Water for Irrigation

This page discusses an ongoing debate in the gastrointestinal (GI) endoscopy community about the safety of using tap water, compared to sterile water, to irrigate the patient’s GI lumen during colonoscopy. According to the endoscope manufacturers, sterile water is recommended during both endoscopic irrigation and distal lens cleaning.

Article: Read (click here) Dr. Muscarella’s “Tap Water Used for Irrigation during GI Endoscopy: A Recommendation and Assessment of the Infection Risk.”

Podcast: Listen to Dr. Muscarella’s reading of his article “Tap Water Used for Irrigation during GI Endoscopy: A Recommendation and Assessment of the Infection Risk.”

YouTube: For background, an interesting and well-produced video of this debate, hosted by a professional GI endoscopy organization, may be watched on “YouTube” by clicking here.

Organizations: The following lists the (public-domain) recommendations of several professional organizations (and one hospital group):

— The American Society for Gastrointestinal Endoscopy (ASGE): ASGE published a guideline in 2014 entitled “Guidelines for safety in the gastrointestinal endoscopy unit.”  Click here to read it (refer to recommendation #14 on p. 367).

In this guideline ASGE recommends that:

Although the multiple-society guideline recommends using sterile water in the irrigation bottle, it is acceptable to use tap water because this has been shown to be safe. — ASGE

(Note: It is unclear whether ASGE’s recommendation in this 2014 guideline is limited to irrigation during colonoscopy, or whether its scope might also include the water used to cleanse the ERCP endoscope’s air/water channels during ERCP.)

Interesting, ASGE recommended 3 years ago in its endorsed guideline “Multi-society guideline on reprocessing flexible gastrointestinal endoscopes, 2011,” however, that:  “Sterile water should be used to fill the water bottle” — click here.

This recommendation is the same as that which was included in the first multi-society’s guideline, which was published in 2003 and is also entitled “Multi-society guideline for reprocessing flexible gastrointestinal endoscopes” — click here.

As well as ASGE, the Joint Commission and Association of periOperative Registered Nurses (AORN), among others, endorsed this 2003 guideline.

— The Society for Gastroenterology Nurses and Associates (SGNA): Similarly, SGNA recommends in its position statement “Reprocessing of water bottle used during endoscopy” (updated: September, 2011;  click here) that:

Sterile water should be used in the water bottle for all endoscopic procedures. — SGNA

— The Association for Professionals in Infection Control and Epidemiology (APIC): Consistent with SGNA’s position statement and the aforementioned multi-society guideline, APIC writes in its “APIC guideline for infection prevention and control in flexible endoscopy, 2000” (click here, refer to p. 149) that:

Sterile water should be used to fill the bottle for endoscopic irrigation.” — APIC

— Kaiser Foundation Hospitals: In its “Program-wide Scope Reprocessing Competency Package,” created by the National Disinfection and Sterilization Task Force and last revised: August 2007, Kaiser Foundation Hospitals writes that (click here):

Sterile water should be used to fill the water bottle (used for cleaning the lens and irrigation during the procedure).  The water bottle and its connecting tube should be sterilized at least daily (unless disposable). — Kaiser Foundation

(Note: An evaluation of such disposable irrigation tubing may be read by clicking here.)

Manufacturers:  The following lists the (public-domain) recommendations of several endoscope manufacturers:

— FujiFilm: “Sterile water should be used during endoscopic irrigation or distal lens cleaning.”  (Click here: “Reprocessing Summary and Guide for Fujinon/Fujifilm Flexible GI Endoscopes.” Reference: FRG-120323)

— Olympus: “Use sterile water only. Non-sterile water may cause patient
cross-contamination and infection” (referring to the water used by the GI endoscope’s air/water system). (Click here: “Instructions for the EVIS Exera Duodenoscope: Olympus TJF Type 160 VR”; reference: GE1672 11)

— Pentax: “Use only sterile water for irrigation and inspection purposes.” (Click here: “Manual Reprocessing Guidelines for 30/31& 30K/31K Series GI Videoscopes.” MK-001, Rev B)

Remarks: So, what’s a GI endoscopy unit to do, use tap or sterile water for irrigation during GI endoscopy?

Lawrence F Muscarella, PhD, this blog’s writer,  provides his recommendation in his article “Tap Water Used for Irrigation during GI Endoscopy: A Recommendation and Assessment of the Infection Risk” —  click here.


Originally posted 2-18-2014, Rev A; updated 5/29/2014, Rev A.

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