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 Positive screen for Hepatitis B was 1.6% and also 1.6% for HIV. Duration Male Female OGDs done Screened(%) HIV +ve(%) Hepatitis B +ve(%) Feb 2014-July 2014 19 23 42 August 2014-Jan 2015 14 8 22 1 Feb 2015-July2015 12 18 30 Aug 2015-Feb 2016 Total 63 61 124 124(100) 2(1.6)

Results Cost analysis A protocol of universal 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.phac-aspc.gc.ca American Society of Gastrointestinal Endoscopy guideline for infection control during GI endoscopy. Gastrointestinal Endoscopy 2008;67(6):781-790