MONROEVILLE, Pa., April 1-About 200 patients who underwent colonoscopy at a Pittsburgh-area hospital over a four-month span are being urged to undergo hepatitis and HIV testing because the colonoscopes were not properly cleaned.
Officials at Forbes Regional Hospital in Monroeville, Pa., said patients who had a colonoscopy with either of two specific instruments between Oct. 28 and Feb. 26 were asked to return for free hepatitis and HIV testing. So far, 172 patients have taken up the offer, said a hospital spokesman.
Action Points
- Assure patients that contracting infection from colonoscopy is extremely rare; there are no reports of HIV infection from a contaminated colonoscope and only two reports of hepatitis.
The hospital said the risk of transmitting these infections was extremely low. As far as could be determined, according to a published report, there have only been two incidents nationally in which hepatitis infection was transmitted via a contaminated colonoscope. There have been no HIV transmissions.
The problem occurred when hospital workers failed to immediately notice that there were auxiliary channels on the fiberoptic tubes on the model of a new colonoscope, the Olympus CFQ160A/L, made by Olympus America in Melville, N.Y.
The tubes were not defective nor were the auxiliary channels used by Forbes' physicians, and such channels had not existed in other colonoscopes previously employed at the hospital. Hospital employees then discovered the unrecognized and unused channels had not been correctly cleaned and disinfected.
The infection scare has led the hospital to adopt a new policy that calls for hospital staffers to be trained on all newly purchased medical equipment, even if the new equipment is exactly like the older instruments.
So few cases exist in which a patient has been infected by the blood-borne viruses from an endoscopic device that it's difficult to calculate a person's risk.
The Centers for Disease Control and Prevention in Atlanta has said it is not aware of any widespread problems linked to colonoscopes. According to the Pittsburgh Post Gazette, the CDC has noted two possible cases of hepatitis C associated with improperly disinfected colonoscopes. In 2003, there were reports of improper cleaning of colonoscopes by hospitals in New York and California. Patients in those hospitals also underwent hepatitis and HIV testing.
"To our knowledge, there have been only a few instances of hepatitis transmission documented among these cases and no reports of HIV transmission," said Jennifer E. Rudin, M.D., chief of infectious disease at Forbes.
According to the American Society of Gastrointestinal Endoscopy, over 10 million GI endoscopic procedures are performed in the U.S. every year, and reports of pathogen transmission as a result of these exams are rare.
"All published episodes of pathogen transmission related to GI endoscopy have been associated with failure to follow established cleaning and disinfection/sterilization guidelines," says the society, which has issued guidelines on proper care of endoscopy equipment.
The guidelines include hospital worker training, using the correct brushes and other cleaning equipment to disinfect endoscopes, taking the instruments apart to be sure all parts are correctly cleaned, and discarding detergents after use.
The American College of Gastroenterology considers colonoscopy the "preferred" screening test for colorectal cancer. It can find most polyps and cancers and, when used properly, can prevent colorectal cancer and deaths. The rate of major complications (perforation and major bleeding) is about 1 per 1000 procedures.