One Colonoscopy Fact You Really Don't Want to Know About
Recent research to be presented at the 40th Annual Conference of the Association for Professionals in Infection Control and Epidemiology (APIC) at Fort Lauderdale this week reveals one fact most people would probably wish that they had never heard about regarding colonoscopies: many are contaminated with “bio dirt”―a euphemism for you-know-what that is found you-know-where during a colonoscopy.
However, it is not just colonoscopes that are used for the colon that were found to possess hidden contaminants, but duodenoscopes and gastroscopes as well reports researchers from the 3M Infection Prevention Division. In an abstract presented at the meeting, the researchers reveal that of 275 flexible duodenoscopes, gastroscopes, and colonoscopes tested for cleanliness, 30 percent, 24 percent, and 3 percent respectively did not pass their cleanliness test.
According to a news release by APIC:
“Annually between 15 and 20 million endoscopy procedures are conducted with reusable endoscope devices to screen various components of a patient’s GI tract. These devices allow healthcare providers to investigate the surface of this organ and identify issues such as polyps or colon cancer. Duodenoscopes, gastroscopes, and colonoscopes examine the duodenum―or the first section of the small intestine, the stomach, and the colon, respectively.
After an endoscope is used for a procedure it is sent for cleaning before being reused with another patient. This reprocessing involves two steps: first, manual cleaning with an enzymatic cleaner and flushing by a hospital technician and second, soaking the device in a high-level disinfectant. The first step is vital to ensure that the disinfection process is effective. After manual cleaning is completed, the technician visually inspects the instrument to ensure cleanliness. However, this study has found that contamination can remain on the device and may be invisible to the naked eye.”
“Three out of 20 is an unexpectedly high number of endoscopes failing a cleanliness criterion,” states Marco Bommarito, PhD, lead investigator and lead research specialist at 3M Infection Prevention Division. “Clearly, we’d like no endoscopes to fail a cleanliness rating.”
According to the CDC, a major risk of all endoscopic procedures is the introduction of pathogens that can lead to infection. Failure to properly disinfect or sterilize equipment carries not only a risk associated with breach of host barriers, but also risk for person-to-person transmission such as with the hepatitis B and C virus or the transmission of environmental pathogens such as Pseudomonas aeruginosa. In fact, there are numerous reported cases of person-to-person transmission that has led the CDC to state that more healthcare-associated outbreaks have been linked to contaminated endoscopes than to any other medical device.
“The cleaning protocols for flexible endoscopes need improvement, such as guidelines tailored to the type of scope or identifying if there is a critical step missing in the manual cleaning process, and documented quality control measures,” says Dr. Bommarito. “These types of improvements could have a positive impact on patient safety.”
Unfortunately, for the patient who goes in for a colonoscopy in the near future, changes that could lessen the contamination problem may not take effect for some time. The best recourse is to talk to your physician about your concerns while pointing out the results of the study presented at the meeting. Furthermore, you could ask if it is possible to be examined with a single-use colonoscope such as one that was approved last year by the FDA.
Image Source: Courtesy of Wikipedia
“A Multi-site Field Study Evaluating the Effectiveness of Manual Cleaning of Flexible Endoscopes with an ATP Detection System” 40th Annual Conference of the Association for Professionals in Infection Control and Epidemiology (APIC), Oral Abstract #040, Sunday, June 9, 9:30-9:45 a.m.