Importances of the Endoscope Cleaning and Disinfecion Techniques in the Prevention of Endoscopic Transmission of Helicobacter pylori

Kim, Do Hoon; Moon, Jae Hyeon; An, Jin Kwang; Kang, Dae Hwan; Song, Geun Am; Cho, Mong; Yang, Ung Seok

Abstract

BACKGROUND/AIMS: H. pylori has been implicated in the pathogenesis of chronic gastritis, gastric ulcer, duodenal ulcer, and gastric cancer. The mode of H. pylori spread among individuals still largely unknown, but three possibilities such as fecal-oral, oral-oral, and gastro-oral transmission were reported. We were not exclusive possibility of H. pylori infection via endoscopic equipmemt, because endoscope was inserted directly into the gastrointestinal tract.
METHODS
Fifty eight patients with upper gastrointestinal symptoms, who had visited Pusan National University Hospital from February 1999 to May 1999 were examined endoscopically and two biopsies were taken in each antrum and fundus for rapid urease test. After endoscopy, we collected the washing fluid from the surface and channel of the endoscope before and after cleaning and disinfection. Then we examined H. pylori contamination by H. pylori DNA PCR.
RESULTS
The numbers of chronic gastritis, gastric ulcer, duodenal ulcer, gastric ulcer with duodenal ulcer, and gastric cancer were 15, 20, 18, 3, and 2, respectively. The positive rates were 84.5% (49/58) with CLO test, 58.6% (34/58) with H. pylori DNA PCR of the washing fluid of the endoscope surface and channel. In patients with CLO test positive, the positive rates of H. pylori DNA PCR is 44.9% (22/49) in endoscope channel, 24.5% (12/49) in surface before disinfection, but H. pylori DNA was not detected in any cases after washing and disinfection recommended by The Korean Society of Gastrointestinal Endoscopy.
CONCLUSIONS
This study demonstrates that endoscopes were frequently contaminated by H. pylori during procedures performed on H. pylori-positive patients and were a potential source of nosocomial spread of the infection. However, this study also shows that the risk of endoscopic transmission of H. pylori infection could be minimized when appropriate cleaning and disinfection techniques were used.