Communicable Disease and Health Protection Quarterly Review: April to June 2005

Policy and practice ... Outbreaks and incidents ... Surveillance ... News from abroad ... Publications ... Features ... The Chief Medical Officer for England announced that everybody aged 65 years and over who have not previously been immunized against pneumococcal infection should be offered pneumococcal polysaccharide vaccine.1 This is the third phase of the immunization programme originally announced in August 2003. People aged 80 years and over were offered the vaccine in 2003/2004,2 and people aged 75 years and over were offered the vaccine in 2004/2005. For individuals aged 5 years and over in at-risk groups, such as those with heart conditions, chronic lung disease and chronic liver disease, and for all those aged 65 years and over, a single dose of 23-valence pneumococcal polysaccharide vaccine is recommended. The Department of Health, Social Services, and Public Safety (DHSSPS) for Northern Ireland published the findings of an independent review of the systems and processes used within Northern Ireland to achieve the cleaning and high-level disinfection of flexible endoscopes following their use in the investigation and treatment of patients.3 The review was carried out following an incident in Northern Ireland in May 2004 when a gastroscope may not have been adequately disinfected, which had led to a detailed observational audit of all endoscopes in use in hospitals throughout Northern Ireland was undertaken in June 2004. This identified concerns with 16 endoscopes including gastroscopes, duodenoscopes and colonoscopes. Concerns fell into two groups: in the first group, one narrow channel in the endoscope was not fully cleaned or disinfected despite going through the normal cleaning and disinfection process and, in the second group, all the channels had been fully cleaned, but one channel may not have been fully disinfected despite going through the normal cleaning and disinfection process. A patient notification exercise offering testing for bloodborne viruses was undertaken for patients associated with endoscopes in the first group. Patients, who had undergone a procedure with an endoscope in which one channel may not have been fully disinfected despite going through the normal cleaning and disinfection process, were contacted and reassured. The risk of acquiring infection from an endoscope was considered to be very low, given the estimated prevalence of bloodborne viruses in the Northern Ireland population to be less than 3 per 1000.