title: [Quality of hygiene in endoscope reprocessing--the fundamentals of indicator-assisted quality management in gastroenterology].
abstract: High level disinfection and infection control in reprocessing gastrointestinal endoscopes is a critical security factor for patients in gastrointestinal health care. National and international guidelines for an adequate high quality disinfection of gastrointestinal endoscopes have been developed aiming to obtain infection control. The German Medical Association has recently published recommendations on quality assurance in gastrointestinal endoscopy including standardised procedures for disinfection and infection control. A prospective study was carried out in a large urban area in both private practices and hospitals to identify and characterise flaws and limitations in disinfection of gastrointestinal endoscopes by measuring a set of indicators of the quality of structures, processes and outcomes. Moreover, the influence of information and continuous medical education on the quality of disinfection and infection control were to be evaluated. The bacterial contamination of endoscopes after reprocessing was measured as a relevant outcome quality indicator. The results revealed substantial flaws in cleaning and disinfection procedures in gastrointestinal endoscopy under routine clinical conditions. Overall, 49 and 39 percent of all (pre- and post-interventionally, resp.) checked endoscopes were contaminated by one or more bacteria. More often failures were discovered in the optic rinse system than in the cleaning/disinfection and the final rinse and drying process. A substantial failure rate was detected in gastrointestinal endoscope reprocessing under routine conditions according to the reprocessing procedure. Compared to manual and semi-automatic cleaning and disinfection, the full automatic cleaning and disinfection machines (RDG-E) showed the best results. Though their cleaning process remains improveable, it seems advisable to prefer RDG-E-machines for disinfection and infection control in gastrointestinal endoscopy. Continuous quality control of disinfection should be obtained by introducing regular microbiological examinations of the reprocessed endoscopes. Negative microbiological controls of the contamination of endoscopes are suitable quality indicators of a quality management system aiming to improve the quality of structures, processes and outcomes in gastroenterological health care.
authors.affiliation: Max von Pettenkofer-Institut für Hygiene und Medizinische Mikrobiologie, Ludwig-Maximilians-Universität, München. BBirkner@t-online.de
authors.forename: Berndt R
authors.initials: BR
authors.lastname: Birkner
authors.forename: Lutz
authors.initials: L
authors.lastname: Bader
authors.forename: Gunnar
authors.initials: G
authors.lastname: Blumenstock
authors.forename: Jürgen F
authors.initials: JF
authors.lastname: Riemann
authors.forename: Hans-Konrad
authors.initials: HK
authors.lastname: Selbmann
mesh_terms: D004203:Disinfection / Q000592:standards; D016145:Endoscopy, Digestive System / Q000592:standards*; D005762:Gastroenterology / Q000592:standards*; D005858:Germany; D006801:Humans; D006920:Hygiene / Q000592:standards*; D017410:Practice Guidelines as Topic; D011785:Quality Assurance, Health Care