Ms Melanie Grigg, Mr Anish Varghese
1Ecosafe International, Mandurah, Australia
Biography:
Anish Varghese is the Contracts Director at Ecosafe International, a specialist water risk management consultancy. His expertise spans infection prevention and healthcare water quality compliance. He works with organisations within healthcare, mining, resources and facilities to ensure water quality compliance and safe water is available to users.
Abstract:
Introduction
Routine use of sterile water during endoscopic procedures is under increasing scrutiny. Australian healthcare services face pressure to reduce costs and environmental impacts associated with single-use sterile water products. Given the natural microbial burden of the gastrointestinal tract and evolving guidance, the infection prevention benefit of sterile water compared with potable water warrants review.
Methods
A literature review evaluated the regulatory context and evidence regarding sterile versus potable water use in gastrointestinal endoscopy. Australian and international guidance documents were reviewed alongside published studies examining infection-related outcomes and water quality requirements associated with intraprocedural water use.
Results
Australian guidance supports a risk-based approach, permitting potable water that meets defined microbiological quality criteria for many endoscopic applications while reserving sterile water for higher-risk circumstances. Similar positions have been adopted internationally. Across the available literature, no increase in infection risk or procedure-related adverse events was identified when high-quality potable water was used for routine gastrointestinal endoscopy under controlled conditions; evidence was strongest for procedures involving the gastrointestinal lumen. In contrast, sterile water use was associated with increased procurement costs, plastic waste and storage burden. The evidence highlighted the importance of robust water quality monitoring and management systems when potable water is utilised.
Conclusion
Current evidence does not demonstrate a measurable infection prevention advantage for routine sterile water use during gastrointestinal endoscopic procedures when high-quality potable water is available and appropriately managed. These findings support consideration of potable water as a sustainable alternative in endoscopy settings, while recognising the need for further research.