Cleaning, disinfection, and sterilization of gastrointestinal endoscopes: approaches in the office.

Bacterial contaimination of endoscopes can be clinically significant. While current data suggest that flexible sigmoidoscopy may entail fewer risks than upper endoscopy, these data are too incomplete to draw this conclusion. Careful cleaning and disinfection after each procedure are recommended. Gas sterilization of the endoscope and gas or heat sterilization of accessory equipment may be necessary in certain clinical situations. It must be remembered that hundreds of thousands of endoscopic procedures were performed in the 1970s using cleaning only without substantial health risk. The processes do not have to be complicated or difficult. Staff must be well trained and must understand the potential risks of working with disinfecting agents such as alkaline glutaraldehyde. It is recommended that the clinician fully understand the cleaning and disinfection steps and be able to perform them. It is important that office procedures be based on efficacy, not convenience. The procedures developed to date are not ideal and the ideal disinfectant has yet to be found. Cleaning and disinfecting machines have been developed, but they are expensive and their efficacy and safety are no better than hand-performed methods. An alternative approach to reducing transmission of infections by endoscopes may be to seek less adherent plastic substances for the endoscope sheath. The introduction of immersible endoscopes has helped with cleaning, but their use may also give rise to a false sense of security. Diligent attention to cleaning and disinfection is still necessary.(ABSTRACT TRUNCATED AT 250 WORDS)

Sedation associated with a more complete colonoscopy.

BACKGROUND: This study examined the effect of sedation on the rate of complete colonoscopic examinations by a family physician performing colonoscopy at an urban family practice residency. The outcomes of biopsies and polypectomies performed during the period of the study were also evaluated. METHODS: Data were prospectively collected on 164 consecutive colonoscopies. Seventy-three percent (124/164) of the examinations were training experiences supervised by the first author. The outcomes of examinations of 126 sedated patients were compared with those of 38 nonsedated patients. Patients were not randomly selected. RESULTS: Examinations of 126 sedated patients were carried out with an 85% reach-the-cecum rate compared with a 31% reach-the-cecum rate for 38 nonsedated patients (P < .05). A higher percentage of examinations done without sedation (16%) were terminated because of pain than were terminated in sedated patients (5%) (P < .05). An electrolyte purge solution was found to be the most effective colonoscopy preparation; only 7% (7/100) of examinations on patients prepared by this method were terminated because of inadequate bowel preparation. Adenomas were found in 11% (14/126) of sedated patients and in 8% (3/38) of nonsedated patients. Cancer was detected in 4 sedated patients. CONCLUSIONS: These findings suggest that sedation in colonoscopy is associated with a higher percentage of complete examinations. Also, patients prepared with an electrolyte purge solution tend to have fewer examinations terminated because of inadequate preparation.

Family practice obstetric ultrasound in an urban community health center. Birth outcomes and examination accuracy of the initial 227 cases.

The initial 227 consecutive prenatal ultrasound examinations by two family physicians in an urban community health center were compared with actual birth outcomes. Of 186 examinations for which follow-up information was available, 162 infants were represented. The sampling rate was 81%. No serious anomalies were noted by ultrasound. One placenta previa, one fetal death, and two unsuspected cases of twins were detected by ultrasound. These data represent one of the first detailed reports of outcomes reflecting family physicians' psychomotor and cognitive skill in the use of obstetric ultrasound. The high accuracy (92% to 96%) of correct ultrasound dating suggests that a short postgraduate continuing medical education course was effective for these two family physicians. The accuracy rate compares favorably to more rigorous training. This structured format utilizing the average of four direct measurements for ultrasound-estimated gestational age and three anatomy ratios for assessing proper imaging relationships or growth symmetry may be useful as other family physicians develop educational methods and quality-assurance protocols in this area.