AIDS: practising safe endoscopy.

The emergence of HIV has provoked a widespread reappraisal of infection control practices in endoscopy units. Infection control practices should be applied to all patients alike without recourse to selection or screening. Although there has only been one reported instance of viral transmission at endoscopy, HIV could in theory be transmitted by a contaminated endoscope. Experience suggests that this is more likely to occur from damaged endoscopes, if an unsuitable disinfectant is used or endoscopes are not precleaned. In-use studies have shown that HIV contaminates endoscopes used on patients with AIDS, but in amounts too small to cause infection in tissue cultures. Cleaning in neutral detergent is extremely effective in removing contaminating micro-organisms, including HIV, from endoscopes. Aldehydes are the disinfectants of choice, but any disinfectant may fail if organic material is not removed by cleaning. After thorough cleaning, short disinfection times (e.g. four minutes) ensure inactivation of all relevant micro-organisms except Cryptosporidium and mycobacteria, although in practice even these organisms are likely to be reduced to non-pathogenic levels. Accidental needlestick injuries are the greatest hazard in the endoscopy suite; needles should not be resheathed and biopsy forceps must be handled with great care. The wearing of gloves should become second nature.