Outbreak of glutaraldehyde-induced proctocolitis

Area of Science:

• Gastroenterology
• Infectious Disease Prevention
• Medical Device Disinfection

Background:

• An outbreak of hemorrhagic proctocolitis was linked to glutaraldehyde disinfectant for colonoscopes.
• Inadequate rinsing procedures were identified as a potential cause.
• Glutaraldehyde is recognized as a potential irritant capable of inducing colitis.

Purpose of the Study:

• To retrospectively assess the incidence of proctocolitis following colonoscopy in patients exposed to glutaraldehyde-disinfected colonoscopes.
• To compare the proctocolitis rate in glutaraldehyde-exposed patients with those exposed to a previous detergent cleaning procedure.

Main Methods:

• Colonoscopic procedures were randomly selected from periods using glutaraldehyde and detergent disinfectants.
• Patients completed a telephone questionnaire detailing post-colonoscopy symptoms.
• Data were analyzed to compare proctocolitis occurrence between the two cleaning methods.

Main Results:

• Higher frequencies of proctocolitis (14/299 vs 3/242) and severe proctocolitis (10/299 vs 1/242) were observed with glutaraldehyde use.
• Severe hemorrhagic proctocolitis occurred significantly more often in the glutaraldehyde group (6/299 vs 0/242).
• Younger age was associated with proctocolitis exclusively during the glutaraldehyde period (p = 0.0008).

Conclusions:

• Inadequate rinsing of colonoscopes disinfected with glutaraldehyde can lead to proctocolitis.
• The proctocolitis is likely caused by the direct irritant action of glutaraldehyde on the colonic mucosa.
• Symptoms resolved spontaneously, with no pathogens identified in stool cultures.