Subscribe to RSS
DOI: 10.1055/s-2001-14959
© Georg Thieme Verlag Stuttgart · New York
Freely Accessible Endoscope Channels Improve Efficacy of Cleaning
Publication History
Publication Date:
31 December 2001 (online)
![](https://www.thieme-connect.de/media/endoscopy/200106/lookinside/thumbnails/10.1055-s-2001-14959-1.jpg)
Background and Study Aims: Inadequate cleaning and disinfection of medical devices, including flexible endoscopes, can result in the transmission of micro-organisms to patients. The aim of this study was to investigate the influence of the design of medical devices on the efficacy of manual cleaning of endoscope channels.
Materials and Methods: The investigation was carried out using four endoscopes (two duodenoscopes and two gastroscopes). The air/water channels of one duodenoscope and one gastroscope were freely accessible and could be brushed. The instrumentation and the air/water channels were contaminated with blood containing Enterococcus faecium as a test organism. After manual cleaning of the channels by flushing and, where possible, brushing, the recovery rates for the test organism were studied.
Results: The comparable rates for recovery of the test organism after cleaning of the instrumentation channels proved that the method used was reproducible. With regard to the air/water channels, the rate of micro-organisms in the cleaning solution recovered after flushing alone was a maximum of 3 % relative to the rate detected after brushing and flushing.
Conclusions: The data collected in the study show that only flushing channels that are not freely accessible resulted in significantly lower (P < 0.001) recovery rates for the test organism. In practice, this means that contamination may remain in the channels, and it shows that the design of a medical device has an important influence on the reprocessing of reusable instruments such as flexible endoscopes.
References
- 1 Allen J, O’Connor-Allen M, Olson M M. Pseudomonas infection of the biliary system resulting from usage of a contaminated endoscope. Gastroenterology. 1987; 92 759-763
- 2 Singh S, Singh R, Kochhar R, et al. Contamination of an endoscope due to Trichosporon beigelli. . J Hosp Infect. 1989; 14 49-53
- 3 Langenberg W, Rauws E AJ, Oudbier J H, Tytgat G NJ. Patient-to-patient transmission of Campylobacter pylori by fiberoptic gastroduodenoscopy and biopsy. J Infect Dis. 1990; 161 507-511
- 4 Nye K, Chadha D K, Hodgkin P, et al. Mycobacterium chelonei isolation from broncho-alveolar lavage fluid and its practical implications. J Hosp Infect. 1990; 16 257-261
- 5 Gorse G J, Messner R L. Infection control practices in gastrointestinal endoscopy in the United States: a national survey. Infect Control Hosp Epidemiol. 1991; 12 289-296
- 6 Spach D H, Silverstein F E, Stamm W E. Transmission of infection by gastrointestinal endoscopy. Ann Intern Med. 1993; 118 117-128
- 7 Campagnaro R L, Teichtahl H, Dwyer B. A pseudoepidemic of Mycobacterium chelonae: contamination of a bronchoscope and autocleaner. Aust NZ J Med. 1994; 24 693-695
- 8 McCracken J. Endoscopy reveals debris, fluid, and damage in patient-ready GI endoscopes. Infect Control Steriliz Technol. 1995; 1 32-43
- 9 Members of the American Society for Gastrointestinal Endoscopy Ad Hoc Committee on Disinfection . Reprocessing of flexible gastrointestinal endoscopes. Gastrointest Endosc. 1996; 43 540-546
- 10 Agerton T, Valway S, Gore B, et al. Transmission of a high drug-resistant strain (strain W1) of Mycobacterium tuberculosis: community outbreak and nosocomial transmission via a contaminated. bronchoscope.: JAMA. 1997; 278 1073-1077
- 11 Blanc D S, Parret T, Janin B, et al. Nosocomial infections and pseudoinfections from contaminated bronchoscopes: two-year follow-up using molecular markers. Infect Control Hosp Epidemiol. 1997; 18 134-135
- 12 Bronowicki J P, Vernard V, Botte C, et al. Patient-to-patient transmission of hepatitis C virus during colonoscopy. N Engl J Med. 1997; 337 237-240
- 13 Michele T M, Cronin W A, Graham N MH, et al. Transmission of Mycobacterium tuberculosis by a fiberoptic bronchoscope. JAMA. 1997; 278 1093-1095
- 14 Alvarado C J, Reichelderfer M. APIC guideline for infection prevention and control in flexible endoscopy. Am J Infect Control. 2000; 28 138-155
- 15 British Society for Gastroenterology Endoscopy Committee Working Party . Cleaning and disinfection of equipment for gastrointestinal endoscopy: report of a Working Party of the British Society of Gastroenterology Endoscopy Committee. Gut. 1998; 42 585-593
- 16 Anonymous . Richtlinie zur Aufbereitung von Endoskopen (Guidelines on endoscope preparation). Vienna: Bundesministerium für Arbeit, Gesundheit und Soziales (Federal Ministry of Labor, Health and Social Affairs) (GZ 204.509/30-VIII/A/8/98, 10.6.98). Mitt Sanitätsverwalt. 1998; 12 20-22
- 17 Anonymous .Guide to the preparation, use and quality assurance of blood components. Bonn; UNO-Verlag/Council of Europe Publishing 2000
- 18 Lewis D. A sterilization standard for endoscopes and other difficult to clean medical devices. Pract Gastroenterol. 1999; 23 28-56
- 19 Anonymous . Testing and evaluating the cleaning and disinfection efficacy of endoscope washer/disinfectors and disinfection automates. Hyg Med. 1995; 20 40-47
- 20 Anonymous . Richtlinie für die Prüfung und Bewertung chemischer Desinfektionsverfahren. Erster Teilabschnitt (Stand 1.1.1981) (Guidelines for testing and evaluating chemical disinfection processes, part 1 [1. Jan 1981]). Zbl Bakt Hyg I Abt Org B. 1981; 172 534-562
- 21 Spicher G, Peters J. Eine Methode zur Kontamination von Testobjekten mit gerinnendem Blut. (A method of contaminating test objects with coagulating blood). Zbl Bakt Hyg B. 1985; 182 89-94
- 22 Alfa M, Sitter D L. In-hospital evaluation of contamination of duodenoscopes: a quantitative assessment of the effect of drying. Hosp Infect Soc. 1991; 19 89-98
- 23 Chan-Myers H, McAlister D, Antonoplos P. Natural bioburden levels detected on rigid lumened medical devices before and after cleaning. Am J Infect Control. 1997; 25 471-476
- 24 Chu N, McAlister D, Antonoplos P A. Natural bioburden levels detected on flexible gastrointestinal endoscopes after clinical use and manual cleaning. Gastrointest Endosc. 1998; 48 137-142
- 25 Rutala W, Gergen M F, Jones J F, Weber D J. Levels of microbial contamination on surgical instruments. Am J Infect Control. 1998; 26 143-145
- 26 Alfa M, Degagne P, Olson N. Worst-case soiling levels for patient-used flexible endoscopes before and after cleaning. Am J Infect Control. 1999; 27 392-401
- 27 Vesley D, Melson J, Stanley P. Microbial bioburden in endoscope reprocessing and in-use evaluation of high-level disinfection capabilities of Cidex PA. Gastroenterol Nurs. 1999; 22 63-68
- 28 Cronmiller J, Nelson D K, Salman G, et al. Antimicrobial efficacy of endoscopic disinfection procedures: a controlled, multifactorial investigation. Gastrointest Endosc. 1999; 50 152-158
- 29 Anonymous .Washer-disinfectors, part 1: general requirements, definitions and tests (prEN ISO 15 883 - 1). Berlin; Beuth, 1999
- 30 Chaufour X, Deva A K, Vickery K, et al. Evaluation of disinfection and sterilization of reusable angioscopes with the duck hepatitis B model. J Vasc Surg. 1999; 30 277-282
B. Dietze, M.D.
Technische Hygiene
Universitätsklinikum Benjamin Franklin
Hindenburgdamm 27
12203 Berlin
Germany
Fax: Fax:+ 49-30-8445-4490
Email: E-mail:martiny@medizin.fu-berlin.de