Download PDF
Endoscopy 2003; 35(4): 295-299
DOI: 10.1055/s-2003-38149
Original Article
© Georg Thieme Verlag Stuttgart · New York

Do Conventional Cleaning and Disinfection Techniques Avoid the Risk of Endoscopic Helicobacter pylori Transmission?

M.  Nürnberg 1 , H.  J.  Schulz 1 , H.  Rüden 2 , K.  Vogt 3
  • 1 Oskar Ziethen Hospital, Lichtenberg, Berlin, Germany
  • 2 Institute of Hygiene, Free University of Berlin, Berlin, Germany
  • 3 Institute of Microbiology, Free University of Berlin, Berlin, Germany
Further Information

Publication History

Submitted 14 August 2001

Accepted after Revision 16 December 2002

Publication Date:
27 March 2003 (online)

Also available at
    Permissions and Reprints

Background and Study Aims: The aim of the present study was to determine whether endoscopes serve as a reservoir for Helicobacter pylori and whether the disinfection technique currently recommended for manual cleaning and disinfection of the instruments completely removes the risk of H. pylori transmission.
Patients and Methods: A prospective study was carried out in 400 patients who were undergoing upper gastrointestinal endoscopy for routine clinical indications. The patients’ H. pylori status of the patients was identified using a urea detection system (HUT) and culture. H. pylori contamination was assayed by culturing rinsing samples from the endoscopes before and after manual cleaning and disinfection. Gastric biopsies were assayed using rapid urease testing (Helicobacter urease test, HUT) of two antral and gastric body biopsies and cultures.
Results: A total of 128 of the 400 patients examined were found to be H. pylori-positive using HUT testing. Endoscopes were contaminated in 54 of the 128 rinsing samples from endoscopes used in H. pylori-positive patients (42 %) before cleaning and disinfection. One of the 128 rinsing samples (0.8 %) was found to be contaminated with H. pylori even after routine manual cleaning and disinfection - indicating that these cleaning and disinfection procedures may be insufficient to eradicate H. pylori from endoscopes completely. No seroconversion was observed during serological follow-up in the patient who had previously been examined with an endoscope contaminated with H. pylori. The patient was still found to be seronegative 5 months after inoculation.
Conclusions: Endoscopes are frequently contaminated with H. pylori immediately after gastroduodenal endoscopy in H. pylori-infected patients. Iatrogenic transmission is possible, as H. pylori can survive manual cleaning and disinfection with 2 % glutaraldehyde, particularly when there is ineffective cleaning before disinfection.

References

  • 1 Guenther T, Roesser A. Pathomorphologisches Spektrum der Helicobacter-pylori-Infektion.  Verdauungskrankheiten. 1998;  2 63-69
    PubMedGoogle Scholar
  • 2 Miehlke S, Meining A, Bayerdörffer E, Malfertheiner P. Helicobacter-pylori-Infektion und die Entwicklung von Magenneoplasien.  Verdauungskrankheiten. 1998;  16 77-83
    PubMedGoogle Scholar
  • 3 Breuer T. Epidemiologie der Helicobacter-pylori-assoziierten gastroduodenalen Erkrankungen.  Verdauungskrankheiten. 1998;  16 48-55
    PubMedGoogle Scholar
  • 4 Makristathis A, Pasching E, Schutze K. et al . Detection of Helicobacter pylori in stool specimens by PCR and antigen enzyme immunoassay.  J Clin Microbiol. 1998;  36 2772-2774
    PubMedGoogle Scholar
  • 5 Enroth H, Engstrand L. Immunomagnetic separation and polymerase chain reaction for detection of Helicobacter pylori in water and stool specimen.  J Clin Microbiol. 1995;  33 2162-2165
    PubMedGoogle Scholar
  • 6 Mapstone N, Lynch D A, Lewis F A. et al . Identification of Helicobacter pylori DNA in the mouths and stomachs of patients with gastritis using PCR.  J Clin Pathol. 1993;  46 540-543
    PubMedGoogle Scholar
  • 7 Gandolfi L. High seroprevalence of IgG against Helicobacter pylori among endoscopists in Taiwan.  Gastrointest Endosc. 1997;  46 292-294
    PubMedGoogle Scholar
  • 8 Kaneko H, Mitsuma T, Kotera H. et al . Are routine cleaning methods sufficient to remove Helicobacter pylori from endoscopic equipment?.  Endoscopy. 1993;  25 435-436
    PubMedGoogle Scholar
  • 9 Katoh M, Saito D, Noda T. et al . Helicobacter pylori may be transmitted through gastrofibroendoscope even after manual hyamine washing.  Jpn J Cancer Res. 1993;  84 117-119
    PubMedGoogle Scholar
  • 10 Langenberg W, Rauws E A, Oudbier J H, Tytgat G N. Patient-to-patient transmission of Campylobacter pylori infection by fiberoptic duodenoscopy and biopsy.  J Infect Dis. 1990;  161 507-511
    PubMedGoogle Scholar
  • 11 Miyaji H, Kohli Y, Azuma T. et al . Endoscopic cross-infection with Helicobacter pylori.  Lancet. 1995;  345 464
    PubMedGoogle Scholar
  • 12 Rohr M R, Castro R, Morais M. et al . Risk of Helicobacter pylori transmission by upper gastrointestinal endoscopy.  Am J Infect Control. 1998;  26 12-15
    PubMedGoogle Scholar
  • 13 Saito T, Fujino M A. Postendoscopic acute gastritis: bacteriological and serological study of an acute infection of Helicobacter pylori. In: Proceedings of the International Gastroenterology Meeting,. 1994: 2-8
    Google Scholar
  • 14 Shimada T, Terano A, Ota S. et al . Risk of iatrogenic transmission of Helicobacter pylori by gastroscopes.  Lancet. 1996;  347 1342-1343
    PubMedGoogle Scholar
  • 15 Sugiyama T, Naka H, Yachi H. et al . Direct evidence by DNA fingerprinting that endoscopic cross-infection of Helicobacter pylori is a cause of postendoscopic acute gastritis.  J Clin Microbiol. 2000;  6 2381-2382
    PubMedGoogle Scholar
  • 16 Ahuja V, Tandon R K. Survey of gastrointestinal endoscope disinfection and accessory reprocessing practices in the Asia-Pacific region.  J Gastroenterol Hepatol. 2000;  15 (Suppl.) G78-G81
    CrossrefPubMedGoogle Scholar
  • 17 DiMarino A J Jr. Noncompliance with FDA and society guidelines for endoscopic reprocessing: implications for patient care.  Gastrointest Endosc Clin N Am. 2000;  10 283-294
    PubMedGoogle Scholar
  • 18 Ayliffe G A. Nosocomial infection associated with endoscopy. In: Mayhall CG (ed) Baltimore; Williams & Wilkins 1996: 680-693
  • 19 Babb J R, Bradley C R. Endoscope decontamination: where do we go from here?.  J Hosp Infect. 1995;  30 (Suppl.) 543-551
    PubMedGoogle Scholar
  • 20 Favero M S, Pugliese G. Infection transmitted by endoscopy: an international problem.  Am J Infect Dis. 1996;  24 343-345
    PubMedGoogle Scholar
  • 21 Kohli Y, Myaji H, Azuma T. et al . Clinical significance of sterilization of endoscopic instruments.  Dig Endosc. 1993;  5 33-37
    PubMedGoogle Scholar
  • 22 Krakamp B. Sicherung der Aufbereitung flexibler Endoskope in der Praxis.  Hyg Med. 1998;  23 69-72
    PubMedGoogle Scholar
  • 23 Lee R ML, Kozarek R A, Sudmida S E. et al . Risk of contamination of sterile biopsy forceps in disinfected endoscopes.  Gastrointest Endosc. 1998;  47 377-381
    PubMedGoogle Scholar
  • 24 Muscarella L F. Advantages and limitations of automatic flexible endoscope reprocessors.  Am J Infect Control. 1996;  24 304-309
    PubMedGoogle Scholar
  • 25 Moayedi P, Lynch D, Axon A. Pseudomonas and endoscopy.  Endoscopy. 1996;  26 554-558
    PubMedGoogle Scholar
  • 26 Ponchon T. Transmission of hepatitis C and prion diseases through digestive endoscopy: evaluation of risk and recommended practices.  Endoscopy. 1997;  29 199-202
    PubMedGoogle Scholar
  • 27 Schlaefer F. Serious bacterial infections after endoscopic procedure.  Arch Intern Med. 1996;  156 572-574
    CrossrefPubMedGoogle Scholar
  • 28 Spach D H, Silverstein F E, Stamm W E. Transmission of infection by gastrointestinal endoscopy and bronchoscopy.  Ann Intern Med. 1993;  118 117-128
    PubMedGoogle Scholar
  • 29 Becheur H, Harzic M, Colardelle P. et al . Contamination des endoscopes et des pinces à biopsies par le virus de l’hépatite C.  Gastroenterol Clin Biol. 2000;  24 906-910
    PubMedGoogle Scholar
  • 30 Fantry G T, Zheng Q X, James S P. Conventional cleaning and disinfection techniques eliminate the risk of endoscopic transmission of Helicobacter pylori.  Am J Gastroenterol. 1995;  90 228-232
    PubMedGoogle Scholar
  • 31 Alvarado C J, Reichelderfer M. APIC guidelines for infection prevention and control in flexible endoscopy. Association for Professionals in Infection Control.  Am J Infect Control. 2000;  28 138-155
    CrossrefPubMedGoogle Scholar
  • 32 European Society of Gastrointestinal Endoscopy. Guidelines on cleaning and disinfection in GI endoscopy: update 1999. Endoscopy 2000 32: 77-80
    Google Scholar
  • 33 Wischnewski N, Kampf G, Gastmeier P. et al . Empfehlungen zur manuellen und maschinellen Aufbereitung von Duodenoskopen.  Verdauungskrankheiten. 1998;  16 199-205
    PubMedGoogle Scholar
  • 34 Kist M, Bereswill S. Helicobacter pylori. Epidemiologie, Diagnose und Therapie.  Mikrobiologe. 1997;  7 209-210
    PubMedGoogle Scholar
  • 35 Vogt K, Lehmann C, Körber J. et al .Überlebensrate von H. pylori unter verschiedenen Transportbedingungen in vitro [abstract].  Paper presented at the Conference of the German Society for Hygiene and Microbiology (Deutsche Gesellschaft für Hygiene und Mikrobiologie). Berlin; 4 - 9 October 1998
    Google Scholar
  • 36 Leodolter A, Hackelsberger A, Malfertheiner P. Diagnoseverfahren in Praxis und spezialisierten Zentren zum Nachweis der Helicobacter-pylori-Infektion.  Verdauungskrankheiten. 1998;  16 84-92
    PubMedGoogle Scholar
  • 37 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
    CrossrefPubMedGoogle Scholar
  • 38 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
    Google Scholar
  • 39 Ishino Y, Ido K, Koiwai H. et al . Pitfalls in endoscope reprocessing: brushing of air and water channels is mandatory for high-level disinfection.  Gastrointest Endosc. 2001;  53 165-168
    CrossrefPubMedGoogle Scholar
  • 40 Alvarado C. Reconciliation of FDA and societal guidelines for endoscope reprocessing.  Gastrointest Endosc Clin N Am. 2000;  10 275-281
    PubMedGoogle Scholar
  • 41 Sytchenko R, Marchetti B, Canard J N. et al . Guidelines of the French Society of Digestive Endoscopy: recommendations for setting up cleaning and disinfection procedures in gastrointestinal endoscopy.  Endoscopy. 2000;  32 807-818
    Article in Thieme ConnectPubMedGoogle Scholar
  • 42 Deutsche Gesellschaft für Hygiene und Mikrobiologie. Desinfektionsmittel-Liste der DGHM: Liste der nach den Richtlinien für die Prüfung chemischer Desinfektionsmittel geprüften und von der Deutschen Gesellschaft für Hygiene und Mikrobiologie als wirksam befundenen Desinfektionsverfahren. Status: 3 March 2000. Berlin; Deutsche Gesellschaft für Hygiene und Mikrobiologie 2000
    Google Scholar
  • 43 Hüppe D, Sommer A, Eisenbach T. Leistungsspektrum niedergelassener Gastroenterologen in Deutschland 1996.  Verdauungskrankheiten. 1998;  16 3-9
    PubMedGoogle Scholar
  • 44 Nilius M, Malfertheiner P. Diagnostische Verfahren bei Helicobacter-pylori-Infektion. In: Malfertheiner P (ed) Helicobacter pylori - von der Grundlage zur Therapie. Stuttgart; Thieme 1996: 139-147
    Google Scholar
  • 45 Jaskowski T D, Martins T B, Hill H R, Litwin C M. Immunoglobulin A antibodies to Helicobacter pylori.  J Clin Microbiol. 1997;  35 2999-3000
    PubMedGoogle Scholar
  • 46 Kosunen T U, Seppälä K, Sipponen P. Diagnostic value of decreasing IgG, IgA and IgM antibody titres after eradication of Helicobacter pylori.  Lancet. 1992;  339 893-895
    CrossrefPubMedGoogle Scholar
  • 47 Cheung R A, Ortiz D, DiMarino A J. GI endoscopic reprocessing practices in the United States.  Gastrointest Endosc. 1999;  50 362-368
    CrossrefPubMedGoogle Scholar
  • 48 Kaczmarek R G, Moore R M, McCrohan J. et al . Multi-state investigation of the actual disinfection/sterilization of endoscopes in health care facilities.  Am J Med. 1992;  92 257-261
    CrossrefPubMedGoogle Scholar
  • 49 Leiss O, Exner M, Niebel J. Vermeidung einer Infektionsübertragung in der Endoskopie: Hygienische Aufbereitung flexibler Endoskope und Maßnahmen zum Personalschutz.  Leber Magen Darm. 1995;  25 251-257
    PubMedGoogle Scholar
  • 50 Muscarella L F. Automatic flexible endoscope reprocessors.  Gastrointest Endosc Clin N Am. 2000;  10 245-257
    PubMedGoogle Scholar

H. J. Schulz, M.D.

Oskar Ziethen Hospital

Fanninger Strasse 32 · 10365 Berlin · Germany

Fax: + 49-30-55182250

Email: schulz@khl-berlin.de