Persistent contamination on colonoscopes and gastroscopes detected by biologic cultures and rapid indicators despite reprocessing performed in accordance with guidelines

Disinfection and Sterilization in Health Care Facilities

“…3,6,8,37 Additionally, recent studies have suggested that current reprocessing guidelines are not sufficient to ensure successful decontamination. 38 In order to minimize patient risks and ensure that reprocessing personnel are properly trained, there should be initial and annual competency testing for each individual who is involved in reprocessing endoscopic instruments. 13,35,36 In general, endoscope disinfection or sterilization with a liquid chemical sterilant or high-level disinfectant involves 5 steps after leak testing: (1) clean: mechanically clean internal and external surfaces, including brushing internal channels and flushing each internal channel with water and a enzymatic cleaner or detergent; (2) disinfect: immerse endoscope in high-level disinfectant (or chemical sterilant) and perfuse (eliminates air pockets and ensures contact of the germicide with the internal channels) disinfectant into all accessible channels, such as the suction/biopsy channel and air/water channel, and expose for a time recommended for specific products; (3) rinse: rinse the endoscope and all channels with sterile water, filtered water (commonly used with automated endoscope reprocessors), or tap water; (4) dry: rinse the insertion tube and inner channels with alcohol and dry with forced air after disinfection and before storage; and (5) store: store the endoscope in a way that prevents recontamination and promotes drying (eg, hung vertically).…”

Outbreaks in Health Care Settings

“…Several studies have shown a high contamination rate, 1% to 2% to 50% to 60%, depending on sampling method in appropriately cleaned and disinfected endoscopes, highlighting the challenges with new technology. 107 The high rate of microbiological contamination may be in part due to the high prevalence of biofilms seen on endoscopes. 108 Between 1966 and 2004, 19 reports of gastrointestinal endoscopy-related outbreaks were published.…”

A pilot study on using chlorine dioxide gas for disinfection of gastrointestinal endoscopes

“…The complex structure of GI endoscopes poses a challenge for thorough cleaning and HLD (Ribeiro and Oliveira, 2012;Ofstead et al, 2015). More seriously, some pathogens including Pseudomonas aeruginosae (Qiu et al, 2015) and M. abscessus (de Groote et al, 2014) show resistance to GA and OPA.…”