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      Surveillance of Endoscopes: Comparison of Different Sampling Techniques

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          To compare different techniques of endoscope sampling to assess residual bacterial contamination.


          Diagnostic study.


          The endoscopy unit of an 1,100-bed university hospital performing ~13,000 endoscopic procedures annually.


          In total, 4 sampling techniques, combining flushing fluid with or without a commercial endoscope brush, were compared in an endoscope model. Based on these results, sterile physiological saline flushing with or without PULL THRU brush was selected for evaluation on 40 flexible endoscopes by adenosine triphosphate (ATP) measurement and bacterial culture. Acceptance criteria from the French National guideline (<25 colony-forming units [CFU] per endoscope and absence of indicator microorganisms) were used as part of the evaluation.


          On biofilm-coated PTFE tubes, physiological saline in combination with a PULL THRU brush generated higher mean ATP values (2,579 relative light units [RLU]) compared with saline alone (1,436 RLU; P=.047). In the endoscope samples, culture yield using saline plus the PULL THRU (mean, 43 CFU; range, 1–400 CFU) was significantly higher than that of saline alone (mean, 17 CFU; range, 0–500 CFU; P<.001). In samples obtained using the saline+PULL THRU brush method, ATP values of samples classified as unacceptable were significantly higher than those of samples classified as acceptable ( P=.001).


          Physiological saline flushing combined with PULL THRU brush to sample endoscopes generated higher ATP values and increased the yield of microbial surveillance culture. Consequently, the acceptance rate of endoscopes based on a defined CFU limit was significantly lower when the saline+PULL THRU method was used instead of saline alone.

          Infect Control Hosp Epidemiol 2017;38:1062–1069

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          Most cited references 18

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          Transmission of infection by flexible gastrointestinal endoscopy and bronchoscopy.

          Flexible endoscopy is a widely used diagnostic and therapeutic procedure. Contaminated endoscopes are the medical devices frequently associated with outbreaks of health care-associated infections. Accurate reprocessing of flexible endoscopes involves cleaning and high-level disinfection followed by rinsing and drying before storage. Most contemporary flexible endoscopes cannot be heat sterilized and are designed with multiple channels, which are difficult to clean and disinfect. The ability of bacteria to form biofilms on the inner channel surfaces can contribute to failure of the decontamination process. Implementation of microbiological surveillance of endoscope reprocessing is appropriate to detect early colonization and biofilm formation in the endoscope and to prevent contamination and infection in patients after endoscopic procedures. This review presents an overview of the infections and cross-contaminations related to flexible gastrointestinal endoscopy and bronchoscopy and illustrates the impact of biofilm on endoscope reprocessing and postendoscopic infection.
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            Multisociety guideline on reprocessing flexible gastrointestinal endoscopes: 2011.

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              Is biofilm accumulation on endoscope tubing a contributor to the failure of cleaning and decontamination?

              We predicted that biofilm would form on surfaces of endoscope tubing in contact with fluids, and may be difficult to remove by current washing procedures. Its presence may protect micro-organisms from disinfectant action and contribute to failure of decontamination prior to re-use. Tubing samples removed from 13 endoscopes that had been sent to an endoscope-servicing centre were examined for the presence of biofilm and bacteria by scanning electron microscopy. Biological deposits were present on all samples tested. Biofilm (bacteria plus exopolysaccharides matrix) was present on the suction/biopsy channels of five of 13 instruments, and was very extensive on one of these. Bacteria and microcolonies were often but not necessarily associated with surface defects on the tubing. All 12 air/water channels examined showed biofilm, and this was extensive on nine samples. Routine cleaning procedures do not remove biofilm reliably from endoscope channels, and this may explain the unexpected failure of decontamination encountered in practice despite good adherence to infection control guidelines.

                Author and article information

                [1 ] Department of Laboratory Medicine, Ghent University Hospital , Ghent, Belgium
                [2 ] OneLIFE, Louvain-la-Neuve, Belgium
                [3 ] Endoscopy Unit, Department of Gastroenterology, Ghent University Hospital , Ghent, Belgium
                [4 ] Department of Clinical Chemistry, Microbiology, and Immunology, Ghent University , Ghent, Belgium
                [5 ] Infection Control Team, Ghent University Hospital , Ghent, Belgium
                Author notes
                Address correspondence to Isabel Leroux-Roels, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium ( Isabel.LerouxRoels@ ).
                Infect Control Hosp Epidemiol
                Infect Control Hosp Epidemiol
                Infection Control and Hospital Epidemiology
                Cambridge University Press (New York, USA )
                21 June 2017
                September 2017
                : 38
                : 9
                : 1062-1069
                S0899823X17001155 00115
                © © 2017 by The Society for Healthcare Epidemiology of America 2017

                This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (, which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited. All rights reserved.

                Figures: 1, Tables: 3, Pages: 8
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