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A Prospective Randomized Trial Comparing Manual and Automated Endoscope Disinfection Methods

Published online by Cambridge University Press:  21 June 2016

Victoria J. Fraser ,
Gary Zuckerman ,
Ray E. Clouse ,
Susan O'Rourke ,
Marilyn Jones ,
Jean Klasner  and
Patrick Murray
Victoria J. Fraser*
Affiliation:
Division of Infectious Disease, Washington University School of Medicine and Barnes Hospital, St. Louis, Missouri
Gary Zuckerman
Affiliation:
Division of Gastroenterology, Washington University School of Medicine and Barnes Hospital, St. Louis, Missouri
Ray E. Clouse
Affiliation:
Division of Gastroenterology, Washington University School of Medicine and Barnes Hospital, St. Louis, Missouri
Susan O'Rourke
Affiliation:
Department of Pathology, Washington University School of Medicine and Barnes Hospital, St. Louis, Missouri
Marilyn Jones
Affiliation:
Department of Pathology, Washington University School of Medicine and Barnes Hospital, St. Louis, Missouri
Jean Klasner
Affiliation:
Department of Pathology, Washington University School of Medicine and Barnes Hospital, St. Louis, Missouri
Patrick Murray
Affiliation:
Department of Medicine, the Division of Laboratory Medicine, Washington University School of Medicine and Barnes Hospital, St. Louis, Missouri
*
Box 8051, Infectious Disease, Barnes Hospital, 660 S. Euclid, St. Louis, MO 63110
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Abstract

Objective:

To compare the efficacy of endoscope disinfection using automated and manual systems.

Design:

Prospective randomized trial.

Setting:

A 1,000-bed tertiary care referral center.

Methods:

All endoscopes underwent a three-stage decontamination process including brushing and cleaning with water and detergent, manual or automated disinfection with 2% glutaraldehyde, and 70% alcohol rinse with forced air drying. Cultures were obtained from endoscopes from both groups before and after alcohol rinse and then after overnight storage.

Results:

Cultures from 8/30 (27%) automated and 11/30 (37%) manually disinfected (P= 0.58) endoscopes grew gram-negative bacteria and/or nontuberculous mycobacteria before the alcohol rinse. After alcohol rinse, 3 (10%) of 30 automated and 8 (27%) of 30 manually disinfected endoscopes remained contaminated (P= 0.28). Manually disinfected endoscopes were contaminated more frequently with coliform bacteria, whereas endoscopes undergoing automated disinfection were more frequently contaminated with nontuberculous mycobacteria, but the differences were not statistically significant. After alcohol rinse and forced air drying, there was no difference in contamination rates between freshly disinfected endoscopes and those stored overnight (7/30 (23%) versus 4/30 (13%), P= 0.50). Colonoscopes and duodenoscopes were contaminated more often than gastroscopes (P=0.00001).

Conclusion:

The persistent endoscope contamination after manual and automated disinfection indicates the importance of developing more reliable and effective disinfection methods.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 14 , Issue 7 , July 1993 , pp. 383 - 389
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1993

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References

1. Shahmir, M, Schuman, BM. Complications of fiberoptic endoscopy. Gastrointest Endosc 1980;26:86–91.CrossRefGoogle ScholarPubMed
2. Classen, DC, Jacobson, JA, Burke, JP, Jackson, JT, Evans, RS. Serious pseudomonas infections associated with endoscopic retrograde cholangiopancreatography, Am J Med 1988;84:590–596.CrossRefGoogle ScholarPubMed
3. Langenberg, W, Rauws, EAJ, Oudbrer, JN, Tytgat, GNJ. Patient to patient transmission of Campylobacter pylori infection by fiberop tic gastroduodenoscopy and biopsy. J Infect Dis 1990;161:507–511.CrossRefGoogle Scholar
4. Beecham, HJ, Cohen, ML, Parkin, WE. Salmonella typhimurium transmission by fiberoptic upper gastrointestinal kndoscopy. JAMA 1979;241:1013–1015.CrossRefGoogle Scholar
5. Allen, JJ, Allen, MO, Olsen, MM, et al. Pseudomonas infection of the biliary system resulting from the use of a contaminated endoscope. Gastroenterology 1987;92:759–763.CrossRefGoogle ScholarPubMed
6. O'Conner, HJ, Babb, JR, Ayliffe, GAJ. Pseudomonas aeruginosa infection during endoscopy. Gastroenterology 1987;92:1451.CrossRefGoogle Scholar
7. Doherty, DE, Falko, JM, Lefkovitzs, N, Rogers, J, Fromkes, J. Pseudomonas aeruginosa sepsis following retrograde cholangiopancreatography (ERCP). Dig Dis Sci 1982;27:169–170.CrossRefGoogle Scholar
8. Schuessler, KN, Rozendaal, B, Taal, C, Meawissen, SGM. Outbreak of Salmonella agona infection after upper intestinal fiberoptic endoscopy. Lancet 1980;1246.Google Scholar
9. Bernie, GG, Quigley, EM, Clements, GB. Case report: endoscopic transmission of hepatitis B virus. Gut 1983;24:171–174.CrossRefGoogle Scholar
10. O'Connor, HJ, Axon, ATR. Gastrointestinal endoscopy: infection and disinfection. Gut 1983;24:1067–1077.CrossRefGoogle ScholarPubMed
11. Karim, QN, Rao, GG, Taylor, M, Baron, JH. Routine cleaning and elimination of Campylobacter pylori from endoscopic biopsy forceps. J Hosp Infect 1989;13:87–90.CrossRefGoogle ScholarPubMed
12. 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)272–280.CrossRefGoogle ScholarPubMed
13. Alvarado, CJ, Stolz, SM, Maki, DM, et al. Nosocomial infections and pseudoinfection from contaminated endoscopes and bronchoscopes, Wisconsin and Missouri. MMWR 1991;40:675–678.Google Scholar
14. 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
15. Babb, JR, Bradley, CR Ayliie, GAJ. Comparison of automated systems for the cleaning and disinfection of flexible fiberoptic endoscopes. J Hosp Infect 1984;5:213–226.CrossRefGoogle Scholar
16. Vesley, D, Norllien, KG, Nelson, B, Ott, B, Streifel, AJ. Significant factors in the disinfection and sterilization of flexible endoscopes. Am I Infect Control 1992;20:291–300.CrossRefGoogle ScholarPubMed
17. Kaczmarek, RG, Moore, RM, McCrohan, J, et al. Multistate investigation of the actual disinfection/sterilization of endoscopes in health care facilities. Am J Med 1992;92:257–261.CrossRefGoogle Scholar
18. Rutala, WA APIC guideline for selection and use of disinfectants. Am J Infect Control 1990;18:99–117.CrossRefGoogle ScholarPubMed
19. Garner, JS, Favero, MS. Guideline for handwashing and hospital environment control, 1985. Am /Infect Control 1986;14:110–126.CrossRefGoogle Scholar
20. Bond, WW, Ott, BJ, Franke, KE, McCracken, JE. Effective use of liquid chemical germicides on medical devices: instrument design problems. In: Block, , ed. Disinfection, Sterilization and Preservation. Philadelnhia. PA Lea & Febiaer: 1991.Google Scholar
21. Favero, MS. Strategies for disinfection and sterilization of endoscopes: the gap between basic principles and actual practice. Infect Control Hosp Ehdemiol 1991;12:279–281.CrossRefGoogle ScholarPubMed
22. Gorse, GJ, Messner, RL. Infection control practice in gastrointestinal endoscopy in the United States: a national survey. Infect Control Hosp Epidemiol 1991;12:289–296.CrossRefGoogle ScholarPubMed
23. Rutala, WA, Clontz, EP, Weber, DJ, Hoffmann, KK. Disinfection practices for endoscopes and other semi-critical items. Infect Control Hosp Epidemiol 1991;12:282–288.CrossRefGoogle ScholarPubMed
24. Collignon, I? Graham, E. How well are endoscoues cleaned and disinfected between patients? Med J Australia 1989;151:269–272.CrossRefGoogle ScholarPubMed
25. Hanson, PJV, Gor, D, Jeffries, DJ, Collins, JV. Elimination of high titre HIV from fiberoptic endoscopes. Gut 1990;31:657–659.CrossRefGoogle Scholar
26. Bond, WW, Moncada, RE. Viral hepatitis B infection risk in flexible fiberoptic endoscopy. Gastrointest Endosc 1978;24:225–230.CrossRefGoogle ScholarPubMed