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Entamoeba histolytica and Giardia lamblia were isolated from the stool sample of a 45- year- old man, and Shigella sonnei was isolated from the stool sample of an 18- year- old woman. Both patients experienced diarrhea and severe abdominal cramps, and prior to onset of digestive symptoms both had been treated by the same chiropractor. The chiropractor had administered colonic irrigations (enemas) to these patients. The device used for this treatment was a gravity- dependent apparatus using 12 liters of tap water. There were no check valves to prevent backflow, so all parts of the apparatus could have become contaminated with feces during each colonic treatment. The chiropractor provided colonic treatment to four or five patients per day. Between patients, the adaptor piece that is inserted into the rectum was placed in a "hot- water sterilizer." What two errors were made by the chiropractor?

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