Hostname: page-component-cd9895bd7-jkksz Total loading time: 0 Render date: 2024-12-26T07:36:07.983Z Has data issue: false hasContentIssue false
  • English
  • Français

Disinfection Practices for Endoscopes and Other Semicritical Items

Published online by Cambridge University Press:  21 June 2016

William A. Rutala ,
Eva P. Clontz ,
David J. Weber  and
Karen K. Hoffmann
William A. Rutala*
Affiliation:
Division of Infectious Diseases, Department of Medicine, University of North Carolina (UNC) School of Medicine and the Department of Hospital Epidemiology, UNC Hospitals, Chapel Hill, North Carolina
Eva P. Clontz
Affiliation:
Division of Infectious Diseases, Department of Medicine, University of North Carolina (UNC) School of Medicine and the Department of Hospital Epidemiology, UNC Hospitals, Chapel Hill, North Carolina
David J. Weber
Affiliation:
Division of Infectious Diseases, Department of Medicine, University of North Carolina (UNC) School of Medicine and the Department of Hospital Epidemiology, UNC Hospitals, Chapel Hill, North Carolina
Karen K. Hoffmann
Affiliation:
Division of Infectious Diseases, Department of Medicine, University of North Carolina (UNC) School of Medicine and the Department of Hospital Epidemiology, UNC Hospitals, Chapel Hill, North Carolina
*
CB # 7030, 547 Burnett-Womack Building, University of North Carolina School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7030
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To determine the disinfection practices employed by North Carolina hospitals for endoscopes and other semicritical patient care items and to discuss minimally acceptable disinfection procedures for these items.

Design:

A survey questionnaire was mailed to all North Carolina hospitals to identity their disinfection practices, and a literature review was conducted to ascertain studies that evaluated disinfection techniques for certain semicritical items.

Participants:

Questionnaires were returned by 107 of 167 (64%) North Carolina acute-care hospitals.

Results:

Most hospitals (91%) used a glutaraldehyde-based disinfectant (59%, 2% glutaraldehyde; 29%, 0.13% glutaraldehyde-0.44% phenol-0.08% phenate; 3%, either); half (51%) of the hospitals immersed the endoscope into disinfectant for >20 minutes, but 44% immersed for <10 minutes; nearly all hospitals (97%) disinfected endoscopes at room temperature. Hospitals rinsed the endoscope with sterile water (16%), tap water (54%), tap water followed by alcohol rinse (27%), or other (2%); 58% of the hospitals treated endoscopes from patients infected with human immunodeficiency virus (HIV), hepatitis B virus (HBV), or Mycobacterium tuberculosis differently (81%, ethylene oxide [ETO] sterilization; 10%, increased exposure time; 10%, other). Twenty percent of the hospitals used an automated washer for processing endoscopic instruments. Rigid endoscopes (e.g., arthroscopes, laparoscopes) were primarily high-level disinfected (57%), ET0 sterilized (17%), or either (13%). The disinfection strategies for other semicritical items (e.g., applanation tonometers, cryosurgical instruments, and diaphragm fitting rings) were highly variable for the responding hospitals.

Conclusions:

This survey indicated the presence of a wide variety of practices for handling semicritical patient care items, many of which are inconsistent with current recommendations. To help establish minimally acceptable disinfection procedures for some patient care instruments (e.g., arthroscopes, laparoscopes, tonometers), the scientific literature was reviewed and recommendations were made.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 12 , Issue 5 , May 1991 , pp. 282 - 288
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1991

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Weber, DJ, Rutala, WA, Li, E. Public health for medical staff. In: Yamada, T, Alpers, DH, Owyang, C, Powell, DW, Silverstein, FE, eds. Textbook of Gastroenterology. Philadelphia, Penn: JB Lippincott Company. In press.Google Scholar
2. Rutala, WA, Weber, DJ. Environmental issues and nosocomial infections. In: Farber, BE ed. Infection Control in Intensive Care. New York, NY: Churchill Livingstone; 1987:131–172.Google Scholar
3. Spaulding, EH. Chemical disinfection of medical and surgical materials. In: Lawrence, CA. Block, SS. eds. Disinfection. Sterilization and Preservation. Philadelphia‘, Penn: Lea and Febiger; 1968:517–531.Google Scholar
4. Garner, JS, Favero, MS. Guideline for handwashing and hospital environmental control, 1985. Am J Infect Control. 1986;14:110–126.Google Scholar
5. Rutala, WA. APIC guideline for selection and use of disinfectants. Am J Infect Control. 1990;18:99–117.Google Scholar
6. Hanson, PJV, Clarke, JR, Nicholson, G, et al. Contamination of endoscopes used in AIDS patients. Lancet. 1989;2:86–88.10.1016/S0140-6736(89)90323-1Google Scholar
7. Hanson, PJV, Gor, D, Jeffries, DJ, Collins, JV. Elimination of high titre HIV from fibreoptic endoscopes. Gut. 1990;31:657–659.Google Scholar
8. Dwyer, DM, Klein, EG, Istre, GR, Robinson, Md, Neumann, DA, McCoy, GA. Salmonella newport infections transmitted by fiberoptic colonoscopy. Gastrointest Endosc. 1987;33:84–87.Google Scholar
9. Cole, EC, Rutala, WA, Nessen, L, Wannamaker, NS, Weber, DJ. Effect of methodology, dilution, and exposure time on the tuberculocidal activity of glutaraldehyde-based disinfectants. Appl Environ Microbiol. 1990;56:1813–1817.CrossRefGoogle ScholarPubMed
10. Best, M, Sattar, SA, Springthorpe, VS, Kennedy, ME. Efficacies of selected disinfectants against Mycobacterium tuberculosis . J Clin Microbiol. 1990;28:2234–2239.Google Scholar
11. Power, EGM, Russell, AD. Sporicidal action of alkaline glutaraldehyde: factors influencing activity and a comparison with other aldehydes. J Appl Bacteriol. 1990;69:261–268.CrossRefGoogle Scholar
12. Best, M, Kennedy, ME, Coates, F. Efficacy of a variety of disinfectants against Listeria spp. Appl Environ Microbiol. 1990;56:377–380.10.1128/aem.56.2.377-380.1990Google Scholar
13. Tyler, R, Ayliie, GAJ, Bradley, C. Virucidal activity of disinfectants: studies with the poliovirus. J Hosp Infect. 1990;15:339–345.CrossRefGoogle ScholarPubMed
14. Pitzurra, M, Greco, M, Corvetti, R, Patavino, V, Pasquarella, C, Cerbini, I. What about the sporicidal activity of glutaraldehydes? 2nd International Conference of the Hospital Infection Society. September 4, 1990, London, England.Google Scholar
15. Rutala, WA Cole, EC, Wannamaker, N, Weber, DJ. Inactivation of Mycobacterium tuberculosis and Mycobacterium bovis by 13 hospital disinfectants. 3rd International Conference of Nosocomial Infections. July 31-August 3, 1990, Atlanta, GA Abstract #71.Google Scholar
16. Dixon, RE, Kaslow, RA, Mackel, DC, Fulderson, CC, Mallison, GE Aqueous quatematy ammonium antiseptics and disinfectants: use and misuse. JAMA. 1976;236:2415–2417.Google Scholar
17. Working Party of the British Society of Gastroenterology. Cleaning and- disinfection of equipment for gastrointestinal flexible endoscopy: interim recommendations of Working Party of the British Society of Gastroenterology. Gut. 1988;29:1134–1151.Google Scholar
18. Jonas, G, Mahoney, A, Murray, J, Gertler, S. Chemical colitis due to endoscope cleaning solutions: a mimic of pseudomembranous colitis. Gastroenterology. 1988;95:1403–1408.Google Scholar
19. Lowry, PW, Jarvis, WR, Oberle, AD, et al. Mycobacterium chelonae causing otitis media in an ear-nose-and-throat practice. N Engl J Med. 1988;319:978–982.Google Scholar
20. Meenhorst, PL, Reingold, AL, Groothuis, DG, et al. Water-related nosocomial pneumonia caused by Legionella pneumonia serogroups 1 and 10. J Infect Dis. 1985;152:356–364.CrossRefGoogle ScholarPubMed
21. Centers for Disease Control. Recommendations for orevention of HIV transmission in health-care settings. MMWR. 1987;36(suppl):S3–S18.Google Scholar
22. Handsfield, HH, Cummings, MJ, Swenson, PD. Prevalence of antibody to human immunodeficiency virus and hepatitis B surface antigen in blood samples submitted to a hospital laboratory: implications for handling specimens. JAMA. 1987;258:3395–3397.10.1001/jama.1987.03400230055031Google Scholar
23. Baker, JL, Kelen, GD, Sivertson, KT, Quinn, TC. Unsuspected human immunodeficiency virus in critically ill emergency patients. JAMA. 1987;257:2609–2611.Google Scholar
24. Kelen, GD, Fritz, S, Qaqish, B, et al. Unrecognized human immunodeficiency virus infections in emergency department oatients. N Engl J Med. 1988;318:1645–1650.Google Scholar
25. Karim, QN, Rao, GG, Taylor, M, Baron, JH. Routine cleaning and the elimination of Campylobacter pylori from endoscopic biopsy forceps. J Hosp Infect. 1989;13:87–90.CrossRefGoogle ScholarPubMed
26. Phillips, J, Hulka, B, Hulka, J, Keith, D, Keith, L. Laparoscopic procedures: The American Association of Gynecologic Laparoscopists' membership survey for 1975. J Reprod Med. 1977;18:227–232.Google Scholar
27. Crow, S, Metcalf, RW, Beck, WC, Bimbaum, D. Disinfection or sterilization? Four views on arthroscopes. Assoc Operating Room Nurses J. 1983;37:854–868.Google Scholar
28. Ad Hoc Committee on Infection Control in the Handling of Endoscopic Equipment. Guidelines for preparation of laparoscopic instrumentation. Assoc Operating Room Nurses J. 1980;32:65–76.Google Scholar
29. Hulka, JF, Wisler, MG, Bruch, C. A discussion: laparoscopic instrument sterilization. Medical Instrumentation. 1977;11;122–123.Google Scholar
30. Loffer, FD. Disinfection vs. sterilization of gynecologic laparoscopy equipment. The experience of the Phoenix surgicenter. J Reprod Med. 1980;25:263–266.Google ScholarPubMed
31. Corson, SL, Block, S, Mintz, C, Dole, M, Wainwright, A. Sterilization of laparoscopes: is soaking sufficient? J Reprod Med. 1979;23:49–56.Google ScholarPubMed
32. Corson, SL, Dole, M, Kraus, R, Richards, L, Logan, B. Studies in sterilization of the laparoscope: II. J Reprod Med. 1979;23:57–59.Google Scholar
33. Johnston, LL, Schneider, DA, Austin, MD, Goodman, FG, Bullock, JM, DeBruin, JA. Two percent glutaraldehyde: a disinfectant in arthroscopy and arthroscopic surgery. J Bone Joint Surg. 1982;64:237–239.Google Scholar
34. Centers for Disease Control. Recommendations for preventing possible transmission of human T-lymphotropic virus type III/lymphadenopathy-associated virus from tears. MMWR. 1985;34:533–534.Google Scholar
35. Naginton, J, Sutehall, GM, Whipp, P Tonometer disinfection and viruses. Brit J Ophthalmol. 1983;67:674–676.CrossRefGoogle Scholar
36. Corboy, JM, Borchardt, KA. Mechanical sterilization of the applanation tonometer. Part l-Bacterial study. Am J Ophthalmol. 1971;71:889–891.Google Scholar
37. Corboy, JM, Goucher, CR, Parnes, CA. Mechanical sterilization of the applanation tonometer. Part 2- Viral study. Am J Ophthalmol. 1971;71:891–893.Google Scholar
38. American Academy of Ophthalmology. Updated recommendations for ophthalmic practice in relation to the human immunodeficiency virus. Clinical Alert 2/4. San Francisco, Calif: American Academy of Ophthalmology; 1998.Google Scholar
39. Craven, ER, Butler, SL, McCulley, JP, Luby, JP. Applanation tonometer tip sterilization for adenovirus type 8. Ophthalmology. 1987;94:1538–1540.10.1016/S0161-6420(87)33250-6Google Scholar
40. Pepose, JS, Linette, G, Lee, SE MacRae, S. Disinfection of goldmann tonometers against human immunodeticiency virus type 1. Arch Ophthalmol. 1989;107:983–985.Google Scholar
41. Ventura, LM, Dix, RD. Viability of herpes simplex virus type 1 on the applanation tonometer. Am J Ophthalmol. 1987;103:48–52.Google Scholar
42. Soukiasian, SH, Asdourian, GK, Weiss, JS, Kachadoorian, HA. A complication from alcohol-swabbed tonometer tips. Am J Ophthalmol. 1988;105:424–425.Google Scholar
43. Koo, D, Bouvier, B, Wesley, M, Coutright, P, Reingold, A. Epidemic keratoconjunctivitis in a university medical center ophthalmology clinic; need for re-evaluation of the design and disinfection of instruments. Infect Control Hosp Epidemiol. 1989;10:547–552.Google Scholar
44. Lettau, LA, Bond, WW, McDougal, JS. Hepatitis and diaphragm fitting. JAMA. 1985;254:752.CrossRefGoogle ScholarPubMed
45. Klein, M, Deforest, A. The inactivation of viruses by germicides. Chem Specialists Manuf Assoc Proc. 1963;49:116–118.Google Scholar