Detection of persistent vegetative bacteria and amplified viral nucleic acid from in-use testing of gastrointestinal endoscopes

被引:56
作者
Deva, AK
Vickery, K
Zou, J
West, RH
Selby, W
Benn, RAV
Harris, JP
Cossart, YE [1 ]
机构
[1] Univ Sydney, Dept Infect Dis, Sydney, NSW 2006, Australia
[2] Royal Prince Alfred Hosp, Dept Surg, Sydney, NSW, Australia
[3] Royal Prince Alfred Hosp, Dept Microbiol, Sydney, NSW, Australia
[4] Royal Prince Alfred Hosp, Dept Gastroenterol, Sydney, NSW, Australia
基金
英国医学研究理事会;
关键词
endoscopes; disinfection; PCR; glutaraldehyde; peracetic acid;
D O I
10.1016/S0195-6701(98)90329-2
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
Hospital-acquired infection attributed to inadequate decontamination of gastrointestinal endoscopes prompted an in use evaluation of recommended procedures. Specimens were obtained from the internal channels of 123 endoscopes before, during and after decontamination by flushing with saline and brushing with a sterile brush, and examined for vegetative bacteria by broth and plate culture. Four endoscopy units were tested; the chemical disinfectants used were: 2% glutaraldehyde in Centres 1 and 2 (automated) and Centre 3 (manual); peracetic acid in Centre 4 (automated). Samples from patients in Centre 1 with known chronic hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV-1) infection were also examined for viral nucleic acid by ultracentrifugation, nucleic acid extraction, reverse transcription (for RNA) and polymerase chain reaction (PCR). No persistent vegetative bacteria were found following standard manual cleaning and disinfection for 20 min in 2% glutaraldehyde in Centres 2 and 3 (N=37). At Centre 1, while plate culture yielded no growth, 34% of samples (10/29) grew vegetative bacteria in broth culture after cleaning and disinfection for 20 min in 2% glutaraldehyde. Investigation revealed an error in manual cleaning; no bacteria were detected in 37 samples taken after this was corrected. At Centre 4, despite the use of peracetic acid as a sterilant, three out of 20 (15%) of post decontamination samples grew bacteria; one contained persistent bacteria. HBV and HCV PCR analysis detected viral nucleic acid in three out of four and four out of six samples from viraemic patients undergoing endoscopy in Centre 1 during the period of improper manual washing. After proper cleaning was instituted, samples from nine out of nine HCV viraemic patients were negative. HIV RNA was detected in five of 14 samples taken from endoscopes after use on HIV positive patients but all post decontamination samples were negative. Detection of bacteria in washes from endoscope channels is a useful warning of a breakdown in decontamination practice. Inadequate brushing of internal channels may result in persistent HCV and HBV viral nucleic acid, the significance of which is not clear. These results reinforce the importance of adequate manual cleaning of endoscopes before chemical disinfection.
引用
收藏
页码:149 / 157
页数:9
相关论文
共 32 条
[1]  
ANDRIEU J, 1995, GASTROEN CLIN BIOL, V19, P340
[2]  
AXON ATR, 1990, WORKING PARTY REPORT, P46
[3]   DISINFECTION AND STERILIZATION OF ENDOSCOPES [J].
BABB, JR .
CURRENT OPINION IN INFECTIOUS DISEASES, 1993, 6 (04) :532-537
[4]   ENDOSCOPIC TRANSMISSION OF HEPATITIS-B VIRUS [J].
BIRNIE, GG ;
QUIGLEY, EM ;
CLEMENTS, GB ;
FOLLET, EAC ;
WATKINSON, G .
GUT, 1983, 24 (02) :171-174
[5]  
BOND EE, 1991, DESINFECTION STERILI, P1097
[6]   VIRAL HEPATITIS-B INFECTION RISK IN FLEXIBLE FIBEROPTIC ENDOSCOPY [J].
BOND, WW ;
MONCADA, RE .
GASTROINTESTINAL ENDOSCOPY, 1978, 24 (05) :225-230
[7]   EVALUATION OF THE STERIS-SYSTEM-1 PERACETIC-ACID ENDOSCOPE PROCESSOR [J].
BRADLEY, CR ;
BABB, JR ;
AYLIFFE, GAJ .
JOURNAL OF HOSPITAL INFECTION, 1995, 29 (02) :143-151
[8]   POLYMERASE CHAIN-REACTION FOR THE DIAGNOSIS OF VIRAL HEPATITIS-B AND HEPATITIS-C [J].
BRECHOT, C .
GUT, 1993, 34 (02) :S39-S44
[9]   DETECTION OF HEPATITIS-C VIRUS-RNA IN THE CELL FRACTION OF SALIVA BEFORE AND AFTER ORAL-SURGERY [J].
CHEN, M ;
YUN, ZB ;
SALLBERG, M ;
SCHVARCZ, R ;
BERGQUIST, I ;
BERGLUND, HB ;
SONNERBORG, A .
JOURNAL OF MEDICAL VIROLOGY, 1995, 45 (02) :223-226
[10]  
CHOMCZYNSKI P, 1987, ANAL BIOCHEM, V162, P156, DOI 10.1016/0003-2697(87)90021-2