Avaliação da efetividade do reprocessamento de endoscópio gastrointestinal flexível

Abstract

Contamination of the flexible gastrointestinai endoscope during examinations requires them to be reprocessed afterwards. However, tbe occurrence of slip-ups during the process may result in the cross transmission of microorganisms between patients. In Brazil, the dearth of research on this topic is liinited to evaluating the effectiveness of reprocessing such equiplnent and the plaiining and execution of corrective and/or preventive actions. This study aimed to evaluate the effectiveness of reprocessing the flexible gastrointestinal endoscope as performed by encloscopy services in the City of Belo Horizonte, Minas Gerais. It presents a cross-sectional study carried out between August 2010 and MarCh 2011. The practices of reprocessing gastrointestinal endoscopes were evaluated in 37 services by appiying questionnaires and sampling air/water channels and suction/biopsy channels in gastroscopes and colonoscopes for microbiological analysis. Contamination of at least one endoscope was found in 91.6% of the 37 monitored services. 84.6% (33/39) of the colonoscopes. and 80.6% of (50/62) of gastroscopes were shown to be contarninated after reprocessing. Microorganisrns were identified from the microbiota of the gastrointestinal tract, with the main ones being: Escherichia coli, Klebsie/la pneumoniae, Pseudoinonas aeruginosa, Acinetobacter bainnannii, and Enterococcus faecalis. Other possible sources of contamination could he considereci, such as tap water and the water used to clean the endoscopes lens and remove detected Mycobacteriuni fortuituni. Mycobacteriuin chelonae, and Pseudomonas aeruginosa and the lack of evidence that the water undergoes microbiological analysis. In colonoscopes, 71.8% (28/39) of the air/water channels and 69.2% (27/39) of the suction/biopsy channeis were contaminated, and, on the average, the microbial ioad was 1400 and 7,800 CFU/ml, respectively. In gastroscopes, 70% (42/60) of the air/water channels and 59.7% (37/62) of the suction/biopsy channels showed the growth of microorganisms, and, on the average, the microbial ioad was 2,500 and 8,900 CFU/mi, respectively. It was confirrned that the recommendations for the reprocessing stages were not being followed by ali of the assessed services and the recommendations invoiving the air/water channeis were the Ieast followed. li was suspected that the main causes for the high rate of containination were not fiiling the channels with a cieaning solution and disinfectant; misuse of the enzyme detergent (soiution temperature and immersion time) non-friction of the air/water channei or indefinite friction frequency in both channeis: undefined volume of water used for rinsing purposes: use of potable water after reprocessing: the non-use of adapters to fui the channels with a cieaning solution, disinfectant, and water: exposure of the endoscope to the disinfectant for a period less than that described on the product iahei: and the Iack of periodic training. It was then concluded that gastrointestinal endoscope reprocessing practices need to be aiigned to the recommendations set forth in the national manual, international guidelines. and the manufacturers guidelines in ali services. For these changes to take place. ali of the professional categories involved in the process need to reach an agreernent as to the transmission of organi sms to patients undergoing gastrointesti nal endoscopy. as evidenced in this study. lt would then be possibie to discuss the clinical practice of reprocessing and reevaluate protocois. It is aiso necessary to foster the continuous search for new technoiogies that could optimize gastrointestinai endoscope reprocessing, as weii as equipment improvements by the manufacturers to further reduce heaith risks to the patients.