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REPROCESSING OF FLEXIBLE GASTROINTESTINAL ENDOSCOPES AFTER A PERIOD OF DISUSE: IS IT NECESSARY?

AS Vergis, D Thomson, P Pieroni, S Dhalla
Brandon Regional Health Centre, Brandon, Manitoba

BACKGROUND: Gastrointestinal (GI) endoscopy is an integral tool in the evaluation and management of many GI and hepatobiliary conditions. Although rare, media reports of infectious complications following GI endoscopy persist in this new millennium. With only limited data available, society guidelines continue to suggest that endoscopes undergo a reprocessing cycle before the first patient of the day. This study aimed to assess the microbiologic stability of GI endoscopes after high-level disinfection.
METHODS: In this multi-phase study, 4 endoscopic retrograde cholangiopancreatography (ERCP) scopes and 3 colonoscopes were evaluated. In phase 1, endoscopes were assayed after initial high-level disinfection and daily for a period of two weeks. In phase 2, this procedure was repeated to confirm phase 1 results. In phase 3, endoscopes were assayed after high-level disinfection and again following a 7-day storage period.
RESULTS: In phase 1, 6 of 70 (8.6%) assays were positive. This involved 4 of 7 (57%) endoscopes (2 colonoscopes and 2 ERCP scopes) and was limited to the first 5 days of the study. No cultures were positive in phase 2. In phase 3, one endoscope had a positive culture. Positive cultures grew only Staphylococcus epidermidis, a low virulence skin organism.
CONCLUSIONS: With proper disinfection and storage, it appears that reprocessing of GI endoscopes is unnecessary after periods of disuse of at least seven days and possibly up to two weeks. Despite recent media reports of infectious complications, society guidelines that recommend more frequent reprocessing seem to lack scientific merit and need to be revisited.

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