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ASGE issues updated infection control guidelines for gastrointestinal endoscopy

May 14, 2008

The American Society for Gastrointestinal Endoscopy (ASGE) has updated its infection control guidelines regarding gastrointestinal (GI) endoscopy. The guidelines note that endoscopy-related infections are a very rare event since the adoption of endoscope reprocessing (cleaning) guidelines. The ASGE infection control guidelines appear in the May issue of GIE: Gastrointestinal Endoscopy, the monthly peer-reviewed scientific journal of the ASGE.

Endoscopy is a procedure that uses an endoscope, a thin, flexible tube with a light and a lens on the end to look into the esophagus, stomach, duodenum, small intestine, colon, or rectum, in order to diagnose or treat a condition. There are many types of endoscopy, including colonoscopy, sigmoidoscopy, gastroscopy, enteroscopy, and esophogogastroduodenoscopy (EGD). ASGE is known as the profession's leader in setting standards of excellence in endoscopy and is committed to setting the highest-quality standards for GI endoscopy through its safety guidelines and the training of its members so that patients receive the best and safest care possible. The infection control guidelines were prepared by the ASGE Standards of Practice Committee.

"Despite the large number and variety of GI endoscopic procedures performed, documented instances of infectious complications remain rare, with an estimated frequency of 1 in 1.8 million procedures," said Todd H. Baron, MD, FASGE, chair of the ASGE Standards of Practice Committee. "Endoscopy is a safe, well-tolerated and potentially life-saving procedure when practiced by expertly trained physicians who follow the practice guidelines set forth by the ASGE and who adhere to general infection control principles, including aseptic techniques and safe injection practices."

The guidelines are issued to disseminate information to promote understanding, which leads to the prevention of infection as a result of a GI endoscopy. Circumstances in which an endoscopy-related infection might occur are discussed in the document, as are measures to prevent such infection, including endoscope reprocessing, antibiotic prophylaxis, and protection of endoscopy personnel.

The single best protection against patient-to-patient transmission of microorganisms by an endoscopy is stringent reprocessing of endoscopes after use, with careful adherence to the "Multi-Society Guidelines for Reprocessing Flexible Gastrointestinal Endoscopes" issued in 2003. The guidelines define and discuss key concepts in endoscope reprocessing.

Endoscopy personnel may facilitate transmission of infection from patient to patient if they fail to carefully adhere to general infection control principles. In particular, appropriate aseptic techniques and safe injection practices should be followed. Improper reuse of syringes and the use of contaminated multiple dose drug vials have been linked to the transmission of hepatitis B and C between consecutive patients treated at health care facilities. Such practices should be avoided, and single use drug vials are recommended. Similarly, use of gloves by health care workers was shown to decrease the incidence of Clostridium difficile associated diarrhea and the point prevalence of asymptomatic C difficile carriage in inpatients.

INFECTION CONTROL GUIDELINES SUMMARY

* Transmission of infection as a result of GI endoscopes is extremely rare, and recently reported cases are invariably attributable to lapses in currently accepted endoscope reprocessing protocols or to defective equipment.

* Endoscopes should undergo high-level disinfection as recommended by governmental agencies and all pertinent professional organizations for the reprocessing of GI endoscopes.

* Extensive training of staff involved in endoscopic reprocessing is mandatory for quality assurance and for effective infection control.

* General infection control principles should be adhered to at the endoscopy unit.

ASGE Guidelines

"Infection Control During GI Endoscopy" is available at: http://asge.org/WorkArea/showcontent.aspx?id=4300

"Antibiotic Prophylaxis for GI Endoscopy" can be accessed at: http://asge.org/WorkArea/showcontent.aspx?id=4298

"Multi-Society Guidelines for Reprocessing Flexible Gastrointestinal Endoscopes" can be accessed at: http://asge.org/WorkArea/showcontent.aspx?id=3376

American Society for Gastrointestinal Endoscopy