A national survey of physicians' and nurses' attitudes toward endoscope cleaning and the potential for cross-infection.

To elicit information on endoscope cleaning practices and the perceived risk of cross-infection, questionnaires were mailed to 500 physicians and 1,000 gastroenterology nurses and associates in November and December 1991. The survey results indicated that while the majority (83% of nurse/associates and 82% of physicians) expressed satisfaction with current cleaning methods, levels of confidence in endoscope reprocessing varied in several key areas. Concern about the potential for device-borne human immunodeficiency virus transmission was expressed by 82% of nurses and 87% of physicians, while 75% of nurses and 53% of physicians feared being liable should cross-infection occur. While most respondents (86% of physicians and 30% of nurses) were unaware of cross-infection incidents, 6% of nurses reported outbreaks in their institutions. According to survey responses, the risk of cross-infection may be attributable to variable cleaning practices--failure to clean scopes before placing them in disinfectant, abbreviated overall cleaning times, and inconsistent disinfectant immersion times--that may be compounded by unreliable automatic disinfectors. At least once a year endoscopes were blocked by debris according to 74% of nurses and 72% of physicians. Reactions to glutaraldehyde had been experienced by 87% of nurses and 65% of physicians. Gastroenterology professionals may be unaware of the actual incidence of cross-infection, but recognize its potential. Lapses in cleaning practices and the difficulty in monitoring postendoscopy nosocomial infections add to their uncertainty.