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flexible endoscopy (1). The conclusions of the Working Party were published in

the form of good practice guidance which gastrointestinal endoscopy units have

used since then. Aldehyde preparations (2% activated glutaraldehyde and

related products) were recommended as first line antibacterial and antiviral

disinfectants and a 4 minute immersion or contact time was recommended as

sufficient for inactivation of vegetative bacteria and viruses (including HIV and


Following changes in safety legislation and an increase in irritancy and

sensitisation to aldehyde disinfectants amongst health care personnel,

modifications to these recommendations were required. A second Working Party

was convened and, in 1993, a special report was published on 'Aldehyde

disinfectants and health in Endoscopy Units'(2). This gave advice on the safe use

of glutaraldehyde and similar aldehyde-containing disinfectants.

An extensive review of infections following upper and lower flexible

gastrointestinal endoscopy and bronchoscopy was published by Spach et al in

1993 (3).

In December 1994 a third Working Party was convened by the BSG to determine

how the 1988 recommendations should be modified. This Working Party has

concluded that most of the recommendations of the previous report have stood

the test of time. In the UK there have been no reports of transmission of infection

resulting from inadequate decontamination of GI endoscopes by those following

the 1988 recommendations. Most countries, and the disinfectant manufacturers,

now recommend 10 minutes or longer immersion in 2% glutaraldehyde for

routine endoscopy. This improves the margin of safety.

A recent Device Bulletin DB 9607 from the Medical Devices Agency of the

Department of Health on the Decontamination of Endoscopes advises that the

user of the disinfectant adopts the disinfectant manufacturers' contact/immersion

times (4). These must be supported by experimental studies which demonstrate

proven efficacy against microorganisms of significance in terms of their

resistance and their association with a particular endoscopic procedure. Leading

2% glutaraldehyde manufacturers recommend a 10 minute contact time for

vegetative pathogens including Ps. aeruginosa and viruses such as HIV and


In response to this, the Working Party has addressed two aspects relating to

cleaning and disinfection.

i. Disinfectant selection 2% glutaraldehyde is the most widely used agent.

It is an effective disinfectant, relatively inexpensive and non damaging to

endoscopes, accessories and automated processing equipment but,

health and safety issues are a source of considerable concern. It is likely

that the legal occupational exposure level for glutaraldehyde will be

reduced substantially within the next few years. This will make it more

difficult and expensive to adhere to the Health and Safety at Work Act

1974 and thereby comply with the Control of Substances Hazardous to

Health Regulations introduced in 1988 and revised in 1994. Accordingly

the Working Party reviewed the current status of glutaraldehyde in

endoscopic practice and assessed alternative disinfectants.

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