[Quality-agreement colonoscopy: an outcome evaluation from the district of North-Württemberg, Germany, 2003 - 2007]

Diverse problems with the hygienically correct reprocessing of endoscopes and resulting transmissions of pathogens over the last decades are well documented. As a consequence, the worldwide first evidence-based compulsory guidelines for all endoscopy units in clinics and practices were implemented in Germany in 2002. The presented study reports for the first time ever on a detailed outcome evaluation of these guidelines. Data of all routine and all required 1st and 2nd re-examinations of endoscopes from all units (clinics and practices) performing endoscopy in the district of Nord-Württemberg, Germany, between 2003 and 2007 were analysed. A significant (p < 0.0001) overall decrease of insufficiently sterilised endoscopes was found during the observation period. The proportion of required re-examinations in clinics was below 10 % already in 2003 and remained within single figure percentages over the following years. In doctors' practices, however, in 2003 nearly every second routine examination of endoscopes required a re-examination and a significant (p < 0.0001) decrease of these figures was only found from 2004 onwards. A significant trend (p < 0.01) of re-processing techniques away from manual techniques towards fully automated procedures could be documented. No significant changes with respect to the localisation or the spectrum of the detected pathogens during control examinations were found. The presented outcome evaluation demonstrates that the implementation of stringent compulsory guidelines in Germany (and the conditional refund from the public health system for screening procedures linked to them) resulted in a substantial and significant improvement of hygiene in the re-processing of flexible endoscopes.