Forceps Sterilization Comparison Autoclave And Eo

Dig Dis Sci (2012) 57:405–412
DOI 10.1007/s10620-011-1884-7

ORIGINAL ARTICLE

Comparison of Sterilization of Reusable Endoscopic Biopsy
Forceps by Autoclaving and Ethylene Oxide Gas
Jai Hoon Yoon • Byung Chul Yoon • Hang Lak Lee •
Jun Kyu Lee • Yong-Tae Kim • Dong Ho Lee • Il Ju Choi
Don Haeng Lee • Dong Hee Kim

•

Received: 19 April 2011 / Accepted: 16 August 2011 / Publishedonline: 9 September 2011
Ó Springer Science+Business Media, LLC 2011

Abstract
Background and Aims Every country has standardized
reprocessing guidelines for reducing the risk of microorganism transmission via reusable biopsy forceps. Sterilization is performed either by autoclaving or with the use of
ethylene oxide (EO) gas. However, there are no clear
standard global recommendations. The aimof this study
was to determine whether EO gas or autoclaving is a safer
and more effective method for the sterilization of reusable
forceps.
Methods This was a prospective study conducted at
multiple tertiary referral centers. Seventy reusable biopsy
forceps that had been reused at least 20 times each were
collected from six endoscopy centers. In all, 61 forceps
from five centers weresterilized using EO gas, and the nine
forceps from the remaining center were placed in an

autoclave. We performed real-time polymerase chain
reaction (RT-PCR) for Mycobacterium tuberculosis and
hepatitis B virus and performed bacterial cultures on the
reusable forceps, which were cut into 2- to 3-cm sections.
The forceps were also scanned with an electron microscope
(EM) to detect surfacedamage and contamination.
Results Escherichia coli bacteria were cultured from 2 of
the 61 (3.3%) reusable biopsy forceps sterilized with EO
gas. On EM scanning, abundant debris and tissue materials
remained on the cup surfaces of the reused biopsy forceps
and on their inner wires. No microorganisms were found on
the autoclaved forceps.
Conclusions Sterilization with EO gas may be inadequatebecause the complicated structure of the forceps may
interfere with sterilization. Therefore, for optimum safety,
reusable biopsy forceps should be sterilized by autoclaving.

J. H. Yoon Á B. C. Yoon Á H. L. Lee
Department of Internal Medicine, Hanyang University College
of Medicine, Seoul, Korea
e-mail: jaihoonyoon@gmail.com

I. J. Choi
Center for Cancer Prevention and Detection,National Cancer Center, Goyang, Korea
e-mail: cij1224@ncc.re.kr

B. C. Yoon (&)
Department of Gastroenterology, Hanyang University
College of Medicine, Seoul, Korea
e-mail: dryoonjh@hanmail.net

D. H. Lee
Department of Internal Medicine,
Inha University College of Medicine, Incheon, Korea
e-mail: ldh@inha.ac.kr

J. K. Lee
Department of Internal Medicine,
Dongguk University College ofMedicine, Goyang, Korea
e-mail: jeromee1971@yahoo.co.kr

D. H. Kim
Healthcare System Gangnam Center, Healthcare Research
Institute, Seoul National University Hospital, Seoul, Korea
e-mail: messmd@chol.com

Y.-T. Kim Á D. H. Lee
Department of Internal Medicine, Seoul National University
College of Medicine, Seoul, Korea
e-mail: yongtkim@snu.ac.kr
D. H. Lee
e-mail: dhljohn@snubh.co.kr123

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Keywords Biopsy forceps Á Sterilization Á
Equipment reuse Á Ethylene oxide Á Autoclave

Introduction
Biopsy forceps are one of the most frequently used
accessories in gastrointestinal endoscopy units, including
both reusable and disposable forceps. Because of cost,
reusable biopsy forceps are used more frequently in some
countries than in others. During reuse, forceps maynosocomially transmit microorganisms due to incomplete
reprocessing of endoscopic accessories. A rough estimate
of the incidence of infection transmitted by endoscopy is 1
case per 1.8 million procedures [1]. Disease transmission is
one of the most important issues concerning reusable
endoscopic accessories such as biopsy forceps, snares, and
papillotomes [2, 3]. The public is becoming...