Rigid sigmoidoscopy : A potential hazard for cross-contamination

Rigid sigmoidoscopy using a disposable or nondisposable sigmoidoscope is a common outpatient procedure. It has been assumed that the nondisposable bellows and light head of the sigmoidoscope remain free from enteric organisms so that the procedure is sterile if a disposable or nondisposable (metal) sigmoidoscope shaft is used. The aim of this study was to identify the presence of organisms within the bellows or light head of the sigmoidoscope. Of 21 patients undergoing rigid sigmoidoscopy with a disposable instrument, bacterial cultures were taken from the inside of sterile Jackson-Pratt bulbs in 12 patients, with the bulbs being used to simulate the nondisposable insufflation bellows. In an additional nine patients, swabs were taken for culture from the inside of the nondisposable light head. Enteric gram-negative Escherichia coli and mixed anaerobic organisms were cultured from the Jackson-Pratt bulbs in two cases, and gram-positive organisms were cultured in another case. Gram-negative organisms, including Bacillus, Proteus mirabilis, Klebsiella, and Enterococcus faecalis, were cultured from the inside of the light head in two cases. Sigmoidoscopy using a disposable instrument is not a sterile procedure and may pose a risk of patient-to-patient cross-contamination by potentially harboring organisms in the bellows or light head.