title: Investigation of an outbreak of bloody diarrhea: association with endoscopic cleaning solution and demonstration of lesions in an animal model.
abstract: OUTBREAK INVESTIGATION: An outbreak of diarrhea, bloody diarrhea, and abdominal cramps occurred among persons undergoing flexible sigmoidoscopy at a branch clinic of a local health center. Illness was associated with use of sigmoidoscopes cleaned by one clinic assistant and appeared to be caused by 2% glutaraldehyde disinfectant solution left in the instruments after cleaning.
  
  
  METHODS
  In subsequent animal studies, colonic instillation of 2% glutaraldehyde solutions caused bloody diarrhea and a distinctive pattern of mucosal damage; similar changes were seen in a review of pathologic samples from other human cases of glutaraldehyde disinfectant-associated diarrhea.
  
  
  CONCLUSIONS
  Our data indicate that improper endoscopic reprocessing can result in serious illness and underscore the importance of adequate training and quality control in this area.
authors.affiliation: Epidemiology and Disease Control Program, Maryland Department of Health and Mental Hygiene, Baltimore.
authors.forename: L
authors.initials: L
authors.lastname: Durante
authors.forename: J C
authors.initials: JC
authors.lastname: Zulty
authors.forename: E
authors.initials: E
authors.lastname: Israel
authors.forename: P J
authors.initials: PJ
authors.lastname: Powers
authors.forename: R G
authors.initials: RG
authors.lastname: Russell
authors.forename: A H
authors.initials: AH
authors.lastname: Qizilbash
authors.forename: J G
authors.initials: JG
authors.lastname: Morris
mesh_terms: D000818:Animals; D003106:Colon / Q000187:drug effects / Q000473:pathology; D003967:Diarrhea / Q000139:chemically induced* / Q000453:epidemiology / Q000473:pathology; D004196:Disease Outbreaks; D004202:Disinfectants / Q000009:adverse effects* / Q000633:toxicity; D004203:Disinfection / Q000592:standards; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced* / Q000453:epidemiology; D005976:Glutaral / Q000009:adverse effects* / Q000633:toxicity; D006801:Humans; D007413:Intestinal Mucosa / Q000187:drug effects / Q000473:pathology; D011786:Quality Control; D051381:Rats; D011919:Rats, Inbred Strains; D020694:Sigmoidoscopes
chemical_list: D004202:Disinfectants; D005976:Glutaral