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For several years now, Q-Net has been concerned
about the inconsistent and somewhat sporadic practice
of rinsing endoscopes with 70% alcohol, followed
by forced-air drying, to prevent bacterial colonization
in the endoscope's moist channels during storage.
Some hospitals are unsure of its importance, having
received mixed messages in the market place (see:
Investor's
Business Daily,
February 14, 2000, p. A1). Some hospitals
have been led to conclude that tap water, filtered
through a 0.2 micron filter, produces 'sterile'
water, arguably obviating the need for drying
the endoscope before storage (again see: Investor's
Business Daily and see "Deja Vu ... all
over again?" Infection Control and Hospital
Epidemiology, October 2000, pages 628, 629).
During
the 1980s and early 1990s, several reports have
linked patient injuries and fatalities to flexible
endoscopes contaminated with Pseudomonas
aeruginosa and other
opportunistic microorganisms (see: MMWR,
October 04, 1991;40(39);675-678). As a result
of these reports, and more recent reports (see:
MMWR,
July 09, 1999;48(26);557-560), Q-Net has stressed
the importance of drying the endoscope before
storage, as this practice significantly reduces
the risk of contaminating patients with potentially
pathogenic waterborne microorganisms.
In
September 1997, almost two years ago, Q-Net wrote
in its newsletter, The Q-NetTM Monthly: "To
facilitate drying and prevent bacterial colonization
during storage, … flush each of the instrument's
internal channels with 70% alcohol, followed
by forced air."
Understanding
the importance of this recommendation, Q-Net reiterated
its position in its newsletter's October 1997
issue: "…
terminally rinse each of the endoscope's internal
channels with 70% alcohol, followed
by forced air, to facilitate drying and prevent
bacteria growth … during storag
Objecting
to this recommendation in the September 1997 issue
of the Q-Net Monthly, two readers of this newsletter
criticized Q-Net's recommendation that the
endoscope be dried before storage:
One
read wrote: "For
the record, I consider (Dr. Muscarella's)
information to be at best misleading, and in some
instances blatantly false."
Another
reader wrote: "I
have read all of your stuff, and find that your
arguments are misleading and biased, as you fail
to even consider another perspective than your
own. If I were to 'rinse' any of
my endoscopes in alcohol and blow dry them, they
would not be sterile, for sure. I want sterilized
instrumentation, not terminally disinfected (instruments
for my operating room)."
Possibly,
if the recommendation of rinsing the endoscope
with 70% alcohol followed by forced air drying
and proper storage had been followed, these recent
reports of multiple patient injuries and a fatality,
some of which were caused by waterborne microorganisms,
might have been avoided.
In
short, whenever an endoscope is processed using
an automated system that immerses the endoscope
in a liquid chemical sterilant, drying the endoscope
is recommended to prevent bacterial colonization
during storage. This recommendation applies
whether the rinse water is tap water or filtered
water labeled as either "bacteria-free" or "sterile."
Regards,
Lawrence
F Muscarella, PhD
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