Abstract
BackgroundThe instrument channels of gastrointestinal (GI) endoscopes may be heavily contaminated with bacteria even after high-level disinfection (HLD). The British Society of Gastroenterology guidelines emphasize the benefits of manually brushing endoscope channels and using automated endoscope reprocessors (AERs) for disinfecting endoscopes. In this study, we aimed to assess the effectiveness of decontamination using reprocessors after HLD by comparing the cultured samples obtained from biopsy channels (BCs) of GI endoscopes and the internal surfaces of AERs.MethodsWe conducted a 5-year prospective study. Every month random consecutive sampling was carried out after a complete reprocessing cycle; 420 rinse and swabs samples were collected from BCs and internal surface of AERs, respectively. Of the 420 rinse samples collected from the BC of the GI endoscopes, 300 were obtained from the BCs of gastroscopes and 120 from BCs of colonoscopes. Samples were collected by flushing the BCs with sterile distilled water, and swabbing the residual water from the AERs after reprocessing. These samples were cultured to detect the presence of aerobic and anaerobic bacteria and mycobacteria.ResultsThe number of culture-positive samples obtained from BCs (13.6%, 57/420) was significantly higher than that obtained from AERs (1.7%, 7/420). In addition, the number of culture-positive samples obtained from the BCs of gastroscopes (10.7%, 32/300) and colonoscopes (20.8%, 25/120) were significantly higher than that obtained from AER reprocess to gastroscopes (2.0%, 6/300) and AER reprocess to colonoscopes (0.8%, 1/120).ConclusionsCulturing rinse samples obtained from BCs provides a better indication of the effectiveness of the decontamination of GI endoscopes after HLD than culturing the swab samples obtained from the inner surfaces of AERs as the swab samples only indicate whether the AERs are free from microbial contamination or not.
Highlights
The instrument channels of gastrointestinal (GI) endoscopes may be heavily contaminated with bacteria even after high-level disinfection (HLD)
We observed a statistically significant difference in the number of samples collected from the biopsy channels (BCs) and automated endoscope reprocessors (AERs) that were positive for aerobic bacteria (p < 0.0001) (Table 1). 10.7% [32/300] of the samples collected from the BC of gastroscopes and 20.8% [25/120] samples from the colonoscopes were found to be culture-positive and were
None of the culture-positive swab samples obtained from the AERs after a complete reprocessing cycle revealed the presence of anaerobic bacteria
Summary
The instrument channels of gastrointestinal (GI) endoscopes may be heavily contaminated with bacteria even after high-level disinfection (HLD). We aimed to assess the effectiveness of decontamination using reprocessors after HLD by comparing the cultured samples obtained from biopsy channels (BCs) of GI endoscopes and the internal surfaces of AERs. Flexible endoscopes are complex reusable instruments, and according to the British Society of Gastroenterology guidelines (February 2008) for decontamination of equipment used for gastrointestinal (GI) endoscopy, special care must be taken when decontaminating endoscopes. The first step in decontamination of the GI endoscopes is thorough manual cleaning using a compatible enzymatic detergent; all accessible channels should be brushed with the detergent and flushed with sterile distilled water, before automatic disinfection using an AER We conducted this prospective study to assess the effectiveness of a complete reprocessing cycle in decontaminating GI endoscopes. We performed culture studies on the samples obtained from biopsy channels (BCs) of the upper (gastroscope) and lower (colonoscope) of the GI endoscopes and from the internal surfaces of the AERs
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