GI endoscopic reprocessing practices in the United States

Background: Patient infection from contaminated gastrointestinal (GI) endos copes can generally be attributed to failure to follow appropriate reproces sing guidelines. Recently, the Food and Drug Administration recommended a 4 5-minute exposure of GI endoscopes to 2.4% glutaraldehyde solutions heated to 25 degrees C. Simultaneously, the American Society for Gastrointestinal Endoscopy (ASGE), the American Gastroenterological Association, and the Soc iety of Gastroenterology Nurses and Associates endorsed a reprocessing guid eline that emphasized manual precleaning and recommended a 20-minute exposu re to a 2.4% glutaraldehyde solution at room temperature. Since then, littl e information has become available regarding actual reprocessing practices in the United States. Methods: A previously developed questionnaire regarding endoscopic disinfec tion practices was mailed to randomly selected members of the ASGE. Results: The survey was sent to 730 members and 294 responded (40.3%). Appr opriate manual cleaning (suctioning detergent through the accessory channel and brushing the channel and valves) is performed by 90.7% of respondents; 69.9% then use automated reprocessors for disinfection or sterilization. G lutaraldehyde is the most widely used chemical disinfectant; 85.3% use glut araldehyde as one of their primary disinfectants. The most commonly used di sinfection time with 2.4% glutaraldehyde is 20 minutes (83.9%) followed by 45 minutes (11.4%). Only 23.8% of users of 2.4% glutaraldehyde heat their s olution; 59.6% of centers test disinfectant concentration daily or more fre quently; 74.0% sterilize nondisposable forceps before use; 29.2% of centers reuse disposable endoscopic accessories (which are more frequently disinfe cted rather than sterilized). Twelve respondents reported cases of endoscop ic cross Infection. Conclusions: A significant minority of endoscopy centers still do not compl etely conform to recent ASGE, American Gastroenterological Association, and the Society of Gastroenterology Nurses and Associates guidelines on disinf ection, and they may not be appropriately disinfecting GI endoscopes. Rigid adherence to recommended guidelines is strongly encouraged to ensure patie nt safety.