Sitemap

Infection Control in Endoscopy

The Editor of a Lonely Planet Travel Guide once enquired of the Curator of one of the world's great museums if the layout of exhibits would remain the same when the museum reopened after major refurbishment. The Curator replied 'Everything will remain as it has always been except for those things which have changed.' From the perspective of the Second Edition of 'Infection Control in Endoscopy' the central tenets remain unchanged. There have however been significant changes, developments and problems.

These include:

• A recognition of the core role of biofilms in water quality. The relatively simplistic concept of simple filter banks to produce high quality rinsing water for endoscopes has proved impractical in many areas. Delivery of bacteria-free water for endoscope rinsing is now a highly complex and frequently expensive undertaking.
• The problems of effective reprocessing to avoid risks of CJD transmission have become even more complicated with the recognition that there may be significant prion concentrations in lymphoid tissue in variant CJD. The implications for endoscope reprocessing are as yet unclear.
• Disease transmission associated with automated flexible endoscope reprocessors (AFER) failures continues. Epidemics of Pseudomonas transmission associated with bronchoscopes appear to relate to inappropriate port devices and AFER connector problems.
• Bacteriological surveillance of water supplies, AFERs and endoscopes has become much more widely accepted than at the time of publication of the First Edition. We make no apologies for stating that it should now be mandatory.
• We have encountered increasing difficulty obtaining well-researched and documented evidence of the mechanism of endoscopy-associated infection transmissions. This appears to relate both to the fear of litigation and also to confidentiality requirements imposed during and after actual litigation. It will be most unfortunate if these constraints increase the risk of similar events occurring because of a lack of information dissemination.
• We have received widespread reports complaining of some AFER and endoscope manufacturers' secrecy. There is increasing concern at the reluctance of companies to notify potential and real defects. Individual instrument and device tracing and warnings are likely to be ineffective because instruments and devices may have been on-sold or transferred to other facilities within large health care organizations.