KAMLOOPS – Interior Health has sent letters to approximately 9,000 patients who underwent endoscopic (scoping) procedures at Royal Inland Hospital in Kamloops between March 6, 2008, and July 15, 2010, notifying them that the scopes used in their procedures may not have received full disinfection.
An endoscope is a long flexible tube used by specially-trained physicians to assist in the diagnosis and treatment of diseases of the gastrointestinal tract. Endoscopes are equipped with lighting and a camera that allows for the viewing of a patient’s GI system. Depending on the procedure, endoscopes are passed through either a patient’s esophagus or colon. The procedures potentially affected by this circumstance were colonoscopy and therapeutic gastroscopy. Colonoscopy involves examination of the colon while gastroscopy is an examination of the small intestine, stomach and esophagus.
The risk of infection transmission to patients is extremely low – between one in one million and one in ten million. No further testing is being recommended for patients, however, Interior Health has taken the precautionary step to inform patients in the interest of transparency.
“We believe that patients would want to have this information even if, as in this case, the risk is extremely low. Additionally, we have an ethical responsibility to inform them,” said Dr. Jeremy Etherington, IH’s Vice-President for Medicine and Quality.
The majority of these patients live in the Thompson Cariboo Shuswap region.
During a review of practices in July, Interior Health discovered an issue in the reprocessing of endoscopes. This was related to the incompatibility of equipment used in the disinfection of endoscopes in a designated area within the Ambulatory Care Unit – not within the Medical Device Reprocessing Department. Other Interior Health hospitals were not affected as the equipment used in other locations differs.
After meticulous manual cleaning, endoscopes are placed in an automated washer for disinfection, one of the final steps in reprocessing. While manufacturer instructions were being followed for the disinfectant machine, a portion of the scope was not receiving high level disinfection. A further review found tubing used for both the endoscope procedure itself and for assisting with washing and disinfection was not compatible with the disinfection washer used by the hospital. Interior Health has reported this information to the separate equipment manufacturers and to Health Canada.
“As soon as we became aware of this situation, Royal Inland immediately changed the incompatible piece of equipment used for disinfection of scopes, and we began a process of review to understand the potential risk to patients,” said Etherington. “We consulted with internal and external experts, and commissioned a thorough review by an external medical microbiologist. And finally, when we understood the nature of risk to patients, we sought advice from clinical ethicists on the matter of disclosure.”
Following evaluation, Interior Health is confident the risk of infection from this situation is extremely remote, and believes there is NO need for specific patient testing, treatment or follow-up.
“Manual cleaning is considered to be the most significant step in minimizing the risk of infection upon reuse of a scope. Through review and evaluation by the external medical microbiologist, we are confident our manual cleaning processes were conducted to a high standard which minimizes the risk to patients,” said Dr. Etherington.
Though the risk to patients is extremely low, Interior Health recognizes patients may have follow-up questions and has established a phone line for this purpose. Staff will be answering calls Monday to Friday from 8 a.m. to 4:30 p.m. and monitoring voicemail messages after hours. The number to call is
1-877-442-2001 (toll free).
In addition, further information is available through Interior Health’s website, at www.interiorhealth.ca