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Recent Update of Gastrointestinal Endoscope Reprocessing

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      Abstract

      As infection-related issues have become one of the most important concerns in endoscopy centers, proper reprocessing of endoscopes has attracted great interest. Compliance with established guidelines for reprocessing is critical to prevent pathogen transmission. However, hospital compliance with guidelines has not been satisfactory. To increase compliance, efforts have focused on developing new and more innovative disinfectants and an automated endoscope reprocessor. Reprocessing must be performed by appropriately trained personnel and regular monitoring of reprocessing is essential for quality assurance to improve compliance.

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      Transmission of infection by gastrointestinal endoscopy and bronchoscopy.

      To review reports on the transmission of infections by flexible gastrointestinal endoscopy and bronchoscopy in order to determine common infecting microorganisms, circumstances of transmission, and methods of risk reduction. Relevant English-language articles were identified through prominent review articles and a MEDLINE search (1966 to July 1992); additional references were selected from the bibliographies of identified articles. All selected articles related to transmission of infection by gastrointestinal endoscopy or bronchoscopy; 265 articles were reviewed in detail. Two hundred and eighty-one infections were transmitted by gastrointestinal endoscopy, and 96 were transmitted by gastrointestinal endoscopy, spectrum of these infections ranged from asymptomatic colonization to death. Salmonella species and Pseudomonas aeruginosa were repeatedly identified as the causative agents of infections transmitted by gastrointestinal endoscopy, and Mycobacterium tuberculosis, atypical mycobacteria, and P. aeruginosa were the most common causes of infections transmitted by bronchoscopy. One case of hepatitis B virus transmission via gastrointestinal endoscopy was documented. Major reasons for transmission were improper cleaning and disinfection procedures; the contamination of endoscopes by automatic washers; and an inability to decontaminate endoscopes, despite the use of standard disinfection techniques, because of their complex channel and valve systems. The most common agents of infection transmitted by endoscopy are Salmonella, Pseudomonas, and Mycobacterium species. To prevent endoscopic transmission of infections, recommended disinfection guidelines must be followed, the effectiveness of automatic washers must be carefully monitored, and improvements in endoscope design are needed to facilitate effective cleaning and disinfection.
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        Multisociety guideline on reprocessing flexible gastrointestinal endoscopes: 2011.

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          Cleaning and disinfection of equipment for gastrointestinal endoscopy. Report of a Working Party of the British Society of Gastroenterology Endoscopy Committee.

          (1998)
          Two per cent glutaraldehyde is the most commonly used disinfectant in endoscopy units within the UK. Unfortunately adverse reactions to glutaraldehyde are common among endoscopy personnel and the Health and Safety Commission has recommended substantial reductions in atmospheric levels of glutaraldehyde in order to comply with the Control of Substances Hazardous to Health Regulations, 1994. The Working Party addressed ways of eliminating or minimising exposure to glutaraldehyde in endoscopy units by reviewing alternative disinfectants and the use of automated washer/disinfectors. Alternatives to glutaraldehyde must be at least as microbicidal as glutaraldehyde, non-irritating and compatible with endoscope components and decontamination equipment. Peracetic acid is a highly effective disinfectant and may be a suitable alternative to glutaraldehyde. Peracetic acid has a vinegary-like odour and is claimed to be less irritating than glutaraldehyde. Experience with this agent remains relatively limited and the Working Party recommends that peracetic acid should be used in sealed or exhaust ventilated facilities until further experience is obtained. It is considerably more expensive than glutaraldehyde, is less stable and large volumes have to be stored. It causes cosmetic (but not functional) damage to endoscopes and is not compatible with some washer/ disinfectors. Chlorine dioxide is a powerful oxidising agent and highly effective as a disinfectant. Once activated it must be stored in sealed containers with little head space. Fumes cause irritation and sealed or exhaust ventilated facilities are necessary. The agent may damage some metallic and polymer components of endoscopes and automated washer/disinfectors and compatibility should be established with equipment manufacturers before the agent is used. Other disinfectants such as peroxygen compounds and quaternary ammonium derivatives are less suitable because of unsatisfactory mycobactericidal and/or virucidal activity, or incompatibility with endoscopes and automated washer/disinfectors. Alcohol is effective but, on prolonged contact, is damaging to lens cements. It is also flammable and therefore unsuitable for use in large quantities in automated systems. Superoxidised water (Sterilox) is an electrochemical solution (anolyte) containing a mixture of radicals with strong oxidising properties. It is highly microbicidal when freshly generated, provided items are thoroughly clean and strict generation criteria are met--that is, current, pH, redox potential. It seems to be safe for users and provided field trials substantiate laboratory efficacy tests, and the agent is non-damaging, it too may become an alternative to glutaraldehyde. When 2% glutaraldehyde is used for manual and automated disinfection, 10 minutes' immersion is recommended for endoscopes before the session and between patients. This will destroy vegetative bacteria and viruses (including hepatitis B virus (HBV) and HIV). A five minute contact period is recommended for 0.35% peracetic acid and for chlorine dioxide (1100 ppm av ClO2), but if immersed for 10 minutes sporicidal activity will also be achieved. At the end of each session 20 minutes' immersion in glutaraldehyde or five minutes in peracetic acid or chlorine dioxide is recommended. Microbiological studies show that 20 minutes of exposure to 2% glutaraldehyde destroys most organisms, including Mycobacterium tuberculosis. The Working Party concludes therefore that immersion of the endoscope in 2% glutaraldehyde for 20 minutes is sufficient for endoscopy involving patients with AIDS and other immunodeficiency states or pulmonary tuberculosis. Similarly, 20 minutes' immersion is recommended at the start of the list and between cases for endoscopic retrograde cholangiopancreatography (ERCP) when high level disinfection is required. Cleaning and disinfection of endoscopes should be undertaken by trained staff in a dedicated room. Thorough cleaning with detergent
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            Author and article information

            Affiliations
            Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea.
            Author notes
            Correspondence: Yun Jeong Lim. Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, 27 Dongguk-ro, Ilsandong-gu, Goyang 410-773, Korea. Tel: +82-31-961-7133, Fax: +82-31-961-9339, limyj@ 123456dongguk.ac.kr
            Journal
            Clin Endosc
            Clin Endosc
            CE
            Clinical Endoscopy
            The Korean Society of Gastrointestinal Endoscopy
            2234-2400
            2234-2443
            May 2013
            31 May 2013
            : 46
            : 3
            : 267-273
            23767038
            3678065
            10.5946/ce.2013.46.3.267
            Copyright © 2013 Korean Society of Gastrointestinal Endoscopy

            This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

            Categories
            Review

            Radiology & Imaging

            endoscopy, gastrointestinal, reprocessing, compliance

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