Infection Control Protocols for Endoscopy Units

Infection Control Definitions for the Endoscopy Unit

Flexible or rigid endoscopes can be used to perform medical examinations on many sterile or microbe-colonized parts of the body. Rigid endoscopes are used in the diagnosis and treatment of joint diseases, internal body cavities, and others. The use of flexible endoscopes began for diagnosing and treating diseases of the digestive tract and bronchial tubes 30 years ago. These endoscopes rely on fiber optic technology surrounded by a flexible layer to allow visualization of the body's internal cavities, organs, and tissues. This scientific breakthrough revolutionized the treatment of digestive and respiratory diseases. Over time, endoscopic surgeries have become a significant part of medical procedures within hospitals. Thanks to these endoscopes, it has become possible to visualize diseases of the digestive tract and lungs, in addition to taking laboratory samples and performing therapeutic procedures without the need for surgery or general anesthesia. Arthroscopes and laparoscopes are considered rigid endoscopes; this type of endoscope is easy to clean, disinfect, and sterilize for infection control as they do not contain internal cavities. In cases where they are not heat-resistant, they can be sterilized using low-temperature sterilization methods such as gas plasma or ethylene oxide gas, or high-level disinfection using chemical solutions"".

Infection Risks Associated with the Use of Endoscopes

As is the case with modern technologies, the use of endoscopes in the medical field may lead to several complications. Generally, the risks from using endoscopes do not arise from the use itself but often occur due to improper maintenance and cleaning of the endoscope in accordance with infection control methods. This may allow the transmission of bacteria, viruses, and other microbes from one patient to another. Endogenous and exogenous microbial infections may occur due to endoscopic surgeries. The primary factor in transmitting endoscopic infections is insufficient cleaning of the endoscope after use, in addition to other factors including improper disinfection and rinsing after disinfection—especially for auxiliary tools used during endoscopy such as water containers connected to the endoscope and sampling tools. Infection transmission may also occur due to the formation of contaminants during the automated reprocessing of the endoscope and its accessories, as a thin biological layer (biofilm) of microbes may form on the internal components of the reprocessing device"".

Types of Infections Related to Infection Control in Endoscopy Use

Endogenous Infection: Infection resulting from internal microbes due to the transmission of microbes colonizing the mucous membranes of the digestive and respiratory systems to the blood and other sterile parts of the body. Examples include:
1- Cholangitis (bile duct inflammation) after dealing with an obstruction.
2- Pneumonia resulting from the entry of a patient's oral secretions into the lungs while under anesthesia.
3- Endocarditis (inflammation of the heart lining) as a result of bacteremia due to endoscopic surgeries; this occurs particularly in patients with rheumatic heart disease who have not undergone prophylactic antibiotic treatment before endoscopic procedures involving penetration of mucous membranes"".

Infection Control for Exogenous Infection: Other injuries resulting from the use of endoscopes occur due to the entry of external microbes into the patient's body via the endoscope. Microbes are transmitted from one patient to another or from the external environment to the patient through the endoscope. Perhaps the most important factors causing infection are poor manual cleaning of the endoscope, failure to disinfect parts of the endoscope properly with disinfectant, and failure to rinse and dry the device well, as well as contamination due to automated reprocessing of endoscopes, such as the formation of a biofilm of microbes in the processing machines. Factors leading to exogenous infection include the inability to sterilize some tools used to penetrate mucous membranes using an autoclave after each use, such as biopsy forceps or cell collection brushes; some of these may be designed for single-use only"".

See also: Infection Control During Endoscopy Use