title: Persistent contamination on colonoscopes and gastroscopes detected by biologic cultures and rapid indicators despite reprocessing performed in accordance with guidelines.
abstract: BACKGROUND
  Pathogens have been transmitted via flexible endoscopes that were reportedly reprocessed in accordance with guidelines.
  
  
  METHODS
  Researchers observed reprocessing activities to ensure guideline compliance in a large gastrointestinal endoscopy unit. Contamination was assessed immediately after bedside cleaning, manual cleaning, high-level disinfection, and overnight storage via visual inspection, aerobic cultures, and tests for adenosine triphosphate (ATP), protein, carbohydrate, and hemoglobin.
  
  
  RESULTS
  All colonoscopes and gastroscopes were reprocessed in accordance with guidelines during the study. Researchers collected and tested samples during 60 encounters with 15 endoscopes. Viable microbes were recovered from bedside-cleaned (92%), manually cleaned (46%), high-level disinfected (64%), and stored (9%) endoscopes. Rapid indicator tests detected contamination (protein, carbohydrate, hemoglobin, or ATP) above benchmarks on bedside-cleaned (100%), manually cleaned (92%), high-level disinfected (73%), and stored (82%) endoscopes. Visible residue was never observed on endoscopes, but it was often seen on materials used to sample endoscopes. Seven endoscopes underwent additional reprocessing in response to positive rapid indicators. Control endoscope channels were free of biologic residue and viable microbes.
  
  
  CONCLUSIONS
  Despite reprocessing in accordance with US guidelines, viable microbes and biologic debris persisted on clinically used gastrointestinal endoscopes, suggesting current reprocessing guidelines are not sufficient to ensure successful decontamination.
authors.affiliation: Ofstead & Associates, Saint Paul, MN; Division of Infectious Diseases, Mayo Clinic, Rochester, MN. Electronic address: cori@ofsteadinsights.com.
authors.forename: Cori L
authors.initials: CL
authors.lastname: Ofstead
authors.affiliation: Ofstead & Associates, Saint Paul, MN.
authors.forename: Harry P
authors.initials: HP
authors.lastname: Wetzler
authors.affiliation: Ofstead & Associates, Saint Paul, MN.
authors.forename: Evan M
authors.initials: EM
authors.lastname: Doyle
authors.affiliation: Ofstead & Associates, Saint Paul, MN.
authors.forename: Catherine K
authors.initials: CK
authors.lastname: Rocco
authors.affiliation: Division of Internal Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Kavel H
authors.initials: KH
authors.lastname: Visrodia
authors.affiliation: Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, NC.
authors.forename: Todd H
authors.initials: TH
authors.lastname: Baron
authors.affiliation: Division of Infectious Diseases, Mayo Clinic, Rochester, MN.
authors.forename: Pritish K
authors.initials: PK
authors.lastname: Tosh
mesh_terms: D020685:Colonoscopes / Q000382:microbiology*; D003666:Decontamination; D004203:Disinfection / Q000379:methods*; D020699:Gastroscopes / Q000382:microbiology*; D019983:Guideline Adherence; D006801:Humans; D017053:Infection Control / Q000379:methods*
keywords: Colonoscope; Endoscope reprocessing; Epidemiology; Gastrointestinal endoscopy; High-level disinfection; Reprocessing medical devices