High-level disinfection of gastrointestinal endoscope reprocessing

Abstract

High level disinfection (HLD) of the gastrointestinal (GI) endoscope is not simply a slogan, but rather is a form of experimental monitoring-based medicine. By definition, GI endoscopy is a semicritical medical device. Hence, such medical devices require major quality assurance for disinfection. And because many of these items are temperature sensitive, low-temperature chemical methods, such as liquid chemical germicide, must be used rather than steam sterilization. In summarizing guidelines for infection prevention and control for GI endoscopy, there are three important steps that must be highlighted: manual washing, HLD with automated endoscope reprocessor, and drying. Strict adherence to current guidelines is required because compared to any other medical device, the GI endoscope is associated with more outbreaks linked to inadequate cleaning or disinfecting during HLD. Both experimental evaluation on the surveillance bacterial cultures and in-use clinical results have shown that, the monitoring of the stringent processes to prevent and control infection is an essential component of the broader strategy to ensure the delivery of safe endoscopy services, because endoscope reprocessing is a multistep procedure involving numerous factors that can interfere with its efficacy. Based on our years of experience in the surveillance of culture monitoring of endoscopic reprocessing, we aim in this study to carefully describe what details require attention in the GI endoscopy disinfection and to share our experience so that patients can be provided with high quality and safe medical practices. Quality management encompasses all aspects of pre- and post-procedural care including the efficiency of the endoscopy unit and reprocessing area, as well as the endoscopic procedure itself.

Keywords: Automated endoscope reprocessor; Bacterial culture; Gastrointestinal endoscopy; High-level disinfection; Liquid chemical germicide.

Figure 1

Manual cleaning procedure for flexible endoscopes including brushing and irrigation of the internal channels with enzymatic detergent solution that should be performed before disinfection.

Figure 2

A manual leak test is conducted to examine any damage in and out of the gastrointestinal endoscope. It is very important to protect the endoscope from damage from the cleansing solution. No air bubbles should appear after attaching the water-resistant cap.