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Endoscope Reprocessing and Infection Control

  • An endoscope consists of a flexible tube, which is passed into the digestive tract to provide a video image, and control knobs, which allow the endoscopist to maneuver the tip of the flexible tube in a precise manner. Within the tube are the electronics necessary to obtain the video image, cables that allow control of the flexible tip, and channels that permit the passage of devices to sample tissue, stop bleeding, or remove polyps. The endoscope is a complex but durable instrument and is safe for use in thousands of procedures.
  • In all areas of medicine and surgery, complex medical devices are generally not discarded after use in one patient but rather are reused in subsequent patients. This practice is very safe, provided that the devices are properly prepared, or reprocessed, prior to each procedure, so as to eliminate any risk that an infection could be transmitted from one patient to another.
  • Prior to the performance of a procedure, an endoscope must be carefully cleaned and disinfected according to guidelines published by the American Society for Gastrointestinal Endoscopy, which have been endorsed by every major medical and nursing association dealing with endoscopy and infection control.1
    • Mechanical cleaning: The operating channels and external portions of the endoscope are washed thoroughly, wiped with special detergents that contain enzymes, and brushed with special cleaning instruments. Studies have shown that these steps alone can eliminate potentially harmful viruses and other microbes from an endoscope. However, much more is done before the endoscope is considered ready for use.
    • Disinfection: Next, the endoscope is soaked continuously for an appropriate time period with one of several FDA-approved liquid chemicals that destroy microorganisms which can cause infections in humans, including the AIDS virus, hepatitis viruses, and potentially harmful bacteria.
    • Post-processing: The instrument is rinsed with water to remove residual chemicals, subjected to a final alcohol rinse, and the internal channels dried with forced air.

Risk of Infection

  • An estimate of the risk of infection from gastrointestinal endoscopy was approximately 1 in 1.8 million procedures.2
  • A recent and comprehensive review of the medical literature and the FDA database found only 35 reported cases of transmission of infection related to endoscopy in the last decade.3 Approximately 17 million lower GI procedures (colonoscopy and flexible sigmoidoscopy) are performed annually in the U.S,4 and a similar number of upper GI procedures are performed.5
  • Thus, the most recent estimate of the risk of infection is approximately 1 in 10 million procedures.6
  • Every reported case of transmission of infection has been associated with a breach in currently accepted reprocessing protocols (or defective equipment). When currently accepted reprocessing guidelines are followed, the risk of transmission of infection is virtually eliminated.

What ASGE is doing to maintain an outstanding safety record

  • ASGE guidelines for infection control during gastrointestinal endoscopy provide the latest techniques and step-by-step directions on the proper procedure for cleaning and disinfecting endoscopes. They have been reprinted in numerous professional medical journals, and are distributed to all members of the society and are regularly reviewed and updated.
  • ASGE works to promote the highest standards of safety during endoscope reprocessing. ASGE works to protect patients by issuing infection control advisories to practitioners when a potential problem is identified.
  • ASGE educates endoscopists on the importance of infection control through educational courses.

REFERENCES

  1. Nelson DB, Jarvis WR, Rutala WA, Foxx-Orenstein AE, Isenberg G, Dash GP, et al. Multi-society guideline for reprocessing flexible gastrointestinal endoscopes. Gastrointest Endosc 2003;58:1-8.
  2. Kimmey MB, Burnett DA, Carr-Locke DL, DiMarino AJ, Jensen DM, Katon R, et al. Transmission of infection by gastrointestinal endoscopy. Gastrointest Endosc 1993;36:885-8.
  3. Nelson DB. Infectious disease complications of GI endoscopy: Part II, exogenous infections. Gastrointest Endosc 2003;57:695-711.
  4. Seeff LC, Richards TB, Shapiro JA, Nadel MR, Manninen DL, Given LS, et al. How many endoscopies are performed for colorectal cancer screening? Results from CDC's survey of endoscopic capacity. Gastroenterology 2004;127:1670-7.
  5. Lieberman DA, De Garmo P, Fleischer D, Eisen GM, Helfand M. Patterns of endoscopy use in the United States. Gastroenterology 2000;118:619-24.
  6. Nelson DB, Muscarella LF. Current issues in endoscope reprocessing and infection control during gastrointestinal endoscopy. World Journal of Gastroenterology 2006;12:3593-964.

Reviewed November 2010