Abstract
Background: It has been suggested that single-use biopsy forceps prevent interpatient transmission
of infection during endoscopy. Passage of sterile forceps through the accessory channel
of the endoscope may lead to contamination, however, if the endoscope has been inadequately
processed. The potential for contamination of single-use biopsy forceps at various
stages of endoscope reprocessing was prospectively evaluated. Methods: A total of 50 disposable biopsy forceps were passed through the accessory channels
of 10 colonoscopes at the following stages of reprocessing: (1) before use in patients
to establish a baseline of high-level disinfection, (2) directly after colonoscopy
to confirm contamination with use, (3) after manual cleaning and flushing of the accessory
channel to support the claim that manual cleaning significantly decreases bioburden,
(4) after manual cleaning and a 2-minute soak in 2% glutaraldehyde to assess for contamination
after an inadequate cleaning time, and (5) after manual cleaning and a 20-minute soak
in 2% glutaraldehyde. The forceps were then sealed in sterile plastic bags after adding
20 mL of thioglycollate broth medium. The suspension was passed through a 0.2-micron
vacuum filter and the filters were cultured. All cultures were incubated more than
48 hours. Results: Biopsy forceps underwent a total of 50 aerobic and 50 anaerobic cultures. Colony-forming
units too numerous to count of GI flora, including Escherichia coli, Klebsiella, Pseudomonas, and Clostridium species, grew on 19 of 20 culture plates from biopsy forceps passed through colonoscopes
immediately after use. One plate in this group grew 3 colony-forming units of E coli. Persistence of GI flora was noted on 5 of 20 plates after manual cleaning of the
colonoscopes. No GI flora were found on forceps after the colonoscopes after soaking
in gluteraldehyde for 2 and 20 minutes. Environmental contaminants including diptheroids,
Staphylococcus, and Streptococcus species grew on 16 culture plates. Conclusions: (1) Single-use biopsy forceps are highly susceptible to contamination during passage
through the accessory channels of improperly cleaned endoscopes. (2) Disinfection
of the colonoscopes in this study prevented contamination of the forceps at baseline
and after reprocessing. (3) Proper endoscope reprocessing may be the most important
factor in preventing biopsy forceps-related interpatient infection. (Gastrointest
Endosc 2002;56:209-12.)
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Article info
Publication history
Accepted:
December 14,
2001
Received in revised form:
October 10,
2001
Received:
July 10,
2001
Footnotes
☆Reprint requests: Richard A. Kozarek, MD, Chief Division of Gastroenterology, Virginia Mason Medical Center, 1100 Seneca St., Seattle, WA 98111.
Identification
Copyright
© 2002 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.
