Reviewing gold standards for processing endoscopes
Staff must receive device-specific training
Endoscopes are classed as semicritical items because they come into contact with mucous membranes or nonintact skin. Semicritical items minimally require high-level disinfection using wet pasteurization or chemical disinfectants, according to the Centers for Disease Control and Prevention’s (CDC) Draft Guideline for Disinfection and Sterilization in Healthcare Facilities, 2003.
The recommendations for high-level disinfection listed below were all ranked "IA" in the draft guidelines. The ranking indicates the strongest level of clinical evidence in support of the practice, suggesting that none of the following recommendations will undergo much revision:
• Meticulous cleaning of the endoscope with an enzymatic detergent recommended by the endoscope manufacturer should be performed immediately after use. Cleaning is essential before the use of currently available automatic endoscope reprocessors.
• All of the channels should be flushed and brushed, if accessible, to remove all organic (e.g., blood, tissue) and other residue. Clean the external surfaces and accessories of the devices by using a soft cloth, sponge, or brushes.
• Reusable accessories (e.g., biopsy forceps or other cutting instruments) that break the mucosal barrier should be cleaned (e.g., ultrasonic clean biopsy forceps) and then sterilized between each patient.
• Endoscopes and accessories that come in contact with mucous membranes are classified as semicritical items and should receive at least high-level disinfection after each patient use.
• A Food and Drug Administration-cleared (FDA) sterilant or high-level disinfectant should be used for sterilization or high-level disinfection.
• The FDA-cleared label claim for high-level disinfection should be used unless scientific studies demonstrate an alternative exposure time is effective for disinfecting semicritical items. For example, if > 2% glutaraldehyde is used, scientific data show that all immersible internal and external surfaces should be in contact with this high-level disinfectant for not less than 20 minutes at 20 degrees C.
• After high-level disinfection, endoscopes (including channels) must be rinsed with sterile water, filtered water, or tap water, followed by a rinse with 70% to 90% ethyl or isopropyl alcohol.
• Personnel assigned to reprocess endoscopes must receive device-specific reprocessing instructions to ensure proper cleaning and high-level disinfection or sterilization. Competency testing of personnel reprocessing endoscopes should be done on a regular basis (e.g., commencement of employment, annually).
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