Current GI Endoscope Disinfection and QA Practices

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 reprocessing using glutaraldehyde in endoscopy services of Goiânia, Brazil

“…Similar data have been found in other studies: 61.0% of centers surveyed in the US reported that endoscopes were carried by hand and that only 26.0% used a container for transport to the reprocessing area (14) . Sealing the endoscope is recommended prior to the cleaning procedure in order to observe any leakage or escape of air from the endoscope and because the immersion in water or cleaning solution may damage the meter (16,17,23) .…”

Recent advances in epidemiology and prevention of gastrointestinal endoscopy related infections

“…Some have argued that routine environmental sampling is expensive and of little value, and that it should be reserved for investigation of outbreaks [9]. However, others have proposed surveillance cultures as a mechanism for quality assurance [10,11,12 ]. In one recent study [13 ], surveillance cultures led to the identification of an automatic endoscope reprocessing unit contaminated with Pseudomonas species, which has been previously reported [14].…”

Multisociety guideline on reprocessing flexible gastrointestinal endoscopes: 2011

“…In a 2004 survey of SGNA members at centers in the Mid-Atlantic states, compliance with published standards was, again, inconsistent, and there was wide variation in adherence to both global principles and specific steps of manual cleaning, highlevel disinfection, drying, and quality monitoring. 38 Most recently, in 2009, the CDC piloted an infection control audit tool during inspection of 68 ambulatory surgical centers in four states to assess adherence to recommended practices. 10 Adherence to recommendations for reprocessing of endoscopic equipment was not uniform in 28.4% of 67 ambulatory surgery centers.…”