Endoscopy Contamination Study

Dissertation of Maíra Marques Ribeiro, Master in Nursing, Federal University of Minas Gerais.

Contamination of the flexible gastrointestinal endoscope as a result of the exams requires the reprocessing of the endoscopes. However, the occurrence of failures during the process may imply the cross-transmission of microorganisms between patients. In Brazil, the scarcity of research in this area limits the evaluation of the effectiveness of the reprocessing of this type of equipment and the planning and execution of corrective and / or preventive actions. The objective of this study was to evaluate the effectiveness of reprocessing of the flexible gastrointestinal endoscope performed at endoscopy services in the city of Belo Horizonte. This is a cross-sectional study carried out between August 2010 and March 2011. The practices of reprocessing the endoscope Gastrointestinal were evaluated in 37 services, from the application of a questionnaire and the collection of samples of the air / water channels and suction / biopsy of gastroscopes and colonoscopes for microbiological analysis. The contamination of at least one endoscope was found in 91.6% of the 37 monitored services, 84.6% (33/39) of the colonoscopes and 80.6% (50/62) of the gastroscopes were contaminated after reprocessing. Microorganisms of the microbiota of the gastrointestinal tract were identified,
Being the main ones: Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii and Enterococcus faecalis.

Other possible sources of contamination can be thought of, such as tap water and water used for cleaning the endoscope lens, due to the detection of Mycobacterium fortuitum,
Mycobacterium chelonae and Pseudomonas aeruginosa and to the lack of proof of microbiological analysis of water.
In the colonoscopes, 71.8% (28/39) of the air / water channels and 69.2% (27/39) of the suction / biopsy channels were contaminated, and, on average, the microbial load was 1,400 And 7,800 CFU / ml, respectively. In the gastroscopes, 70% (42/60) of the air / water channels and 59.7% (37/62) of the suction / biopsy channels showed growth of microorganisms, and, on average, the microbial load was 2,500 and 8,900 UFC / ml, respectively.

Failure to follow all the recommendations of the reprocessing steps in all the evaluated services was verified. The recommendations directed to air / water channels were the least
followed. It was suspected that the main causes for the high contamination rate were: not filling the channels with the cleaning solution and disinfectant; Inadequate use of the enzymatic detergent (solution temperature and immersion time); Non-friction channels
Of air / water or indefinite frequency for friction of both channels; Uncertainty of volume
Water to rinse; Use of drinking water after reprocessing; Not use of adapters to fill the channels with cleaning solution, disinfectant and water; Exposure of the endoscope to the disinfectant for a period shorter than that described on the product label; And absence of periodic training.

It is concluded that it is necessary to adapt the reprocessing practices of the gastrointestinal endoscope to the recommendations set out in the national guidelines international manual and guidelines of the manufacturers in all services.
For these changes to occur, it is necessary that all the professional categories involved in the process convince themselves of the potential of microorganisms transmission to patients who undergo gastrointestinal endoscopy, as pointed out in this study.

Therefore, it will be possible to discuss the clinical practice of reprocessing and to re-evaluate the protocols. Becomes
It is also necessary to promote the continuous search for new technologies that can optimize
Reprocessing of the gastrointestinal endoscope, as well as the improvement of these equipments by the manufacturers, to reduce risks to the patients’ health.

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