Pathogens of Concern: Keeping Our Patients Safe in Endoscopy

Introduction

Gastrointestinal endoscopy is an important tool for the identification and treatment of disorders of the gastrointestinal tract. In the past, many patients had to undergo extensive surgical procedures which are now accomplished using an endoscope. We can remove polyps, gall stones, treat bleeding and dilate strictures all of which used to require surgery. While the endoscopy procedures are safer than surgery, there is still the inherent risk of infection. A thorough understanding of infection prevention and its application to GI endoscopy are crucial to preventing lapses in the reprocessing procedures that could lead to cross contamination and infection spread.

The potential to transmit an infection via an endoscope has been well documented. These incidents have been a result of defective design, reprocessing errors, improper use of accessories and improper storage. Also, improper use of accessories or failure to promptly notify health care facilities of recalled instruments have resulted in unnecessary illness, death and public concern. The risk is especially great in those patients who are immuno-compromised. The negative publicity surrounding these events has an impact on the patient’s perception of our ability to provide safe care. Our understanding of increased risks and taking the right actions will help us provide safe, reliable care and thus reassure our patients.

Infections related to endoscopy may be autologous, that is from the patient’s own bacteria. Transient bacteremia occurs post procedure in 4 to 22% of procedures such as esophageal dilatation, percutaneous endoscopic gastrostomy tube placement and endoscopic variceal ligation. There is a risk of endocarditis in susceptible individuals such as someone with a mechanical heart valve. The ASGE has specific recommendations for the use of prophylactic antibiotics for that population.

Patient to patient infections have not been studied since 1992; the incidence at that time was 1 in 1.8 million procedures. We are currently doing more than 20 million procedures annually. Many infections may be unrecognized or unreported. Incidences involving outbreaks are usually due to a break in reprocessing technique or a contaminated reprocessor. Half of all outbreaks are related to bronchoscopy.

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