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BACKGROUND AND AIMS: Attention to patient safety has increased recently due to outbreaks of nosocomial infections associated with GI endoscopy. The aim of this study was to evaluate current cleaning and disinfection procedures of endoscope channels with high bioburden and biofilm analysis, including the use of resistant mycobacteria associated with postsurgical infections in Brazil. METHODS: Twenty-seven original endoscope channels were contaminated with organic soil containing 10(8) colony-forming units/mL of Pseudomonas aeruginosa, Staphylococcus aureus, or Mycobacterium abscessus subsp bolletii. Biofilms with the same microorganisms were developed on the inner surface of channels with the initial inoculum of 10(5) colony-forming units/mL. Channels were reprocessed following current protocol, and samples from cleaning and disinfection steps were analyzed by bioluminescence for adenosine triphosphate, cultures for viable microorganisms, and confocal microscopy. RESULTS: After contamination, adenosine triphosphate levels increased dramatically, and high bacterial growth was observed in all cultures. After cleaning, adenosine triphosphate levels decreased to values comparable to precontamination levels, and bacterial growth was demonstrated in 5 of 27 catheters, 2 with P aeruginosa and 3 with M abscessus. With regard to induced biofilm, a remarkable reduction occurred after cleaning, but significant microbial growth inhibition occurred only after disinfection. Nevertheless, viable microorganisms within the biofilm were still detected by confocal microscopy, more so with glutaraldehyde than with peracetic acid or O-phataladehyde. CONCLUSION: After the complete disinfection procedure, viable microorganisms could still be detected within the biofilm on endoscope channels. Prevention of biofilm development within endoscope channels should be a priority in disinfection procedures, particularly for ERCP and EUS.

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BACKGROUND: For the effective reprocessing of gastrointestinal endoscopes, contaminants must be removed from the entire surface. However, these devices have long and narrow channels that can make this process difficult. METHODS: In this cross-sectional study, the staff assigned to reprocess gastroscopes and colonoscopes in 37 services located throughout Brazil completed a questionnaire regarding reprocessing practices geared toward the channels in these devices. In addition, samples from these air/water channels were collected for microbiological analysis. RESULTS: Contamination was detected in 71.8% (28/39) of the samples obtained from the air/water channels of colonoscopes, and in 70% (42/60) of the samples from the air/water channels of gastroscopes. The median microbial load was 1,800 colony-forming units (CFU)/mL in the colonoscopes and 750 CFU/mL in the gastroscopes. The main microorganisms isolated from the air/water channels of gastroscopes were Pseudomonas aeruginosa (26.4%), Escherichia coli (18.9%), and Acinetobacter baumannii (9.4%), and those isolated from the colonoscopes included P aeruginosa (46.4%), A baumannii (14.3%), and Klebsiella pneumoniae (10.7%), among others. The possible causes of the contamination of these devices included the failure to fill these channels with cleaning solution, lack of friction during cleansing, and inadequate rinsing. CONCLUSION: The contamination of the air/water channels did in fact represent a risk for the transmission of microorganisms during gastrointestinal endoscopy exams, possibly related to the inadequate reprocessing of these channels.

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A contaminação cio endoscópio gastrointestinal flexível em decorrência dos exames requer o reprocessarnento deles. Entretanto, a ocorrência de falhas durante o processo poderá implicar a transmissão cruzada de microrganismos entre pacientes. No Brasil. a escassez de pesquisas nesta temática limita a avaliação da efetividade do reprocessamento desse tipo de equipamento e o planejamento e a execução de ações corretivas e/ou preventivas. Neste estudo, objetivou-se avaliar a efetividade do reprocessamento do endoscópio gastrointestinal flexível realizado nos serviços de endoscopia da cidade de Belo Horizonte. Trata-se de um estudo transversal, realizado entre agosto de 2010 e março de 2011. As práticas do reprocessamento do endoscópio gastrointestinal foram avaliadas em 37 serviços, a partir da aplicação de questionário e da coleta de amostras dos canais de ar/água e de sucçãolbiópsia de gastroscópios e colonoscópios para análise microbiológica. A contaminação de pelo menos um endoscópio foi constatada em 9 1.6% dos 37 serviços monitorados. 84,6% (33/39) dos colonoscópios e 80,6% (50/62) dos gastroscópios apresentaram-se contaminados após o reprocessamento. Identificaram-se microrganismos da microbiota do trato gastrointestinal, sendo os principais: Escherichia coli, Klebsiella pneuinoniae, Pseudoinonas aeruginosa, Acinetobacter haumannii e Enterococcus faecalis. Outras possíveis fontes de contaminação podem ser pensadas, como água de torneira e água utilizada para a limpeza da lente do endoscópio. devido à detecção de Mycobacterium fortuituin, Mycobacterium chelonae e Pseudoinonas aeruginosa e à falta de comprovação de análise microbiológica da água. Nos colonoscópios, 7 1.8% (28/39) dos canais de ar/água e 69,2% (27/39) dos canais de sucção/biópsia encontravam-se contaminados, e. em média, a carga microbiana foi de 1.400 e 7.800 UFC/ml, respectivamente. Nos gastroscópios, 70% (42/60) dos canais de ar/água e59,7% (37/62) dos canais de sucção/biópsia...

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CONTEXT: The endoscopic procedure safety depends on the use of an adequately reprocessed device which quality is related to each of its operational steps. OBJECTIVE: To characterize the reprocessing of endoscopes using glutaraldehyde in endoscopy services METHODS: Study was conducted by observing the reprocessing of 60 endoscopes from 20 medical practices of the municipality of Goiânia, GO, central area of Brazil. RESULTS: This study showed failure in all reprocessing steps. The pre-washing was performed in 24 (40.0%) of the endoscope. In the cleaning steps, was identify the improper use of enzymatic detergent, and in 27 (45.0%) cases, the brushing of internal channels was not performed. All 60 endoscopes were submitted to this disinfectant. However, for 33 (55.0%) of the cases the internal channels was not filled. The total immersion of endoscope in the glutaraldehyde was not performed in 39 (65.0%) cases. The recommended minimum total immersion time for exposure to 2% glutaraldehyde solution was followed only for 12 (20.0%) endoscopes. There was no filter for water treatment used in the rinse of most endoscopes 54 (90.0%) and to dry the internal channels only 6 (10.0%) of them used compressed air. Adequate storing conditions were identified. CONCLUSION: Considering the particularities of the endoscope and its reprocessing, it is imperative to establish protocols to ensure the quality of the disinfection and the prevention of cross-contamination.

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CONTEXT: The endoscopic procedure safety depends on the use of an adequately reprocessed device which quality is related to each of its operational steps. OBJECTIVE: To characterize the reprocessing of endoscopes using glutaraldehyde in endoscopy services METHODS: Study was conducted by observing the reprocessing of 60 endoscopes from 20 medical practices of the municipality of Goiânia, GO, central area of Brazil. RESULTS: This study showed failure in all reprocessing steps. The pre-washing was performed in 24 (40.0 percent) of the endoscope. In the cleaning steps, was identify the improper use of enzymatic detergent, and in 27 (45.0 percent) cases, the brushing of internal channels was not performed. All 60 endoscopes were submitted to this disinfectant. However, for 33 (55.0 percent) of the cases the internal channels was not filled. The total immersion of endoscope in the glutaraldehyde was not performed in 39 (65.0 percent) cases. The recommended minimum total immersion time for exposure to 2 percent glutaraldehyde solution was followed only for 12 (20.0 percent) endoscopes. There was no filter for water treatment used in the rinse of most endoscopes 54 (90.0 percent) and to dry the internal channels only 6 (10.0 percent) of them used compressed air. Adequate storing conditions were identified. CONCLUSION: Considering the particularities of the endoscope and its reprocessing, it is imperative to establish protocols to ensure the quality of the disinfection and the prevention of cross-contamination.

CONTEXTO: A segurança do procedimento endoscópico depende do uso de um aparelho adequadamente reprocessado e a qualidade do reprocessamento está relacionada a cada uma das etapas operacionais desse processo. OBJETIVO: Caracterizar o reprocessamento de endoscópios pelo uso do glutaraldeído em serviços de endoscopia. MÉTODOS: Estudo conduzido em 20 serviços de endoscopia digestiva do município de Goiânia, GO. A amostra se constituiu de endoscópios utilizados para endoscopia digestiva alta. Os dados foram obtidos mediante observação direta de 60 reprocessamentos de endoscópios. Resultado - Foram observadas falhas em todas as etapas do reprocessamento. Em 24 (40,0 por cento) endoscópios foi realizada a pré-lavagem. Na etapa da limpeza, foi identificado o uso inadequado do detergente enzimático e em 27 (45,0 por cento) não foi realizada a escovação dos canais internos. Todos os 60 endoscópios foram submetidos ao desinfetante, entretanto para 33 (55,0 por cento) não foi aspirado o produto nos canais internos. O tempo de exposição ao glutaraldeído foi observado apenas para 12 (20 por cento) dos endoscópios. O enxágue de 54 (90,0 por cento) dos endoscópios ocorreu com o uso de água não-filtrada e, para a secagem dos canais internos, apenas 6 (10,0 por cento) utilizaram o ar comprimido. Foram identificadas condições adequadas para o armazenamento. CONCLUSÃO: Considerando as particularidades do reprocessamento dos endoscópios é imperativo estabelecer protocolos para assegurar a qualidade da desinfecção e a prevenção da contaminação cruzada.

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El riesgo de transmisión de infección en procedimientos endoscópicos es muy bajo y la mayoría han sido reportados durante los años 80. Se han descrito transmisión principalmente bacteriana, aunque también algunos casos, infección por virus hepatitis B y C. La mayoría de los casos son asociados a prácticas inadecuadas de reprocesamiento por lo que actualmente existen guías internacionales de limpieza y desinfección de endoscopios, los cuales incluyen técnicas de limpieza, enjuague, desinfección, secado y almacenamiento. La limpieza es el paso crítico en el reprocesamiento de los endoscopios y debe realizarse siempre antes de la desinfección. Todos los procesos de desinfección pueden fracasar si la limpieza ha sido inadecuada. La adherencia a las directrices de desinfección es un factor clave que determina la seguridad del endoscopio. Si bien pueden variar las circunstancias, el entrenamiento y los recursos locales, siempre deben mantenerse altos estándares de desinfección. En general, se pueden remover todos los microorganismos, salvo excepciones como los priones en la variante de enfermedad de Creutzfeldt-Jacob. Aunque no hay casos reportados de transmisión, en estos casos es necesario tomar conductas especiales en cuanto al uso de los endoscopios. Es importante monitorear la eficacia del procedimiento de desinfección a intervalos regulares. Además, todo el personal de la salud en una unidad de endoscopía debe recibir entrenamiento en las medidas de control estándar incluyendo aquellas diseñadas para proteger tanto a los pacientes como a los trabajadores de la salud.

The risk of endoscopy-related transmission of a disease is very low and the majority has been reported during the 80´s. Bacterial transmission has been described mostly; also some cases of infection from hepatitis B and C. The majority of outbreaks was related to inadequate reprocessing practices, so international guidelines of cleaning and disinfection have been developed, including cleaning, rinsing, disinfection and drying techniques; as well as endoscope storage. Cleaning is the critical step in endoscope reprocessing and should be done always before the disinfection step. All disinfection processes could fail if cleaning is inadequate. Compliance with endoscope disinfection guidelines is the key factor that determines endoscopy safety. While local circumstances, training and resources may vary, high standards of disinfection must always be observed. In general, all kinds of microorganisms can be removed, but there are exceptions, like prions in the variant of Creutzfeldt-Jakob disease. Although there have not been reported cases of transmission, it is necessary to take some precautions of the use of the endoscopes. It is important to monitor the efficacy of the disinfection procedure at regular intervals. Also, all healthcare personnel in an endoscopy unit should receive training in standard infection control measures, including those designed to protect both patients and healthcare workers.

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BACKGROUD: Endoscopes are routinely used in hospitals and clinics of the world and they can be potential sources of cross-infection when the decontamination process is unsuitable AIM: The routines of flexible endoscope (bronchoscopes, esophagogastroduodenoscopes and colonoscopes) disinfection procedures used in two Brazilian university hospitals were evaluated during a 3-year period METHODS: Aleatory samples from internal channels of endoscopes were collected after patient examination and after cleaning/disinfection procedures RESULTS: A contamination >3 log10 was achieved in samples recovered from endoscopes after patient examination. These samples yielded gram-negative bacilli (n = 142: 56 percent), gram-positive cocci (n = 43: 17 percent), yeast cells (n = 43: 17 percent), and gram-positive bacilli (n = 26: 10 percent). Approximately, 72 out of 149 samples (48.32 percent) collected after undergoing the cleaning and disinfection procedures disclosed gram-negative bacilli (n = 55: 61 percent), gram-positive cocci (n = 21: 23 percent), gram-positive bacilli (n = 8: 9 percent) and yeast cells (n = 6: 7 percent). Esophagogastroduodenoscopes and colonoscopes were the most frequently contaminated devices. Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli, Enterobacter spp, Serratia marcescens, Proteus mirabilis, Citrobacter freundii, Staphylococcus aureus, Staphylococcus coagulase negative, Micrococcus luteus, Candida albicans, C. tropicalis, C. glabrata, C. guilliermondii, Bacillus spp and Corynebacterium spp were predominantly identified CONCLUSION: Inappropriate cleaning and low times of disinfection were respectively the major factors associated with the presence of microorganisms in colonoscopes and esophagogastroduodenoscopes. By analyzing the identified germs, hospital disinfection was considered of either intermediate or poor level. After this investigation, both university centers improved their previous protocols for...

RACIONAL: Endoscópios são rotineiramente utilizados em hospitais e clínicas e podem ser fontes potenciais de infecção cruzada quando a descontaminação é inadequada OBJETIVO: As rotinas de descontaminação dos endoscópios flexíveis (broncoscópios, gastrocópios e colonoscópios) realizadas em dois hospitais universitários do Brasil foram avaliadas durante 3 anos MATERIAL E MÉTODOS: Amostras aleatórias foram coletadas dos canais internos dos endoscópios, depois que o aparelho era utilizado nos pacientes e após o processo de desinfecção RESULTADOS: Contaminação superior a 103 foi verificada em amostras coletadas após o exame endoscópico, sendo isolado bacilos gram-negativos (n = 142: 56 por cento), cocos gram-positivos (n = 43: 17 por cento), leveduras (n = 43: 17 por cento) e bacilos gram-positivos (n = 26: 10 por cento). Em 72 das 149 amostras coletadas após procedimentos de limpeza e desinfecção, detectou-se bacilos gram-negativos (n = 55: 61 por cento), cocos gram-positivos (n = 21: 23 por cento), bacilos gram-positivos (n = 8: 9 por cento) e leveduras (n = 6: 7 por cento). Gastroscópios e colonoscópios eram os aparelhos com maior freqüência e taxa de contaminação. Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli, Enterobacter spp, Serratia marcescens, Proteus mirabilis, Citrobacter freundii, Staphylococcus aureus, Staphylococcus coagulase negative, Micrococcus luteus, Candida albicans, C. tropicalis, C. glabrata, C. guilliermondii, Bacillus spp and Corynebacterium spp foram os mais identificados CONCLUSÃO: A limpeza inapropriada e curto período de tempo de desinfecção eram, respectivamente, os maiores fatores associados com a presença de microrganismos em gastroscópios e colonoscópios. De acordo com os organismos isolados, considera-se que a desinfecção nos hospitais era de nível baixo a intermediário. Após a investigação, os centros de endoscopia adequaram seus protocolos, sanando os problemas verificados nos procedimentos...

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