Bacterial presence on flexible endoscopes vs time since disinfection

Abstract

Aim: To correlate the length of endoscope hang time and number of bacteria cultured prior to use.

Methods: Prospectively, we cultured specimens from 19 gastroscopes, 24 colonoscopes and 5 side viewing duodenoscopes during the period of 2011 to 2015. A total of 164 results had complete data denoting date of cleansing, number of days stored and culture results. All scopes underwent initial cleaning in the endoscopy suite utilizing tap water, and then manually cleaned and flushed. High level disinfection was achieved with a Medivator^© DSD (Medivator Inc., United States) automated endoscope reprocessor following manufacturer instructions, with Glutacide^® (Pharmax Limited, Canada), a 2% glutaraldehyde solution. After disinfection, all scopes were stored in dust free, unfiltered commercial cabinets for up to 7 d. Prior to use, all scopes were sampled and plated on sheep blood agar for 48 h; the colony count was obtained from each plate. The length of endoscope hang time and bacterial load was analyzed utilizing unpaired t-tests. The overall percentage of positive and negative cultures for each type of endoscope was also calculated.

Results: All culture results were within the acceptable range (less than 200 cfu/mL). One colonoscope cultured 80 cfu/mL after hanging for 1 d, which was the highest count. ERCP scopes cultured at most 10 cfu, this occurred after 2 and 7 d, and gastroscopes cultured 50 cfu/mL at most, at 1 d. Most cultures were negative for growth, irrespective of the length of hang time. Furthermore, all scopes, with the exception of one colonoscope which had two positive cultures (each of 10 cfu/mL), had at most one positive culture. There was no significant difference in the number of bacteria cultured after 1 d compared to 7 d when all scopes were combined (day 2: P = 0.515; day 3: P = identical; day 4: P = 0.071; day 5: P = 0.470; day 6: P = 0.584; day 7: P = 0.575). There was also no significant difference in the number of bacteria cultured after 1 day compared to 7 d for gastroscopes (day 2: P = 0.895; day 3: P = identical; day 4: P = identical; day 5: P = 0.893; day 6: P = identical; day 7: P = 0.756), colonoscopes (day 2: P = 0.489; day 4: P = 0.493; day 5: P = 0.324; day 6: P = 0.526; day 7: P = identical), or ERCP scopes (day 2: P = identical; day 7: P = 0.685).

Conclusion: There is no correlation between hang time and bacterial load. Endoscopes do not need to be reprocessed if reused within a period of 7 d.

Keywords: Bacteria; Colonoscopy; Endoscopic retrograde cholangiopancreatography; Endoscopy; Gastroscopy; Hang time; Processing.

Figure 1

Percentage of negative cultures obtained for all endoscopes throughout the test period. The large percentage of negative cultures is consistent from 1 to 7 d of hang time and between the different types of scopes.ERCP: Endoscopic retrograde cholangiopancreatography.

Figure 2

Percentage of positive cultures obtained for all endoscopes throughout the test period. ERCP: Endoscopic retrograde cholangiopancreatography.

Figure 3

Number of positive culture samples at each level of colony forming units for each endoscope type, where the number of negative cultures for gastroscopes was 67 (n = 73), for colonoscopes 67 (n = 78) and endoscopic retrograde cholangiopancreatography scopes was 12 (n = 14). ERCP: Endoscopic retrograde cholangiopancreatography.