfectants and sterilants for reprocessing of flexible gastrointestinal endoscopes. Gastroenterol Nurs 22:127–134, 1999CrossRefGoogle Scholar
  7. 7.
    Kovacs BJ, Chen YK, Kettering JD, Aprecio RM, Roy I: High-level disinfection of gastrointestinal endoscopes: Are current guidelines adequate? Am J Gastroenterol 94:1546–1550, 1999CrossRefGoogle Scholar
  8. 8.
    Foliente RL, Kovacs BJ, Aprecio RM, Bains HJ, Kettering JD, Chen YK: Efficacy of high-level disinfectants for reprocessing GI endoscopes in simulated-use testing. Gastrointest Endosc 53:456–462, 2001CrossRefGoogle Scholar
  9. 9.
    Cheung RJ, Ortiz D, DiMarino AJ: GI endoscopic reprocessing practices in the United States. Gastrointest Endosc 50:263–268, 1999CrossRefGoogle Scholar
  10. 10.
    Leung J, Vallero R, Wilson R: Surveillance cultures to monitor quality of gastrointestinal endoscope reprocessing. Am J Gastroenterol 98:3–5, 2003CrossRefGoogle Scholar
  11. 11.
    Moses FM, Lee J: Surveillance cultures to monitor quality of gastrointestinal endoscope reprocessing. Am. J Gastroenterol 98:77–81, 2003CrossRefGoogle Scholar
  12. 12.
    Nelson DB: Infection control during gastrointestinal endoscopy. J Lab Clin Med 141:159–167, 2003CrossRefGoogle Scholar
  13. 13.
    Gorse GJ, Messner RL: Infection control practices in gastrointestinal endoscopy in the United States: A national survey. Infect Control Hosp Epidemiol 12:289–296, 1991CrossRefGoogle Scholar
  14. 14.
    Rutala WA, Clontz EP, Weber DJ, Hoffmann KK: Disinfection practices for endoscopes and other semicritical items. Infect Control Hosp Epidemiol 12:282–288, 1991CrossRefGoogle Scholar
  15. 15.
    Kaczmarek RG, Moore RM, McCrohan J, Goldmann DA, Reynolds C, Caquelin C, Israel E: Multi-state investigation of the actual disinfection/sterilization of endoscopes in health care facilities. Am. J Med 92:257–261, 1992CrossRefGoogle Scholar
  16. 16.
    Brullet E, Ramirez-Armengol JA, Camp R, et al.: Cleaning and disinfection practices in digestive endoscopy in Spain: Results of a national survey. Endoscopy 33:864–868, 2001CrossRefGoogle Scholar
  17. 17.
    Alfa MJ, Olson N, DeGagne P, Jackson M: A survey of reprocessing methods, residual viable bioburden, and soil levels in patient-ready endoscopic retrograde choliangiopancreatography duodenoscopes used in Canadian centers. Infect Control Hosp Epidemiol 23:198–206, 2002CrossRefGoogle Scholar
  18. 18.
    Position Statement: Multi-society guideline for reprocessing flexible gastrointestinal endoscopes. Gastrointest Endosc 58:1–8, 2003; Am J Infect Control 31:309–315, 2003CrossRefGoogle Scholar
  19. 19.
    Muscarella LF: Application of environmental sampling to flexible endoscope reprocessing: The importance of monitoring the rinse water. Infect Cont Hosp Epidemiol 23:285–289, 2002CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, Inc. 2004

Authors and Affiliations

  1. 1.Gastroenterology ServiceWalter Reed Army Medical CenterWashingtonUSA

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