Correspondence
Transmission of Hepatitis C Virus during Colonoscopy
N Engl J Med 1997; 337:1848-1849December 18, 1997
- Article
To the Editor:
Bronowicki et al. (July 24 issue)1 report the probable transmission of hepatitis C virus infection from a seropositive patient to a husband and wife at the time of colonoscopy. They clearly demonstrate the necessity of proper reprocessing of flexible gastrointestinal endoscopes and accessories by pointing out the multiple breaches of established recommendations for the reprocessing of colonoscopes. These breaches included failing to clean the endoscope's air, water, and biopsy-suction channels manually and limiting the glutaraldehyde soak to five minutes, as well as failing to steam-sterilize (autoclave) the biopsy forceps between uses.
The American Society for Gastrointestinal Endoscopy's Ad Hoc Committee on Disinfection has confirmed the general safety of gastrointestinal endoscopy with respect to reports of transmission of infection between patients.2 The committee found that only 28 cases of endoscopic transmission of infection with water-borne (pseudomonas), enteric (such as Escherichia coli), or cutaneous bacteria had been reported since the introduction of specific guidelines for endoscopic cleaning and disinfection. Estimating that 40 million endoscopic procedures were undertaken in the United States from 1988 to 1992, the committee concluded that the incidence of transmission of infection was approximately 1 in 1.8 million gastrointestinal endoscopic procedures. The possibility of underreporting or failure to recognize endoscopic transmission of infection was acknowledged. In each of the 28 reported cases, there was a breach in the recommended cleaning or disinfecting procedures or, alternatively, contamination of an automated endoscope reprocessor or accessories.
The report emphasized the importance of manual cleaning before the instrument is reprocessed with a disinfectant or sterilant solution. This reprocessing should occur in a dedicated room, in the context of strict quality assurance; the endoscope should be thoroughly washed before being immersed in a 2 percent glutaraldehyde solution at 20°C for 20 minutes. A final rinse of all channels with 70 percent alcohol is required. Following these recommendations should minimize if not eliminate the risk of endoscopic cross-contamination.
2 ReferencesRichard A. Kozarek, M.D.
American Society for Gastrointestinal Endoscopy, Manchester, MA 01944-13141
Bronowicki J-P ,Venard V ,Botte C , et al. Patient-to-patient transmission of hepatitis C virus during colonoscopy. N Engl J Med 1997;337:237-240
Full Text | Web of Science | Medline2
American Society for Gastrointestinal Endoscopy Ad Hoc Committee on Disinfection
CrossRef | Web of Science | Medline
Author/Editor Response
The authors reply:
To the Editor: We agree with Kozarek on the general safety of gastrointestinal endoscopy when the recommended cleaning or disinfecting procedures are respected.1 Because the hepatitis C virus is enveloped, a hepatitis C outbreak is unlikely if appropriate cleaning and disinfection procedures are followed. Indeed, very few cases of viral hepatitis C infection after endoscopy have been reported. This low incidence could be due in part to the difficulty of recognizing acute hepatitis C in the majority of cases. We sought to make physicians aware of the risk of transmission of hepatitis C virus in the case of inadequate disinfection of the endoscope and accessories. Several studies assessing the degree of adherence to guidelines for the cleaning and disinfection of gastrointestinal endoscopes were published between 1988 and 1992, and they pointed out the high rate of inadequate disinfection procedures.2
We also sought to call attention to the risk of cross-infection related to repeated use of disposable syringes by anesthetists. This practice seems to be common despite the publication of recommendations for infection control for anesthesiology.3,4
4 ReferencesJean-Pierre Bronowicki, M.D.
Marc-André Bigard, M.D.
Centre Hospitalier Universitaire de Nancy, 54500 Vandoeuvre, France1
American Society for Gastrointestinal Endoscopy Ad Hoc Committee on Disinfection
CrossRef | Web of Science | Medline2
Spach DH ,Silverstein FE ,Stamm WE . Transmission of infection by gastrointestinal endoscopy and bronchoscopy. Ann Intern Med 1993;118:117-128
Web of Science | Medline3
Trepanier CA ,Lessard MR ,Brochu JG ,Denault PH . Risk of cross-infection related to the multiple use of disposable syringes. Can J Anaesth 1990;37:156-159
CrossRef | Web of Science | Medline4
Recommendations for infection control for the practice of anesthesiology. Park Ridge, Ill.: American Society of Anesthesiologists, 1994.
- Citing Articles (6)
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1
J. S. Khan, B. J. Moran. (2011) Iatrogenic perforation at colonic imaging. Colorectal Disease 13:5, 481-493
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Indrani Banerjee, Beryl Primrose Gladstone, Miren Iturriza-Gomara, James J. Gray, David W. Brown, Gagandeep Kang. (2008) Evidence of intrafamilial transmission of rotavirus in a birth cohort in South India. Journal of Medical Virology 80:10, 1858-1863
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Y. Shemer-Avni, M. Cohen, A. Keren-Naus, E. Sikuler, N. Hanuka, A. Yaari, E. Hayam, L. Bachmatov, R. Zemel, R. Tur-Kaspa. (2007) Iatrogenic Transmission of Hepatitis C Virus (HCV) by an Anesthesiologist: Comparative Molecular Analysis of the HCV-E1 and HCV-E2 Hypervariable Regions. Clinical Infectious Diseases 45:4, e32-e38
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Philippe Vanhems, Angele Gayet‐Ageron, Thierry Ponchon, Claude Bernet, Jean‐Alain Chayvialle, Christine Chemorin, Leone Morandat, Marie‐Ange Bibollet, Philippe Chevallier, Jacques Ritter, Jacques Fabry. (2006) Follow‐up and Management of Patients Exposed to a Flawed Automated Endoscope Washer‐Disinfector in a Digestive Diseases Unit • . Infection Control and Hospital Epidemiology 27:1, 89-92
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Richard A. KOZAREK. (1999) Endoscope and Accessory Reprocessing. Digestive Endoscopy 11:2, 103-107
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P.V. Holland. (1998) Post-Transfusion Hepatitis: Current Risks and Causes. Vox Sanguinis 74:S2, 135-141
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