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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