Cases point to widespread scope contamination.(Clinical Rounds)

LOS ANGELES -- Nearly 6,000 patients were potentially exposed to blood-borne pathogens from improperly disinfected colonoscopes, gastroscopes, endoscopes, and cystoscopes in California over a 2-year period, state health officials reported.

The episodes, documented in a poster presented at the annual meeting of the Society for Healthcare Epidemiology of America, suggest that a widely publicized episode involving colonoscopy patients in a Pennsylvania community hospital is not an anomaly. Media reports revealed in late March that 200 patients were offered free HIV and hepatitis screening at a suburban Pittsburgh hospital after it was discovered that auxiliary channels in colonoscopes were not properly disinfected for 4 months.

The California study, too, cited auxiliary channel problems in the potential exposure of 2,050 colonoscopy patients in four hospitals from December 2002 to October 2004. Thousands of other hospital and clinic patients were notified of faulty automated endoscope reprocessor valves or fittings or technician lapses that potentially compromised the sterility of equipment used during their endoscopic procedures.

Erica Weiss, a researcher with the California Department of Health Services, said at the meeting that additional potential exposures at one acute care hospital and three clinics were identified after submission of the poster.

California, which has been a leader in tracking endoscope reprocessing errors, issued an alert 18 months ago. The problem is by no means confined to one or two states, said Jon Rosenberg, M.D., principal investigator of the study and a medical epidemiologist in the communicable diseases branch of CDHS.

"We have been called by other states and other countries. It's a global problem--a problem wherever endoscopy is done," Dr. Rosenberg said in an interview.

Reports of potential exposures have increased exponentially as screening guidelines have encouraged healthy older adults to undergo colonoscopy. Often, cleaning devices do not quite fit endoscopes properly, or ...