title: Comparison of sterilization of reusable endoscopic biopsy forceps by autoclaving and ethylene oxide gas.
abstract: OBJECTIVE
  Every country has standardized reprocessing guidelines for reducing the risk of microorganism transmission via reusable biopsy forceps. Sterilization is performed either by autoclaving or with the use of ethylene oxide (EO) gas. However, there are no clear standard global recommendations. The aim of this study was to determine whether EO gas or autoclaving is a safer and more effective method for the sterilization of reusable forceps.
  
  
  METHODS
  This was a prospective study conducted at multiple tertiary referral centers. Seventy reusable biopsy forceps that had been reused at least 20 times each were collected from six endoscopy centers. In all, 61 forceps from five centers were sterilized using EO gas, and the nine forceps from the remaining center were placed in an autoclave. We performed real-time polymerase chain reaction (RT-PCR) for Mycobacterium tuberculosis and hepatitis B virus and performed bacterial cultures on the reusable forceps, which were cut into 2- to 3-cm sections. The forceps were also scanned with an electron microscope (EM) to detect surface damage and contamination.
  
  
  RESULTS
  Escherichia coli bacteria were cultured from 2 of the 61 (3.3%) reusable biopsy forceps sterilized with EO gas. On EM scanning, abundant debris and tissue materials remained on the cup surfaces of the reused biopsy forceps and on their inner wires. No microorganisms were found on the autoclaved forceps.
  
  
  CONCLUSIONS
  Sterilization with EO gas may be inadequate because the complicated structure of the forceps may interfere with sterilization. Therefore, for optimum safety, reusable biopsy forceps should be sterilized by autoclaving.
authors: Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea. jaihoonyoon@gmail.com
authors: Jai Hoon
authors: JH
authors: Yoon
authors: Byung Chul
authors: BC
authors: Yoon
authors: Hang Lak
authors: HL
authors: Lee
authors: Jun Kyu
authors: JK
authors: Lee
authors: Yong-Tae
authors: YT
authors: Kim
authors: Dong Ho
authors: DH
authors: Lee
authors: Il Ju
authors: IJ
authors: Choi
authors: Don Haeng
authors: DH
authors: Lee
authors: Dong Hee
authors: DH
authors: Kim
mesh_terms: D004202:Disinfectants / Q000627:therapeutic use*; D004866:Equipment Contamination; D017743:Equipment Reuse; D004869:Equipment Safety; D005027:Ethylene Oxide / Q000627:therapeutic use*; D006358:Hot Temperature / Q000627:therapeutic use*; D006801:Humans; D011446:Prospective Studies; D013242:Sterilization; D013525:Surgical Instruments / Q000382:microbiology*
chemical_list: D004202:Disinfectants; D005027:Ethylene Oxide