The Risk of Exogenous Infection During GI Endoscopy

The potential for infection exists whenever individuals reprocessing GI endoscopes do not follow established guidelines. No cases of nosocomial infection linked to a GI endoscope contaminated with infectious agents from an exogenous source (ie, another patient or the environment) have been documented when the endoscope (and biopsy forceps or other reusable endoscopic accessories) was reprocessed in strict accordance with current reprocessing guidelines and instructions. This finding is reassuring considering that more than 10 million GI endoscopic procedures are performed each year in the United States alone. Colonoscopy, for example, which is reportedly performed 4.4 million times each year in the United States, is a crucial GI endoscopic procedure used to screen patients for colon cancer, the second leading cause of cancer-related deaths in the United States. Education about the safety and effectiveness of colonoscopy and its reported low risk of infection is crucial to ensure patient compliance with scheduled screenings and exams. As a result of overall adherence to published endoscope reprocessing guidelines over the past 10 years, only 35 cases of likely or possible infection caused by a contaminated GI endoscope have been reported (Weber et al, 1999; Nelson et al, 2003). Of these 35 cases, disease transmission was suspected or confirmed during colonoscopy in only five cases. Based on these num

*Editor's Note: The first author is employed by industry.

bers, the reported risk of exogenous infection from a contaminated GI endoscope in general, and a colonoscope in particular, can be calculated to approximate 1 in 3 million and 1 in 9 million, respectively.

Although a plethora of clinical data indicate that current endoscope reprocessing guidelines are adequate and prevent disease transmission, efforts to educate GI physicians about the required step-by-step instructions provided in several published endoscope reprocessing guidelines remain a centerpiece of GI endoscopy training (DiMarino, 1999; Cheung et al, 1999). Complacency and failure by GI physicians to acknowledge and appreciate the potential for infection during GI endoscopy, although rarely reported, can compromise patient safety and generate appropriate concern by patient advocacy groups and governmental agencies. Development and implementation of a quality assurance (QA) program that, among other considerations, monitors all of the steps of endoscope reprocessing are necessary to maintain the reported low risk of disease transmission during GI endoscopy. It is important that the QA program ensures the endoscope and all of its internal channels (even if not used during the procedure), valves, and removable components are reprocessed in strict compliance with the published endoscope reprocessing guidelines, as well as the reprocessing instructions provided by the endoscope's manufacturer and the manufacturer of the automated endoscope reprocessor (AER), if used.

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