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GI endoscopic reprocessing practices in the United States
R J Cheung1, D Ortiz, A J DiMarino
1Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
Background:
Patient infection from contaminated gastrointestinal (GI) endoscopes can generally be attributed to failure to follow appropriate reprocessing guidelines. Recently, the Food and Drug Administration recommended a 45-minute exposure of GI endoscopes to 2.4% glutaraldehyde solutions heated to 25 degrees C. Simultaneously, the American Society for Gastrointestinal Endoscopy (ASGE), the American Gastroenterological Association, and the Society of Gastroenterology Nurses and Associates endorsed a reprocessing guideline that emphasized manual precleaning and recommended a 20-minute exposure to a 2.4% glutaraldehyde solution at room temperature. Since then, little information has become available regarding actual reprocessing practices in the United States.
Methods:
A previously developed questionnaire regarding endoscopic disinfection practices was mailed to randomly selected members of the ASGE.
Results:
The survey was sent to 730 members and 294 responded (40.3%). Appropriate manual cleaning (suctioning detergent through the accessory channel and brushing the channel and valves) is performed by 90.7% of respondents; 69.9% then use automated reprocessors for disinfection or sterilization. Glutaraldehyde is the most widely used chemical disinfectant; 85.3% use glutaraldehyde as one of their primary disinfectants. The most commonly used disinfection time with 2.4% glutaraldehyde is 20 minutes (83.9%) followed by 45 minutes (11.4%). Only 23.8% of users of 2.4% glutaraldehyde heat their solution; 59.6% of centers test disinfectant concentration daily or more frequently; 74.0% sterilize nondisposable forceps before use; 29.2% of centers re-use disposable endoscopic accessories (which are more frequently disinfected rather than sterilized). Twelve respondents reported cases of endoscopic cross infection.
Conclusions:
A significant minority of endoscopy centers still do not completely conform to recent ASGE, American Gastroenterological Association, and the Society of Gastroenterology Nurses and Associates guidelines on disinfection, and they may not be appropriately disinfecting GI endoscopes. Rigid adherence to recommended guidelines is strongly encouraged to ensure patient safety.
Insights
Many endoscopy centers do not fully follow reprocessing guidelines for gastrointestinal (GI) endoscopes, potentially risking patient safety. Adherence to disinfection protocols is crucial for preventing infections and ensuring patient well-being.
Area of Science:
- Gastroenterology
- Infection Control
- Medical Device Reprocessing
Background:
- Patient infections from gastrointestinal (GI) endoscopes are often linked to improper reprocessing.
- Recent guidelines from the FDA and professional societies offer differing reprocessing recommendations.
- Current practices in the United States following these guidelines are not well-documented.
Purpose of the Study:
- To assess current gastrointestinal endoscope reprocessing practices in the United States.
- To evaluate adherence to established disinfection and sterilization guidelines.
- To identify potential gaps in endoscope reprocessing that may impact patient safety.
Main Methods:
- A questionnaire on endoscopic disinfection practices was distributed to members of the American Society for Gastrointestinal Endoscopy (ASGE).
- The survey targeted randomly selected ASGE members to gather data on reprocessing procedures.
- Response rates and specific reprocessing steps were analyzed from returned questionnaires.
Main Results:
- A 40.3% response rate was achieved from 730 surveyed ASGE members.
- While 90.7% perform manual precleaning, 69.9% utilize automated reprocessors.
- Glutaraldehyde is the primary disinfectant for 85.3%, with 83.9% using a 20-minute exposure time; only 23.8% heat the solution.
- Disinfectant concentration testing and sterilization of reusable accessories show variable adherence.
Conclusions:
- A notable proportion of endoscopy centers do not fully comply with current ASGE and associated society guidelines for endoscope disinfection.
- Inconsistent adherence to reprocessing protocols may compromise the effectiveness of GI endoscope disinfection.
- Strict compliance with recommended guidelines is essential to guarantee patient safety and prevent cross-contamination.