Download Routine screening for hepatitis B and Human

Routine screening for Hepatitis B and
Human Immunodeficiency virus before
upper gastrointestinal endoscopy: is it
necessary?
By
Dr Ray-Offor E FWACS,FMAS,DMAS(Ind), Dr Aneke NC MBBS
Oak Endoscopy Centre Port Harcourt Rivers State
Nigeria.
Introduction
• Oesophagogastroduodenoscopy (OGD) is a useful tool for
accurate diagnosis and treatment of diseases in the upper
gastrointestinal (G) tract.
• There is the need to prevent the transmission of infection
from patient to patient and patient to staff in the endoscopy
suite.
• A minimum of high level disinfection of endoscopes and
quality control measures are mandatory for infection control
in the endoscopy suite.
Aims
• To study the prevalence of Hepatitis B and Human
Immunodeficiency virus HIV in GI endoscopy patients while
assessing the need for routine pre-endoscopy screening for
these diseases.
Patients and method
• Study design
– A retrospective observational study
• Setting
– A premier ambulatory care endoscopy centre in Port
Harcourt Nigeria
• Patients
– All consecutive patients undergoing upper GI endoscopy in
the centre.
• Period of study
– February 2014 to February 2016( 2 years)
Methodology
• Data extracted from centre records.
• There was routine Hepatitis and Retroviral screen test for HIV I&II before
all procedures
• Personal protective protocol adopted in all positive cases.
• High level disinfection of endoscopes before and after procedures using
Ammonium chloride (Umonium) after manual cleaning in enzymatic
solution – Cidezyme- Johnson & Johnson and rinsing in water. Final rinsing
of endoscope in sterile water before use.
• Patients were followed up after procedures with phone calls
• Staff of endoscopy team observed for infection.
• The variables studied were
– demographics
– Cost factor
• PPE vs Lab test (Hepatitis B & RVS)
– screen test results
– post infection rate
Statistical analysis
• IBM SPSS version 20 Chicago IL USA
Results
• 124 cases of upper GI endoscopies performed during the
study period
• Age range was from 15 months to 85 years
• 63 males and 61 females M:F =1:1
Duration
Male Female
OGDs
done
HIV
Screened(%) +ve(%)
Hepatitis B
+ve(%)
Feb 2014-July 2014
19
23
42
42
0
0
August 2014-Jan 2015
14
8
22
22
0
1
Feb 2015-July2015
12
18
30
30
1
1
Aug 2015-Feb 2016
18
12
30
30
1
0
Total
63
61
124
124(100)
2(1.6)
2(1.6)
• Positive screen for Hepatitis B was 1.6% and also 1.6% for HIV.
Results
• Cost analysis
• PPE (N1,800)
• Screen test- HIV (N1,500) and Hepatitis B(N1,500)
• A protocol of universal
basic precaution was applied
in all patients with positive
screen result (face mask, gown, gloves )
• There was no recorded case of post endoscopy infection
Conclusion
• A universal basic precaution protocol is recommended during
the procedures and while reprocessing endoscopes
• Routine pre-procedure screen for Hepatitis and Human
Immunodeficiency virus is not advised
References
• Rutala WA, Weber DJ. Disinfection and sterilization: An
overview. American Journal of Infection Control 2013;
41(5):S2-5.
• Infection prevention and control guideline For Flexible
Gastrointestinal Endoscopy and flexible bronchoscopy.
Public Health Agency of Canada http://www.phacaspc.gc.ca
• American Society of Gastrointestinal Endoscopy guideline
for infection control during GI endoscopy.
Gastrointestinal Endoscopy 2008;67(6):781-790