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Transmission of Infection by Gastrointestinal Endoscopy and Bronchoscopy

David H. Spach, MD; Fred E. Silverstein, MD; and Walter E. Stamm, MD
[+] Article and Author Information

From the University of Washington, Seattle, Washington. Requests for Reprints: Walter E. Stamm, MD, Division of Infectious Diseases, ZA-89, Harborview Medical Center, 325 9th Avenue, Seattle, WA 98104. Disclosure: Dr. Silverstein consults for and has equity in Vision Sciences Inc., the company that developed the sheathed endoscope (described in reference 132). Acknowledgments: The authors thank Jan Hirschmann, MD, Benjamin Lipsky, MD, David Saunders, MD, and Sarah McVicker for reviewing the manuscript; and Andrew Blair, PhD, for the computer-generated drawing of the endoscope.


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1993;118(2):117-128. doi:10.7326/0003-4819-118-2-199301150-00008
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Objective: To review reports on the transmission of infections by flexible gastrointestinal endoscopy and bronchoscopy in order to determine common infecting microorganisms, circumstances of transmission, and methods of risk reduction.

Data Sources: Relevant English-language articles were identified through prominent review articles and a MEDLINE search (1966 to July 1992); additional references were selected from the bibliographies of identified articles.

Study Selection: All selected articles related to transmission of infection by gastrointestinal endoscopy or bronchoscopy; 265 articles were reviewed in detail.

Data Synthesis: Two hundred and eighty-one infections were transmitted by gastrointestinal endoscopy, and 96 were transmitted by bronchoscopy. The clinical spectrum of these infections ranged from asymptomatic colonization to death. Salmonella species and Pseudomonas aeruginosa were repeatedly identified as the causative agents of infections transmitted by gastrointestinal endoscopy, and Mycobacterium tuberculosis, atypical mycobacteria, and P. aeruginosa were the most common causes of infections transmitted by bronchoscopy. One case of hepatitis B virus transmission via gastrointestinal endoscopy was documented. Major reasons for transmission were improper cleaning and disinfection procedures; the contamination of endoscopes by automatic washers; and an inability to decontaminate endoscopes, despite the use of standard disinfection techniques, because of their complex channel and valve systems.

Conclusions: The most common agents of infection transmitted by endoscopy are Salmonella, Pseudomonas, and Mycobacterium species. To prevent endoscopic transmission of infections, recommended disinfection guidelines must be followed, the effectiveness of automatic washers must be carefully monitored, and improvements in endoscope design are needed to facilitate effective cleaning and disinfection.

Figures

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Figure 1.
Nosocomial transmission of microorganisms via endoscopes.

Flow diagram shows major routes and sources of nosocomial transmission of microorganisms via endoscopes.

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Figure 2.
Resistance of microorganisms to disinfectants.

Descending order of in vitro resistance to germicidal chemicals. Modified from reference 2; reproduced with the permission of the author and publisher.

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Figure 3.
Cross-section of typical gastrointestinal endoscope.

A schematic drawing of a fiberoptic gastrointestinal endoscope shows the complex internal design.

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