Infection Control During Gastrointestinal Endoscopy

Abstract

Dr Douglas Nelson is a staff physician in the department of gastroenterology at the Minneapolis VA Medical Center (Minnesota, USA) and a Professor of Medicine at the University of Minnesota (USA). He has written numerous articles on the subject of infection control during gastrointestinal endoscopy, and was the lead author of the "Multi-society guideline for reprocessing flexible gastrointestinal endoscopes" (1).

Intestinal obstruction associated with chronic peritonitis caused by Sphingomonas paucimobilis

“…For simple EGDS, with or without biopsies, the reported rate of bacteremia ranges from 0% to 8%, with a mean frequency of 4%. The risk of bacteremia does not seem to increase with biopsy or polypectomy [33,34]. More invasive endoscopic procedures associated with a higher incidence of bacteremia are oesophageal stricture dilatation (5-62%), sclerotherapy for oesophageal varices (0-52%), and laser therapy in upper gastrointestinal tract (31-34%) [35,36].…”

“…Among upper gastrointestinal tract endoscopic procedures, bacterial peritonitis has been described only after oesophageal sclerotherapy and endoscopic variceal ligation, with a mean rate of 2.3% (range 1.1-60%) and 3.7% (range 0-15.8%), respectively [33][34][35][36][37]. However, this bacterial peritonitis, which occurs after a lag of 1-4 days, is not necessarily related to the bacteremia that occurs within 24 h of the procedure.…”

Effectiveness of current disinfection procedures against biofilm on contaminated GI endoscopes

“…In clinical practice, favorable conditions for the bacterial biofilm formation can be found in a variety of settings, including on the surface of GI endoscope channels 14,15 . Biofilm formation is M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT usually regarded as a stepwise process, in which microorganisms attach to wet surfaces, where they form communities embedded in a polysaccharide matrix 16 .…”

Estimation of average bioburden values on flexible gastrointestinal endoscopes after clinical use and cleaning: Assessment of the efficiency of cleaning processes

“…The mean frequency of post-procedure bacteremia ranges from 0.5% for flexible sigmoidoscopy to 2.2% for colonoscopy, 4.2% for esophagogastroduodenoscopy, 8.9% for variceal ligation, 11% for endoscopic retrograde cholangiopancreatography, 15.4% for variceal sclerotherapy, and 22.8% for esophageal dilation. 25 Although post-procedure bacteremia is not uncommon, it seldom results in infectious complications. Exogenous infections transmitted during endoscopy, which are extremely rare, generally result from failure to follow accepted guidelines for the cleaning and disinfection of gastrointestinal endoscopes, underscoring the importance of meticulous attention to endoscope reprocessing.…”

“…Finally, although the risk of patient-staff transmission of infection is also rare, standard infection-control recommendations are important in protecting both patients and health-care providers. 25 Gastrointestinal procedures have been associated with a wide range of infectious complications, including bacterial endocarditis. Although the rate of bacteremia from patient's own flora is quite high after some procedures, only a few cases of endocarditis caused by gastrointestinal instrumentation have been reported.…”