IS UNIVERSAL SCREENING OF INDIVIDUALS FOR HBV, HCV AND HIV BEFORE ENDOSCOPY JUSTIFIED? AN AUDIT OF THE CURRENT PRACTICES

Abstract

Objective: To find out the current practices of sterilization and decontamination of endoscopy equipment, and to
compare them with the current practical guidelines in rest of the world.
Material and Methods: This was a retrospective study carried out from January 2014 to December 2014 in the Departments
of Medicine HMC, KTH, Peshawar. All the patients scheduled for endoscopy are screened for any evidence of
Hepatitis B Virus (HBV), Hepatitis C Virus (HCV) and Human Immunodeficiency Virus (HIV) by third generation ELISA
test. The approximate cost of these screening tests from the hospital main laboratory is Rs 650 and it is between Rs
900 to 3000 from the outside private laboratory facilities. The endoscope is soaked in a decontaminant solution for
30 mins in the morning before the start of the procedures. The endoscope is the washed with water and air dried. In
between the procedures, the endoscope is wiped cleaned with a gauze piece soaked in saline and then introduced
in another patient.
Results: As all the patients are screened for any evidence of HBV, HCV and HIV, it is presumed that the iatrogenic
infection due to endoscope would be negligible. Universal screening for the evidence of these infections comes at
average Rs 1000 per patient as compared to Rs 35 for the endoscope cleaning with the cleansing and rinsing of all the
channels of the endoscope with 2% glutaraldehyde solution (Cidex, Johnson and Johnson Medical Inc., Arlington, TX)
for 15 minutes through automated Endodisinfector followed by rinsing the channels with water and later purging with air.
Conclusion: Timely intervention in terms of Endodisinfection and appropriate training of the staff in sterilization and
disinfection of the endoscopes as per international guidelines is suggested before it becomes a human rights issue.