Comparison of equipment management and cleaning protocols for rigid sigmoidoscopy Paul J. B. Simpson,* Paul J. McMurrick,* Adrian L. Polglase* and Cherry E. Koh† *Department of Surgery, Cabrini Monash University, Cabrini Health Malvern†The Alfred Hospital, Victoria, Australia Key words Sigmoidoscopy, Proctoscopy, Sterilisation, Enzymatic cleaning, Insufflation bellows, Cleaning protocol. Abbreviations CSSANZ, Colorectal Surgical Society of Australasia; HBA, horse blood agar; VRE, vancomycin resistant enterococcus. Correspondence Assoc Prof Paul McMurrick, Victorian Colorectal Clinic, Suite 20 Cabrini Medical Centre, Isabella Street, Malvern, Vic. 3144, Australia. Email: pjm@colorectal.com.au P. J. B. Simpson MBBS/LLB; P. J. McMurrick MBBS (Hons) FRACS FASCRS; A. L. Polglase MBBS (Hons) MS, FRACS, FRCS (Eng), FRCS Ed, FACS; C. E. Koh MBBS. The first author is a surgeon in training. This manuscript has not been published and is not under consideration elsewhere. All authors are in agreement as to the content of this manuscript. Accepted for publication 1 July 2009. doi: 10.1111/j.1445-2197.2010.05279.x Abstract Background: To provide outcome data relating to cleaning of rigid sigmoidoscopy equipment comparing commonly used techniques, allowing a framework for general guidelines for use in clinical practice. Methods: A total of 104 rigid sigmoidoscopies were performed in the rooms of two colorectal surgeons using standard techniques. A three-way randomization was per- formed adopting the following variables: enzymatic washing versus steam sterilization of the light head, disposable versus reusable bellows and use with versus without an air filter. Aerosol from each system was collected on agar plates, and review of colony count numbers was performed. Results: Gross faecal contamination of the rigid sigmoidoscope light head did not occur during any of the procedures. One plate grew a single-gram negative colony; all other contaminated plates showed environmental flora only. Reusable bellows in combination with an air filter showed lower mean colony counts (environmental flora) from the pre-procedure cultures as well as from the bellows’ cultures. Conclusion: Enteric flora in this study was rarely aerosolized, and the use of an air filter may decrease this likelihood even further. There is no advantage in using disposable insufflation bellows when compared with the reusable type, allowing con- siderable cost saving. Washing the light head between procedures with enzymatic solution is a safe cheap and effective method of decontamination. Introduction The cleaning of endoscopes has received considerable attention in recent years. The literature has concentrated on the more complex issues raised by decontamination of flexible endoscopes. Informa- tion on the use of rigid sigmoidoscopes and their cleaning require- ments is sparse. Recent changes in guidelines for cleaning of these instruments have been based on level 5 evidence and have significant cost implications. Indications for rigid sigmoidoscopy include rectal bleeding, iden- tification of rectal polyps, screening of rectal cancer and investiga- tion of other anorectal symptoms. The equipment used includes four main components: light source, rigid sigmoidoscope, light head (airtight viewing window and fibre optic light connection) and insuf- flation bellows. Only the rigid sigmoidoscope itself comes into direct contact with the patient. There is however a theoretical risk of aerosol contami- nation of the other components. We conducted a survey of members of the Colorectal Surgical Society of Australia and New Zealand (CSSANZ) and received 35 responses. Of the members who responded, 85% (n = 30) performed rigid sigmoidoscopy in their consulting rooms of which ninety percent (n = 27) used a disposable rigid sigmoidoscope. All CSSANZ members use non-disposable insufflation bellows, and about half also use a filter in series with the bellows (Table 1). These figures, in conjunction with our own personal experience, show that reusable insufflation bellows are still widely employed despite concerns about the potential for aspiration of faecal fluid and therefore, cross-contamination of subsequent patients. 1 The Austra- lian Therapeutic Goods Administration have advised on appropriate ORIGINAL ARTICLE ANZJSurg.com © 2010 The Authors ANZ Journal of Surgery © 2010 Royal Australasian College of Surgeons ANZ J Surg 80 (2010) 728–731