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Background: It has been suggested that single-use biopsy forceps will prevent inter-patient transmission of infection during endoscopy. Passage of sterile forceps through the biopsy channel can lead to contamination, however, if the endoscope is inadequately reprocessed.We prospectively evaluated the potential for contamination of single-use biopsy forceps at various stages of endoscope reprocessing. Methods: A total of forty disposable biopsy forceps (Microvasive Inc., Natick, MA) were passed through the biopsy channels of ten colonoscopes at various stages of reprocessing. Ten forceps were passed through the channels prior to use on patients to establish a baseline of high-level disinfection. Ten forceps were passed directly after colonoscopy to confirm contamination with use. Ten forceps were passed after manual cleaning and flushing of the biopsy channel to evaluate the effectiveness of manual cleaning to reduce bioburden. Finally ten were passed through the biopsy channel after either a 2- or 20-minute soak in 2% glutaraldehyde (Cidex™, Johnson & Johnson, Arlington, TX). The forceps were then sealed in sterile plastic bags and 15 ml of soy broth was added. The suspension was passed through a 0.2-micron filter, and the filters were cultured. All cultures were incubated more than 48 hours. Results: Biopsy forceps underwent a total of 40 aerobic and 40 anaerobic cultures. TNTC gastrointestinal flora grew on 19 of 20 plates from biopsy forceps passed through colonoscopes immediately after use (one plate grew only 3 colonies). Persistent gastrointestinal flora was noted on 5 of 20 plates from forceps passed through colonoscopes after manual cleaning alone. No gastrointestinal flora was found on forceps after the colonoscopes were exposed to gluteraldehyde soaks of 2 or 20 minutes. Nonpathogenic organisms including diptheroids, staphylococcus, and streptococcus grew on 16 plates. Conclusions: 1) Disposable biopsy forceps are highly susceptible to contamination from passage through the biopsy channels of improperly cleaned endoscopes. 2) High-level disinfection of the colonoscopes in this study prevented contamination of the forceps with pathogenic organisms. 3) Proper endoscope reprocessing may be the most important factor in preventing inter-patient infection, whether new biopsy forceps or sterilized reusable forceps are utilized. |
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