Multi-state investigation of the actual disinfection/sterilization of endoscopes in health care facilities.
OBJECTIVE
The purpose of this investigation was to observe and assess the actual disinfection or sterilization of endoscopes in health care facilities.


METHODS
A total of 22 hospitals and four ambulatory care centers in three states were studied. Facility protocols were reviewed, interviews conducted with relevant personnel, actual disinfection or sterilization procedures observed, and biologic tests performed to determine and assess disinfection/sterilization procedures.


RESULTS
Fundamental errors observed during the course of the investigation included respective failures to time the period of disinfection, to clean all channels, to flush all channels with disinfectant, to fully immerse the endoscope in the disinfectant solution, and to use a disinfectant. At 78% of the facilities, failure to sterilize all biopsy forceps was observed. A total of 23.9% of the bacterial cultures from the internal channels of 71 gastrointestinal endoscopes grew 100,000 colonies or more of bacteria. These cultures were obtained after the completion of all disinfection/sterilization procedures and the device was deemed ready for use in the next patient.


CONCLUSIONS
These data indicate that actual disinfection/sterilization procedures for endoscopes are not always optimal, and high-level disinfection of gastrointestinal endoscopes is not always achieved.
Kaczmarek
R G
RG
Center for Devices and Radiological Health, Food and Drug Administration, Rockville, Maryland 20852.
Moore
R M
RM
McCrohan
J
J
Goldmann
D A
DA
Reynolds
C
C
Caquelin
C
C
Israel
E
E
D000163:Acquired Immunodeficiency Syndrome / Q000453:epidemiology; D000554:Ambulatory Care Facilities; D002985:Clinical Protocols / Q000592:standards; D004203:Disinfection / Q000379:methods / Q000592:standards* / Q000706:statistics & numerical data; D019723:Endoscopes; D004724:Endoscopy / Q000145:classification; D004866:Equipment Contamination / Q000706:statistics & numerical data; D005069:Evaluation Studies as Topic; D006742:Hospital Bed Capacity; D006761:Hospitals; D006801:Humans; D007484:Iowa; D008396:Maryland; D008404:Massachusetts; D008484:Medicaid / Q000706:statistics & numerical data; D010343:Patient Admission / Q000706:statistics & numerical data; D017064:Process Assessment, Health Care; D013242:Sterilization / Q000379:methods / Q000592:standards* / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D014481:United States