Recommendations for Endoscope Disinfection

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Subject: Recommendations for Endoscope Disinfection

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Introduction

The following recommendations are offered for disinfection of endoscopes: 
  • Every endoscopy should be performed with a clean, disinfected endoscope. The use of disposable-component systems (i.e., sheathed endoscopes) can provide an alternative to conventional chemical disinfection.

  • Manual cleaning of the endoscope’s surface, valves, and channels is the most important step for preventing the transmission of infections during endoscopy. Manual cleaning should occur immediately after each procedure to prevent drying of secretions or formation of a biofilm, both of which may be difficult to remove. The endoscope should be disassembled as much as possible and immersed in warm water and an enzymatic detergent, washed on the outside with disposable sponges or swabs, and brushed on the distal end with a small toothbrush. Valves should be removed and cleaned by brushing away adherent debris, and the hollow portions should be flushed with detergent solution. The biopsy-suction channel should be thoroughly cleaned with a brush that is appropriate for the instrument and channel size. Automatic washing devices can be used but do not replace manual cleaning.

  • The scope should receive a high level disinfection with a disinfectant approved by the U.S. Federal Drug Administration (FDA; http://www.fda.gov/cdrh/ode/germlab.html). Many societies support the use of soaking the endoscope, valves, and all internal channels for at least 20 minutes in >2% glutaraldehyde at 20°C. The scope should be completely immersed, and all channels should be perfused. The newest multisociety guideline recommends phasing out nonimmersable scopes.

  • Endoscope channels should be rinsed with water and then 70% alcohol, dried with compressed air, and hung vertically overnight to reduce bacterial colonization when the endoscopes are not in use.

  • Accessories such as biopsy forceps should be mechanically cleaned and autoclaved after each use.

Bibliography

Axon AT. Working party report to the World Congresses: disinfection and endoscopy: summary and recommendations. J Gastroenterol Hepatol. 1991;6:23–24. [View Abstract]
Multi-society guideline for reprocessing flexible gastrointestinal endoscopes. Gastrointest Endosc.  2003;58:1–8.
Nelson D.Newer technologies for endoscope disinfection: electrolyzed acid water and disposable-component endoscope systems. Gastrointest Endosc Clin North Am. 2000;10:319–328. [View Abstract]
Spach DH, Silverstein FE, Stamm WE. Transmission of infection by gastrointestinal endoscopy and bronchoscopy. Ann Intern Med. 1993;118:117–128. [View Abstract]
Tandon RK. Disinfection of gastrointestinal endoscopes and accessories. J Gastroenterol Hepatol. 2000;15(Suppl):S69–S72.
 
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