DISINFECTION AND ENDOSCOPY - SUMMARY AND RECOMMENDATIONS

This working party was convened by the organizers of the World Congresses of Gastroenterology, Sydney 1990. Its remit was to produce a report on disinfection in endoscopy. Endoscopy plays an essential role in the management of gastrointestinal disorders; its benefits far outweigh the occasional complications which arise. Nevertheless, case reports and surveys performed over a 20-year period confirm that endoscopic procedures do occasionally cause cross-infection1 and the current epidemic with human immunodeficiency virus (HIV) has highlighted the potential for more serious disease transmission if suitable precautionary measures are not generally applied in endoscopy practice. Contaminated equipment may cause infection in three ways: transmission of pathogenic organisms from one patient to another, the commonest example being Salmonellosis;2-10 transmission of infection such as hepatitis B (HBV) from patient to staff by needle-stick injury; and introduction of opportunistic organisms which colonize endoscopic and ancillary equipment on storage. This may cause focal sepsis or septicaemia, particularly in the immunocompromised, or cholangitis and pancreatic sepsis following endoscopic retrograde cholangiopancreatography (ERCP). 11-14 These risks can be eliminated by the use of effective cleaning and disinfection techniques, by providing suitable staff training and by paying attention to endoscopy room procedures. Both HBV and HIV are inactivated by all currently accepted disinfecting or sterilizing procedures. The working party has reviewed the world literature on infection in endoscopy, and disinfection practice, and has considered the guidelines issued by individual national endoscopy groups. The recommendations in this document are the consensus view of this working party which considers them to be the minimum standards of disinfection which should be adopted at this time. The working party considers that disinfection in endoscopy has been under-researched in relation to its importance in clinical practice. These recommendations may require modification in the light of future research and development. Furthermore, clinical considerations, national guidelines and legal considerations may justify a course of action at variance with the recommendations of this report.