QUALITY IMPROVEMENT IN GASTROINTESTINAL ENDOSCOPY - MICROBIOLOGIC SURVEILLANCE OF DISINFECTION

Background: Cleaning and disinfection procedures play an essential rol e in the prevention of infection transmission in gastrointestinal endo scopy. In spite of published detailed guidelines, several variants and weak points still exist. Methods: Cleaning-disinfection procedures we re carried out according to ''Working Party, Sydney 1990.'' A microbio logic surveillance protocol tested the contamination of endoscopes and of automatic washing machines. To assess and improve the efficacy of disinfection, we adopted a quality assurance program. Results: During a 2-year follow-up, the outside surfaces of gastroscopes were contamin ated in 60.5% and channels in 41.3%; the outside areas of colonoscopes were contaminated in 62.3% and channels in 40.3%. Isolated bacteria w ere gram-negative organisms, particularly Pseudomonas species, and gra mpositive organisms, mostly Staphylococcus species. The water reservoi rs of automatic washing machines were frequently contaminated by Pseud omonas aeruginosa. The disinfection of washing machines and alcohol ri nsing of endoscopes after standard procedures significantly reduced th e bacterial contamination. Conclusions: The microbiologic surveillance pointed out the main weak points that could be improved by the adopti on of corrective interventions. Quality assurance is a feasible method to assess the efficacy of cleaning-disinfection, and its wide applica tion would improve quality of care.