Hostname: page-component-848d4c4894-m9kch Total loading time: 0 Render date: 2024-05-31T10:51:12.935Z Has data issue: false hasContentIssue false
  • English
  • Français

Multi-society Guideline for Reprocessing Flexible Gastrointestinal Endoscopes

Published online by Cambridge University Press:  02 January 2015

Douglas B. Nelson ,
William R. Jarvis ,
William A. Rutala ,
Amy E. Foxx-Orenstein ,
Gerald Isenberg ,
Georgia P. Dash ,
Carta J. Alvarado ,
Marilee Ball ,
Joyce Griffin-Sobel  and
Carol Petersen
...Show all authors
Get access Rights & Permissions [Opens in a new window]

Extract

The beneficial role of gastrointestinal endoscopy for the prevention, diagnosis, and treatment of many digestive diseases and cancer is well established. Like many sophisticated medical devices, the endoscope is a complex, reusable instrument that requires reprocessing before being used on subsequent patients. The most commonly used methods for reprocessing endoscopes result in high-level disinfection. To date, all published episodes of pathogen transmission related to gastrointestinal endoscopy have been associated with failure to follow established cleaning and disinfection/sterilization guidelines or use of defective equipment. Despite the strong published data regarding the safety of endoscope reprocessing, concern over the potential for pathogen transmission during endoscopy has raised questions about the best methods for disinfection or sterilization of these devices between patient uses.

Type
SHEA Position Paper
Information
Infection Control & Hospital Epidemiology , Volume 24 , Issue 7 , July 2003 , pp. 532 - 537
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2003

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Favero, MS, Bond, WW. Disinfection of medical and surgical materials. In: Block, SS, ed. Disinfection, Sterilization, and Preservation. Philadelphia: Lippincott Williams & Wilkins; 2001:881–917.Google Scholar
2.Spach, DH, Silverstein, FE, Stamm, WE. Transmission of infection by gastrointestinal endoscopy and bronchoscopy. Ann Intern Med 1993;118:117–128.CrossRefGoogle ScholarPubMed
3.Kimmey, MB, Burnett, DA, Carr-Locke, DL, et al. Transmission of infection by gastrointestinal endoscopy. Gastrointest Endosc 1993;36:885–888.CrossRefGoogle Scholar
4.Lo Passo, C, Pernice, I, Celeste, A, Perdichizzi, G, Todaro-Luck, F. Transmission of Trichosporon asahii esophagitis by a contaminated endoscope. Mycoses 2001;44:13–21.CrossRefGoogle ScholarPubMed
5.Bronowicki, J-P, Venard, V, Botté, C, et al. Patient-to-patient transmission of hepatitis C virus during colonoscopy. N Engl J Med 1997;337:237–240.CrossRefGoogle ScholarPubMed
6.Le Pogam, S, Gondeau, A, Bacq, Y. Nosocomial transmission of hepatitis C virus. Ann Intern Med 1999;131:794.CrossRefGoogle ScholarPubMed
7.Tennenbaum, R, Colardelle, P, Chochon, M, Maisonneuve, P, Jean, F, Andrieu, J. Hepatitis C after retrograde cholangiography [in French]. Gastroenterol Clin Biol 1993;17:763–775.Google ScholarPubMed
8.Food and Drug Administration. Draft Guidance for the Content of Premarket Notifications for Endoscopes Used in Gastroenterology and Urology. Rockville, MD: National Press Office; 1995.Google Scholar
9.Garner, JS, Favero, MS. CDC guideline for handwashing and hospital environmental control, 1985. Infect Control 1986;7:231–243.Google Scholar
10.DiMarino, AJ Jr, Leung, J, Ravich, W, et al. Reprocessing of flexible gastrointestinal endoscopes. Gastrointest Endosc 1996;43:540–546.CrossRefGoogle Scholar
11.Alvarado, CJ, Reichelderfer, M. APIC guidelines for infection prevention and control in flexible endoscopy. Am J Infect Control 2000;28:138–155.CrossRefGoogle ScholarPubMed
12.American Society for Testing and Materials. Standard Practice for Cleaning and Disinfection of Flexible Fiberoptic and Video Endoscopes Used in the Examination of the Hollow Viscera. West Conshohocken, PA: American Society for Testing and Materials; 2000. F1518-00.Google Scholar
13.Association of Perioperative Registered Nurses. Recommended Practices for Use and Care of Endoscopes: 2002 Standards, Recommended Practices, and Guidelines. Denver: Association of Perioperative Registered Nurses; 2002:229–232.Google Scholar
14.Society of Gastroenterology Nurses and Associates. Standards of infection control in reprocessing of flexible gastrointestinal endoscopes. Gastroenterology Nursing 2000;23:172–187.CrossRefGoogle Scholar
15.Gorse, GJ, Messner, RL. Infection control practices in gastrointestinal endoscopy in the United States: a national survey. Infect Control Hosp Epidemiol 1991;12:289–296.CrossRefGoogle ScholarPubMed
16.Kaczmarek, RG, Moore, RM Jr, John, M, et al. Multi-state investigation of the actual disinfection/sterilization of endoscopes in health care facilities. Am J Med 1992;92:257–261.CrossRefGoogle ScholarPubMed
17.Reynolds, CD, Rhinehart, E, Dreyer, P, Goldman, DA. Variability in reprocessing policies and procedures for flexible fiberoptic endoscopes in Massachusetts hospitals. Am J Infect Control 1992;20:283–290.CrossRefGoogle ScholarPubMed
18.Jackson, FW, Ball, MD. Correction of deficiencies in flexible fiberoptic sigmoidoscope cleaning and disinfection technique in family practice and internal medicine offices. Arch Fam Med 1997;6:578–582.CrossRefGoogle ScholarPubMed
19.Cheung, RJ, Ortiz, D, DiMarino, AJ Jr. GI endoscopic reprocessing practices in the United States. Gastrointest Endosc 1999;50:362–368.CrossRefGoogle ScholarPubMed
20.Muscarella, LF. Current instrument reprocessing practices: results of a national survey. Gastroenterology Nursing 2001;24:253–260.CrossRefGoogle ScholarPubMed
21.Rutala, WA, Weber, DJ, the Healthcare Infection Control Practices Advisory Committee. Guideline for disinfection and sterilization in healthcare facilities. Am J Infect Control. In preparation.Google Scholar
22.Merritt, K, Hitchins, VM, Brown, SA. Safety and cleaning of medical materials and devices. J Biomed Mater Res 2000;53:131–136.3.0.CO;2-I>CrossRefGoogle ScholarPubMed
23.Babb, JR, Bradley, CR. Endoscope reprocessing: where do we go from here? J Hosp Infect 1995;30:543–551.CrossRefGoogle Scholar
24.Hanson, PJV, Gor, D, Clarke, JR, et al. Contamination of endoscopes used in AIDS patients. Lancet 1989;2:86–88.CrossRefGoogle ScholarPubMed
25.Vesley, D, Norlien, KG, Nelson, B, Ott, B, Streifel, AJ. Significant factors in the disinfection and sterilization of flexible endoscopes. Am J Infect Control 1992;20:291–300.CrossRefGoogle ScholarPubMed
26.Rutala, WA. APIC guideline for selection and use of disinfectants. Am J Infect Control 1996;24:313–342.CrossRefGoogle ScholarPubMed
27.Urayama, S, Kozarek, RA, Sumida, S, Raltz, S, Merriam, L, Pethigal, P. Mycobacteria and glutaraldehyde: is high-level disinfection of endoscopes possible? Gastrointest Endosc 1996;43:451–456.CrossRefGoogle ScholarPubMed
28.British Society of Gastroenterology. Cleaning and disinfection of equipment for gastrointestinal endoscopy: report of a Working Party of the British Society of Gastroenterology Endoscopy Committee. Gut 1998;42:585–593.CrossRefGoogle Scholar
29.Chu, NS, McAlister, D, Antonoplos, PA. Natural bioburden levels detected on flexible gastrointestinal endoscopes after clinical use and manual cleaning. Gastrointest Endosc 1998;48:137–142.CrossRefGoogle ScholarPubMed
30.Cronmiller, JR, Nelson, DK, Salman, G, et al. Antimicrobial efficacy of endoscopic disinfection procedures: a controlled, multifactorial investigation. Gastrointest Endosc 1999;50:152–158.CrossRefGoogle ScholarPubMed
31.Kovacs, BJ, Chen, YK, Kettering, JD, Aprecio, RM, Roy, I. High-level disinfection of gastrointestinal endoscopes: are current guidelines adequate? Am J Gastroenterol 1999;94:1546–1550.CrossRefGoogle ScholarPubMed
32.Vesley, D, Melson, J, Patricia, S. Microbial bioburden in endoscope reprocessing and an in-use evaluation of the high-level disinfection capabilities of Cidex PA. Gastroenterology Nursing 1999;22:63–68.CrossRefGoogle Scholar
33.The European Society of Gastrointestinal Endoscopy. Guidelines on cleaning and disinfection in GI endoscopy. Endoscopy 2000;32:77–83.Google Scholar
34.Graham, DY, Osato, MS. Disinfection of biopsy forceps and culture of Helicobacter pylori from gastric mucosal biopsies. Am J Gastroenterol 1999;94:1422–1423.CrossRefGoogle ScholarPubMed
35.Association of Perioperative Registered Nurses. Recommended Practices for High-Level Disinfection: 2002 Standards, Recommended Practices, and Guidelines. Denver: Association of Perioperative Registered Nurses; 2002:211–216.Google Scholar
36.Food and Drug Administration. FDA-Cleared Sterilants and High Level Disinfectants With General Claims for Processing Reusable Medical and Dental Devices 1/30/02. Rockville, MD: National Press Office; 2002. Available at www.fda.gov/cdrh/ode/germlab.html. Accessed December 9, 2002.Google Scholar
37.Collins, FM. Kinetics of tuberculocidal response by alkaline glutaraldehyde in solution and on an inert surface. J Appl Bacteriol 1986;61:87–93.CrossRefGoogle Scholar
38.Collins, FM. Bactericidal activity of alkaline glutaraldehyde solution against a number of atypical mycobacterial species. J Appl Bacteriol 1986;61:247–251.CrossRefGoogle ScholarPubMed
39.Ascenzi, JM, Ezzell, RJ, Wendt, TM. A more accurate method for measurement of tuberculocidal activity of disinfectants. Appl Environ Microbiol 1987;53:2189–2192.CrossRefGoogle ScholarPubMed
40.Collins, FM. Use of membrane filters for measurement of mycobacterial activity of alkaline glutaraldehyde solution. Appl Environ Microbiol 1987;53:737–739.CrossRefGoogle Scholar
41.Best, M, Sattar, SA, Springthorpe, VS, Kennedy, ME. Efficacies of selected disinfectants against Mycobacterium tuberculosis. J Clin Microbiol 1990;28:2234–2239.CrossRefGoogle ScholarPubMed
42.Cole, EC, Rutala, WA, Nessen, L, Wannamaker, NS, Weber, DJ. Effect of methodology, dilution, and exposure time on the tuberculocidal activity of glutaraldehyde-based disinfectants. Appl Environ Microbiol 1990;56:1813–1817.CrossRefGoogle ScholarPubMed
43.Hanson, PJV, Gor, D, Jeffries, DJ, Collins, JV. Elimination of high titre HIV from fiberoptic endoscopes. Gut 1990;31:657–659.CrossRefGoogle Scholar
44.Hanson, PJ, Jeffries, DJ, Collins, JV. Viral transmission and fibreoptic endoscopy. J Hosp Infect 1991;18:136–140.CrossRefGoogle ScholarPubMed
45.Rutala, WA, Cole, EC, Wannamaker, NS, Weber, DJ. Inactivation of Mycobacterium tuberculosis and Mycobacterium bovis by 14 hospital disinfectants. Am J Med 1991;91(suppl 3B):267S–271S.CrossRefGoogle ScholarPubMed
46.Hanson, PJ, Chadwick, MV, Gaya, H, Collins, JV. A study of glutaraldehyde disinfection of fibreoptic bronchoscopes experimentally contaminated with Mycobacterium tuberculosis. J Hosp Infect 1992;22:137–142.CrossRefGoogle ScholarPubMed
47.Best, M, Springthorpe, VS, Sattar, SA. Feasibility of a combined carrier test for disinfectants: studies with a mixture of five types of microorganisms. Am J Infect Control 1994;22:152–162.CrossRefGoogle ScholarPubMed
48.Jackson, J, Leggett, JE, Wilson, D, Gilbert, DN. Mycobacterium gordonae in fiberoptic bronchoscopes. Am J Infect Control 1996;24:19–23.CrossRefGoogle ScholarPubMed
49.Chanzy, B, Due-Bin, DL, Rousset, B, et al. Effectiveness of a manual disinfection procedure in eliminating hepatitis C virus from experimentally contaminated endoscopes. Gastrointest Endosc 1999;50:147–151.CrossRefGoogle ScholarPubMed
50.Fuselier, HA Jr, Mason, C. Liquid sterilization versus high level disinfection in the urologic office. Urology 1997;50:337–340.CrossRefGoogle ScholarPubMed
51.Rutala, WA, Weber, DJ. Disinfection of endoscopes: review of new chemical sterilants used for high-level disinfection. Infect Control Hosp Epidemiol 1999;20:69–76.CrossRefGoogle ScholarPubMed
52.Rutala, WA, Weber, DJ. Importance of lumen flow in liquid chemical sterilization. Am J Infect Control 1999;20:458–459.Google Scholar
53.Sorin, M, Segal-Maurer, S, Urban, C, Combest, A, Rahal, JJ. Nosocomial transmission of imipenem-resistant Pseudomonas aeruginosa following bronchoscopy associated with improper connection to the Steris System 1 processor. Infect Control Hosp Epidemiol 2001;20:514–516.Google Scholar
54.Centers for Disease Control and Prevention. Bronchoscopy-related infections and pseudoinfections: New York, 1996 and 1998. MMWR 1999;48:557–560.Google Scholar
55.Allen, JI. Pseudomonas aeruginosa infection during endoscopy: reply. Gastroenterology 1987;93:1451. Letter.CrossRefGoogle Scholar
56.Streulens, MJ, Rost, F, Deplano, A, et al. Pseudomonas aeruginosa and Enterobacteriaceae bacteremia after biliary endoscopy: an outbreak investigation using DNA macrorestriction analysis. Am J Med 1993;95:489–498.CrossRefGoogle Scholar
57.O'Connor, HJ, Babb, JR, Ayliffe, GAJ. Pseudomonas aeruginosa infection during endoscopy. Gastroenterology 1987;93:1451.CrossRefGoogle ScholarPubMed
58.Alvarado, CJ, Stolz, SM, Maki, DG. Nosocomial infections from contaminated endoscopes: a flawed automated endoscope washer. An investigation using molecular epidemiology. Am J Med 1991;91(suppl 3B):272S–280S.CrossRefGoogle ScholarPubMed
59.Centers for Disease Control and Prevention. Nosocomial infection and pseudoinfection from contaminated endoscopes and bronchoscopes: Wisconsin and Missouri. MMWR 1991:40:675–678.Google Scholar
60.Fraser, VJ, Jones, M, Murray, PR, Medoff, G, Zhang, Y, Wallace, RJ Jr. Contamination of flexible fiberoptic bronchoscopes with Mycobacterium chelonae linked to an automated bronchoscope disinfection machine. Am Rev RespirDis 1992;145:853–855.CrossRefGoogle Scholar
61.Gerding, DN, Peterson, LR, Vennes, JA. Cleaning and disinfection of fiberoptic endoscopes: evaluation of glutaraldehyde exposure time and forced-air drying. Gastroenterology 1982;83:613–618.CrossRefGoogle ScholarPubMed
62.Allen, JI, Allen, MOC, Olson, MM, et al. Pseudomonas infection of the biliary system resulting from use of a contaminated endoscope. Gastroenterology 1987;92:759–763.CrossRefGoogle ScholarPubMed
63.Alfa, MJ, Sitter, DL. In hospital evaluation of contamination of duodeno-scopes: a quantitative assessment of the effects of drying. J Hosp Infect 1991;19:89–98.CrossRefGoogle ScholarPubMed
64.Noy, MF, Harrison, L, Holmes, GKT, Cockel, R. The significance of bacterial contamination of fiberoptic endoscopes. J Hosp Infect 1980;1:53–61.CrossRefGoogle Scholar
65.Meenhorst, PL, Reingold, AL, Groothuis, D. Water-related nosocomial pneumonia caused by Legionella pneumophila serogroups 1 and 10. J Infect Dis 1985;152:356–364.CrossRefGoogle ScholarPubMed
66.Wright, EP, Collins, CH, Yates, MD. Mycobacterium xenopi and Mycobacterium kansasii in a hospital water supply. J Hosp Infect 1985;6:175–178.CrossRefGoogle Scholar
67.Rutala, WA, Weber, DJ. Water as a reservoir of nosocomial pathogens. Infect Control Hosp Epidemiol 1997;18:609–616.CrossRefGoogle ScholarPubMed
68.Wallace, RJ Jr, Brown, BA, Driffith, DE. Nosocomial outbreaks/pseudo-outbreaks caused by nontuberculous mycobacteria. Annu Rev Microbiol 1998;52:453–490.CrossRefGoogle ScholarPubMed
69.Nelson, DB, Barkun, AN, Block, KP, et al. Transmission of infection by gastrointestinal endoscopy. Gastrointest Endosc 2001;54:824–828.CrossRefGoogle ScholarPubMed
70.Rutala, WA, Hamory, BH. Expanding role of hospital epidemiology: employee health–chemical exposure in the health care setting. Infect Control Hosp Epidemiol 1989;10:261–266.CrossRefGoogle ScholarPubMed
71.Occupational Safety and Health Administration. Air contaminants, final rule. 58 Federal Register 35338–35351 (1993).Google Scholar
72.Weber, DJ, Rutala, WA. Occupational risks associated with the use of selected disinfectants and sterilants. In: Rutala, WA, ed. Disinfection, Sterilization, and Antisepsis in Healthcare. Champlain, NY: Polyscience Publications; 1998:211–226.Google Scholar
73.American Conference of Governmental Industrial Hygienists. Threshold Limit Values for Chemical Substances and Physical Agents and Biologic Exposure Indices. Cincinnati: American Conference of Governmen Industrial Hygienists; 2001.Google Scholar
74. Occupational Safety and Health Administration: hazard communication standard, 29 CFR 1910.1200.Google Scholar
75.Occupational Safety and Health Administration: occupational exposure to bloodborne pathogens, final rule. 56 Federal Register 64003–64182 (1991).Google Scholar
76.Carr-Locke, DL, Conn, MI, Faigel, DO, et al. Personal protective equipment. Gastrointest Endosc 1999;49:854–857.Google ScholarPubMed
77.Bond, WW, Hedrick, ER. Microbiological culturing of environment and medical-device surfaces. In: Isenberg, HD, Gilchrist, MJR, eds. Clinical Microbiology Procedures Handbook. Washington, DC: American Society for Microbiology; 1992:11.0.1–11.0.9.Google Scholar
78.Dixon, RE. Investigation of endemic and epidemic nosocomial infection data. In: Bennett, JL, Brachman, P, eds. Hospital Infection, 3rd ed. Boston: Little Brown; 1992:109–135.Google Scholar
79.Food and Drug Administration. Medical device reporting (MDR). Available at www.fda.gov/cdrh/mdr/. Accessed November 20, 2002.Google Scholar