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Multi-society Guideline for Reprocessing Flexible Gastrointestinal Endoscopes

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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.

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1.Favero, MS, Bond, WW. Disinfection of medical and surgical materials. In: Block, SS, ed. Disinfection, Sterilization, and Preservation. Philadelphia: Lippincott Williams & Wilkins; 2001:881917.
2.Spach, DH, Silverstein, FE, Stamm, WE. Transmission of infection by gastrointestinal endoscopy and bronchoscopy. Ann Intern Med 1993;118:117128.
3.Kimmey, MB, Burnett, DA, Carr-Locke, DL, et al. Transmission of infection by gastrointestinal endoscopy. Gastrointest Endosc 1993;36:885888.
4.Lo Passo, C, Pernice, I, Celeste, A, Perdichizzi, G, Todaro-Luck, F. Transmission of Trichosporon asahii esophagitis by a contaminated endoscope. Mycoses 2001;44:1321.
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;337:237240.
6.Le Pogam, S, Gondeau, A, Bacq, Y. Nosocomial transmission of hepatitis C virus. Ann Intern Med 1999;131:794.
7.Tennenbaum, R, Colardelle, P, Chochon, M, Maisonneuve, P, Jean, F, Andrieu, J. Hepatitis C after retrograde cholangiography [in French]. Gastroenterol Clin Biol 1993;17:763775.
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 Draft Guidance for the Content of Premarket Notifications for Endoscopes Used in Gastroenterology and Urology.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.
9.Garner, JS, Favero, MS. CDC guideline for handwashing and hospital environmental control, 1985. Infect Control 1986;7:231243.
10.DiMarino, AJ Jr, Leung, J, Ravich, W, et al. Reprocessing of flexible gastrointestinal endoscopes. Gastrointest Endosc 1996;43:540546.
11.Alvarado, CJ, Reichelderfer, M. APIC guidelines for infection prevention and control in flexible endoscopy. Am J Infect Control 2000;28:138155.
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.
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; 2002:229232.
14.Society of Gastroenterology Nurses and Associates. Standards of infection control in reprocessing of flexible gastrointestinal endoscopes. Gastroenterology Nursing 2000;23:172187.
15.Gorse, GJ, Messner, RL. Infection control practices in gastrointestinal endoscopy in the United States: a national survey. Infect Control Hosp Epidemiol 1991;12:289296.
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;92:257261.
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;20:283290.
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;6:578582.
19.Cheung, RJ, Ortiz, D, DiMarino, AJ Jr. GI endoscopic reprocessing practices in the United States. Gastrointest Endosc 1999;50:362368.
20.Muscarella, LF. Current instrument reprocessing practices: results of a national survey. Gastroenterology Nursing 2001;24:253260.
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.
22.Merritt, K, Hitchins, VM, Brown, SA. Safety and cleaning of medical materials and devices. J Biomed Mater Res 2000;53:131136.
23.Babb, JR, Bradley, CR. Endoscope reprocessing: where do we go from here? J Hosp Infect 1995;30:543551.
24.Hanson, PJV, Gor, D, Clarke, JR, et al. Contamination of endoscopes used in AIDS patients. Lancet 1989;2:8688.
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;20:291300.
26.Rutala, WA. APIC guideline for selection and use of disinfectants. Am J Infect Control 1996;24:313342.
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;43:451456.
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;42:585593.
29.Chu, NS, McAlister, D, Antonoplos, PA. Natural bioburden levels detected on flexible gastrointestinal endoscopes after clinical use and manual cleaning. Gastrointest Endosc 1998;48:137142.
30.Cronmiller, JR, Nelson, DK, Salman, G, et al. Antimicrobial efficacy of endoscopic disinfection procedures: a controlled, multifactorial investigation. Gastrointest Endosc 1999;50:152158.
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;94:15461550.
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;22:6368.
33.The European Society of Gastrointestinal Endoscopy. Guidelines on cleaning and disinfection in GI endoscopy. Endoscopy 2000;32:7783.
34.Graham, DY, Osato, MS. Disinfection of biopsy forceps and culture of Helicobacter pylori from gastric mucosal biopsies. Am J Gastroenterol 1999;94:14221423.
35.Association of Perioperative Registered Nurses. Recommended Practices for High-Level Disinfection: 2002 Standards, Recommended Practices, and Guidelines. Denver: Association of Perioperative Registered Nurses; 2002:211216.
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.
37.Collins, FM. Kinetics of tuberculocidal response by alkaline glutaraldehyde in solution and on an inert surface. J Appl Bacteriol 1986;61:8793.
38.Collins, FM. Bactericidal activity of alkaline glutaraldehyde solution against a number of atypical mycobacterial species. J Appl Bacteriol 1986;61:247251.
39.Ascenzi, JM, Ezzell, RJ, Wendt, TM. A more accurate method for measurement of tuberculocidal activity of disinfectants. Appl Environ Microbiol 1987;53:21892192.
40.Collins, FM. Use of membrane filters for measurement of mycobacterial activity of alkaline glutaraldehyde solution. Appl Environ Microbiol 1987;53:737739.
41.Best, M, Sattar, SA, Springthorpe, VS, Kennedy, ME. Efficacies of selected disinfectants against Mycobacterium tuberculosis. J Clin Microbiol 1990;28:22342239.
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;56:18131817.
43.Hanson, PJV, Gor, D, Jeffries, DJ, Collins, JV. Elimination of high titre HIV from fiberoptic endoscopes. Gut 1990;31:657659.
44.Hanson, PJ, Jeffries, DJ, Collins, JV. Viral transmission and fibreoptic endoscopy. J Hosp Infect 1991;18:136140.
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):267S271S.
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;22:137142.
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;22:152162.
48.Jackson, J, Leggett, JE, Wilson, D, Gilbert, DN. Mycobacterium gordonae in fiberoptic bronchoscopes. Am J Infect Control 1996;24:1923.
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;50:147151.
50.Fuselier, HA Jr, Mason, C. Liquid sterilization versus high level disinfection in the urologic office. Urology 1997;50:337340.
51.Rutala, WA, Weber, DJ. Disinfection of endoscopes: review of new chemical sterilants used for high-level disinfection. Infect Control Hosp Epidemiol 1999;20:6976.
52.Rutala, WA, Weber, DJ. Importance of lumen flow in liquid chemical sterilization. Am J Infect Control 1999;20:458459.
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;20:514516.
54.Centers for Disease Control and Prevention. Bronchoscopy-related infections and pseudoinfections: New York, 1996 and 1998. MMWR 1999;48:557560.
55.Allen, JI. Pseudomonas aeruginosa infection during endoscopy: reply. Gastroenterology 1987;93:1451. Letter.
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;95:489498.
57.O'Connor, HJ, Babb, JR, Ayliffe, GAJ. Pseudomonas aeruginosa infection during endoscopy. Gastroenterology 1987;93:1451.
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):272S280S.
59.Centers for Disease Control and Prevention. Nosocomial infection and pseudoinfection from contaminated endoscopes and bronchoscopes: Wisconsin and Missouri. MMWR 1991:40:675678.
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;145:853855.
61.Gerding, DN, Peterson, LR, Vennes, JA. Cleaning and disinfection of fiberoptic endoscopes: evaluation of glutaraldehyde exposure time and forced-air drying. Gastroenterology 1982;83:613618.
62.Allen, JI, Allen, MOC, Olson, MM, et al. Pseudomonas infection of the biliary system resulting from use of a contaminated endoscope. Gastroenterology 1987;92:759763.
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;19:8998.
64.Noy, MF, Harrison, L, Holmes, GKT, Cockel, R. The significance of bacterial contamination of fiberoptic endoscopes. J Hosp Infect 1980;1:5361.
65.Meenhorst, PL, Reingold, AL, Groothuis, D. Water-related nosocomial pneumonia caused by Legionella pneumophila serogroups 1 and 10. J Infect Dis 1985;152:356364.
66.Wright, EP, Collins, CH, Yates, MD. Mycobacterium xenopi and Mycobacterium kansasii in a hospital water supply. J Hosp Infect 1985;6:175178.
67.Rutala, WA, Weber, DJ. Water as a reservoir of nosocomial pathogens. Infect Control Hosp Epidemiol 1997;18:609616.
68.Wallace, RJ Jr, Brown, BA, Driffith, DE. Nosocomial outbreaks/pseudo-outbreaks caused by nontuberculous mycobacteria. Annu Rev Microbiol 1998;52:453490.
69.Nelson, DB, Barkun, AN, Block, KP, et al. Transmission of infection by gastrointestinal endoscopy. Gastrointest Endosc 2001;54:824828.
70.Rutala, WA, Hamory, BH. Expanding role of hospital epidemiology: employee health–chemical exposure in the health care setting. Infect Control Hosp Epidemiol 1989;10:261266.
71.Occupational Safety and Health Administration. Air contaminants, final rule. 58 Federal Register 3533835351 (1993).
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; 1998:211226.
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.
74. Occupational Safety and Health Administration: hazard communication standard, 29 CFR 1910.1200.
75.Occupational Safety and Health Administration: occupational exposure to bloodborne pathogens, final rule. 56 Federal Register 6400364182 (1991).
76.Carr-Locke, DL, Conn, MI, Faigel, DO, et al. Personal protective equipment. Gastrointest Endosc 1999;49:854857.
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; 1992:11.0.111.0.9.
78.Dixon, RE. Investigation of endemic and epidemic nosocomial infection data. In: Bennett, JL, Brachman, P, eds. Hospital Infection, 3rd ed. Boston: Little Brown; 1992:109135.
79.Food and Drug Administration. Medical device reporting (MDR). Available at www.fda.gov/cdrh/mdr/. Accessed November 20, 2002.

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