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Endoscopy 2003; 35(3): 197-202
DOI: 10.1055/s-2003-37270
Original Article
© Georg Thieme Verlag Stuttgart · New York

Standardized Reprocessing of Reusable Colonoscopy Biopsy Forceps is Effective: Results of a German Multicenter Study

M.  Jung 1 , U.  Beilenhoff 1 , M.  Pietsch 2 , B.  Kraft 2 , G.  Rippin 3
  • 1St. Hildegardis Hospital, Mainz, Germany
  • 2Dept. of Hygiene and Environmental Medicine, Johannes-Gutenberg-Universität, Mainz, Germany
  • 3Institute of Medical Statistics, University of Mainz, Mainz, Germany
Further Information

Publication History

Submitted: 24 October 2002

Accepted after Revision: 16 December 2002

Publication Date:
13 February 2003 (online)

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Background and Study Aims: National and international guidelines recommend that a standardized protocol consisting of cleaning, ultrasound cleaning, and sterilization should be used for the reprocessing of endoscopic accessories in order to reduce the risk of transmission of microorganisms. This German multicenter study investigated the efficacy of standardized reprocessing of reusable biopsy forceps used during colonoscopy.
Materials and Methods: Ten endoscopy centers (eight hospitals and two private practices) used 330 biopsy forceps during routine colonoscopy. The forceps were used once, five times, or 20 times for colonoscopy, based on a randomization plan. The reprocessing protocol consisted of manual cleaning with an enzymatic agent, ultrasound cleaning with an enzymatic agent (30 min, 40 °C, 47 Hz), neutralization, drying, and sterilization (5 min, 134 °C). Aldehydes were not used, and the protocol did not include a disinfection step. The biopsy forceps were sent to three microbiological institutes, based on a randomization plan, to have them tested for the presence of organisms, including identification of bacteria.
Results: A total of 318 of the 330 forceps were evaluable; 314 forceps (98.74 %) were sterile after use once, five times, or 20 times. Four forceps were contaminated with Staphylococcus epidermidis (n = 2), Bacillus licheniformis (n = 1) and Corynebacterium aquaticum (n = 2). All of 25 forceps were sterile after being used 20 times.
Conclusion: Colonoscopy biopsy forceps can be reliably reprocessed following this standardized protocol, even without aldehydes.

References

  • 1 Spach D H, Silverstein F E, Stamm W E. Transmission of infection by gastrointestinal endoscopy and bronchoscopy.  Ann Intern Med. 1993;  118 117-128
    PubMedSearch in Google Scholar
  • 2 Kommission für Krankenhaushygiene und Infektionsprävention beim Robert-Koch-Institut. Empfehlung: Anforderungen an die Hygiene bei der Aufbereitung flexibler Endoskope und endoskopischen Zusatzinstrumentariums.  Bundesgesundheitsbl Gesundheitsforsch Gesundheitsschutz. 2002;  4 412-414
    PubMedSearch in Google Scholar
  • 3 Froehlich F, Gonvers J J, Vader J P. et al . Appropriateness of gastrointestinal endoscopy: risk of complications.  Endoscopy. 1999;  31 684-686
    Thieme ConnectPubMedSearch in Google Scholar
  • 4 European Society of Gastrointestinal Endoscopy (ESGE)/European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA). Guidelines on cleaning and disinfection in GI endoscopy, updated 1999; protocol for the reprocessing of endoscopy accessories, revised edition 1999.  Endoscopy. 2000;  32 77-83
    Thieme ConnectPubMedSearch in Google Scholar
  • 5 Roth K, Heeg P, Reichl R. et al . Qualitätssicherung bei der Aufbereitung von Zubehör für flexible Endoskope. Wie sauber sind gereinigte Instrumente wirklich?.  Zent Steril. 1999;  7 84-96
    PubMedSearch in Google Scholar
  • 6 Ministere de l’Emploi et de la Solidarité, Direction Générale de la Santé 5c, Direction de l’Hospitalisation et de l’Organisation Des Soins E2, Republic of France. Circulaire DGS/5CDHOS/E2/2001/138 du 14 mars 2001 relative aux précautions à observer lors de soins en vue de réduire les risques de transmission d’agents transmissibles non conventionnels. Internet; http://www.hosmat.com/circulaires/textes01/138.htm 2001
    Search in Google Scholar
  • 7 Report of a Working Party of the British Society of Gastroenterology Endoscopy Committee. Cleaning and disinfection of equipment for gastrointestinal endoscopy.  Gut. 1998;  42 585-593
    PubMedSearch in Google Scholar
  • 8 Alvarado C J, Reichelderfer M. APIC guideline for infection prevention and control in flexible endoscopy.  Am J Infect Control. 2000;  28 138-155
    CrossrefPubMedSearch in Google Scholar
  • 9 Systchenko R, Marchetti B, Canard J N. et al . Guidelines of the French Society of Digestive Endoscopy: recommendations for setting up cleaning and disinfection procedures in gastrointestinal endoscopy.  Endoscopy. 2000;  32 807-818
    Thieme ConnectPubMedSearch in Google Scholar
  • 10 Leiss O, Beilenhoff U, Bader L. et al . Leitlinien zur Aufbereitung flexibler Endoskope und endoskopischen Zusatzinstrumentariums im internationalen Vergleich.  Z Gastroenterol. 2002;  40 531-542
    Thieme ConnectPubMedSearch in Google Scholar
  • 11 Axon A TR, Beilenhoff U, Bramble M G. et al . Variant Creutzfeldt-Jakob disease (vCJD) and gastrointestinal endoscopy.  Endoscopy. 2001;  33 1070-1080
    Thieme ConnectPubMedSearch in Google Scholar
  • 12 Task Force vCJK. Abschlussbericht: Die Variante der Creutzfeld-Jakob-Krankheit (vCJK). Epidemiologie, Erkennung, Diagnostik und Prävention unter besonderer Berücksichtigung der Risikominimierung einer iatrogenen Übertragung durch Medizinprodukte, insbesondere chirurgische Instrumente.  Bundesgesundheitsbl Gesundheitsforsch Gesundheitsschutz. 2002;  45 376-394
    PubMedSearch in Google Scholar
  • 13 Dwyer D M, Klein E G, Istre G R. et al . Salmonella Newport infections transmitted by fiberoptic colonoscopy.  Gastrointest Endosc. 1987;  33 84-87
    CrossrefPubMedSearch in Google Scholar
  • 14 Langenberg W, Rauws E A, Oudbier J H. Patient-to-patient transmission of Campylobacter pylori by fiberoptic gastroduodenoscopy and biopsy.  J Infect Dis. 1990;  161 507-511
    PubMedSearch in Google Scholar
  • 15 Bronowicki J P, Venard V, Botté C. et al . Patient-to-patient transmission of hepatitis C virus during colonoscopy.  N Engl J Med. 1997;  337 237-240
    CrossrefPubMedSearch in Google Scholar
  • 16 Kozarek R A, Attia F M, Sumida S E. et al . Reusable biopsy forceps: a prospective evaluation of cleaning, function, adequacy of tissue specimen, and durability.  Gastrointest Endosc. 2001;  53 812-816
    PubMedSearch in Google Scholar
  • 17 Kinney T P, Kozarek R A, Raltz S, Attia F. Contamination of single-use biopsy forceps: a prospective in vitro analysis.  Gastrointest Endosc. 2002;  56 209-212
    CrossrefPubMedSearch in Google Scholar
  • 18 Yang R, Ng S, Nichol M, Laine L. A cost and performance evaluation of disposable and reusable biopsy forceps in GI endoscopy.  Gastrointest Endosc. 2000;  51 266-270
    CrossrefPubMedSearch in Google Scholar
  • 19 Wolfsen H C. Advantages of reusable accessories.  Gastrointest Endosc Clin N Am. 2000;  10 349-359
    PubMedSearch in Google Scholar
  • 20 Deprez P H, Horsmans Y, van Hassel M. et al . Disposable versus reusable biopsy forceps: a prospective cost evaluation.  Gastrointest Endosc. 2000;  51 262-265
    PubMedSearch in Google Scholar
  • 21 Lejeune C, Prost P, Michiels C. et al . Pinces à biopsie jetables versus réutilisables: évaluation économique prospective dans l’unité d’endoscopie digestive du CHU de Dijon.  Gastroenterol Clin Biol. 2001;  25 669-673
    PubMedSearch in Google Scholar
  • 22 Rizzo J, Bernstein D, Gress F. A performance, safety and cost comparison of reusable and disposable endoscopic biopsy forceps: a prospective, randomized trial.  Gastrointest Endosc. 2000;  51 257-261
    PubMedSearch in Google Scholar
  • 23 Sautereau D, Palazzo L. Pinces à biopsies à usage unique en endoscopie digestive: sage décision ou caricature du principe de précaution?.  Gastroenterol Clin Biol. 2001;  25 653-655
    PubMedSearch in Google Scholar
  • 24 Chanzy B, Duc-Bin D L, Rousset B. et al . Effectiveness of a manual disinfection procedure in eliminating hepatitis C virus from experimentally contaminated endoscopes.  Gastrointest Endosc. 1999;  50 147-151
    PubMedSearch in Google Scholar
  • 25 Hanson P J, Gor D, Jeffries D J, Collins J V. Elimination of high titre HIV from fiberoptic endoscopes.  Gut. 1990;  31 657-659
    PubMedSearch in Google Scholar
  • 26 Bader L, Blumenstock G, Birkner B. Hygea (Hygiene in der Gastroenterologie-Endoskop-Aufbereitung): Studie zur Qualität der Aufbereitung von flexiblen Endoskopen in Klinik und Praxis.  Z Gastroenterol. 2002;  40 157-170
    Thieme ConnectPubMedSearch in Google Scholar

M. Jung, M.D.

Dept. of Internal Medicine · St. Hildegardis Hospital

Hildegardstrasse 2 · 55131 Mainz · Germany

Fax: + 49-6131-147753

Email: M.Jung.Hildegardis-Mz@t-online.de