Water as a Reservoir of Nosocomial Pathogens

Abstract

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.

Gastric Wash-Based Molecular Testing for Antibiotic Resistance in Helicobacter pylori

“…Additionally, since the PCR assay is based on DNA evaluation, contamination of gastric fluids or endoscopic equipment is possible and may result in false-positive results [31]. This suggestion should be ruled out in the present study, though, as scrupulous routine procedures in conformance to guidelines were adopted in the process of disinfecting both the endoscope and the accessories [32]. …”

An outbreak of Pseudomonas aeruginosa infections following thoracic surgeries occurring via the contamination of bronchoscopes and an automatic endoscope reprocessor

“…[23][24][25] These recommendations must be strictly followed, and the cleaning step cannot be overemphasized. Cleaning itself dramatically reduces the bioburden on endoscopes.…”

Comparison of Sterilization of Reusable Endoscopic Biopsy Forceps by Autoclaving and Ethylene Oxide Gas

“…In general, each country and set of international guidelines recommends a standardized reprocessing protocol for endoscopic accessories, including steps such as basic manual cleaning and immersion, ultrasonic cleaning, rinsing, drying, sterilization, and storage [3,[6][7][8][9][10][11]. Sterilization is the most important of these steps because it is the process through which the forceps are most effectively freed of microorganisms.…”

“…Although a few reports exist about the reprocessing of biopsy forceps, they were limited to investigation of whether the outer surfaces of the forceps, such as the cup and outer sheath, were adequately sterilized against microorganisms. Some national and international guidelines are already in place, including those of the Association for Professionals in Infection Control and Epidemiology (APIC), the European Society of Gastrointestinal Endoscopy (ESGE), and the European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA), which stipulate that autoclaving is the only reliable method for the sterilization of reusable biopsy forceps; other guidelines, such as the Korean national guidelines, do not outline an exact sterilization method [3,6,8,[10][11][12][13]. In Korea, almost all endoscopy units use EO gas sterilization instead of autoclaving because autoclaving is more likely to cause subsequent malfunctioning of the biopsy forceps.…”