duties ; at least annually ; anytime a breach is identified ; when a major technique or new endoscope or reprocessing accessory is introduced ; and in the context of local quality control efforts ).
The delayed processing of endoscopes has become a hot topic . This guideline recommends that manual cleaning begin according to the instructions for use ( IFU ), which is usually within an hour after the endoscope is released from the procedure . If cleaning is delayed beyond this time period , the manufacturer ’ s IFU for delayed processing must be followed . It is recommended that soiled endoscopes be transported immediately to the reprocessing area in a fully enclosed , puncture-resistant , leak-proof containers with a biohazard label .
It is recommended that only clean cleaning implements are used ; if reusable cleaning implements are used , they must be cleaned and disinfected between uses . The guideline also recommends the use of fresh cleaning solution for each endoscope . If the cleaning solution falls outside the recommended temperature and dilution range , it is recommended that it be replaced .
If an endoscope undergoes high-level disinfection , it is recommended to perform this disinfection step in an automated endoscope reprocessor ( AER ) using a high-level disinfectant or sterilant that is compatible with the AER and sterilizer IFU . The importance of adhering to the endoscope manufacturer ’ s IFU was emphasized . Some duodenoscopes contain an elevator wire channel that may not effectively be disinfected by some AERs and that this step should be performed manually . In addition , the endoscope and components should be attached using only approved connectors , per the AER and endoscope manufacturer ’ s IFU to ensure contact of all internal surfaces with the high-level disinfectant solution . If the AER cycle is interrupted , the entire cycle should be repeated .
Recent research links incomplete endoscope drying to multiple outbreaks of waterborne organisms ( data shows a reported endoscope contamination rate of 80 percent ). This research signifies that the methods of drying flexible endoscopes need to change — and this multi-society guideline includes new drying recommendations . Prior to this newfound information , 70 percent to 90 percent ethyl or isopropyl alcohol was injected into the endoscope channels to dry the channels . Alcohol was recommended because it purged and promoted the evaporation of residual water within endoscope channels , thereby decreasing the chances for bioburden buildup . There is little data on the possible benefits of alcohol flushes . Based on research , this guideline recommends drying the endoscope channels and areas not dried with a cloth with forced , pressure-regulated filtered air — with a sufficiently prolonged flow of medical air through all accessible channels . For best results , it is ideal for this step to occur simultaneously for all channels and for a duration of at least 10 minutes . Flexible endoscopes should be completely dried after processing and before use . Note : This guideline recommends following manufacturers ’ IFU regarding the use of ethyl or isopropyl alcohol for drying endoscopes . There was a case report that switched to suctioning 70 percent alcohol through a duodenoscope working channel , followed by compressed air during the drying phase . It was reported that this helped contain an outbreak of Pseudomonas aeruginosa . In addition , a conclusion from the pulmonary literature suggests that using alcohol for drying purposes significantly reduces bronchoscope contamination rates ; however , the fixation properties of alcohol could lead to the retention of organisms within the endoscope . At this time , there is no data to strongly support or refute the use of alcohol flushes for the drying of endoscopes .
Proper storing of endoscopes is important to prevent contamination . This updated guideline includes information on proper endoscope handling , including the need for personnel to perform hand hygiene and wear clean gloves during all phases of endoscope handling . Endoscopes may be stored in drying cabinets or conventional cabinets , and always in a way that does not allow for moisture to collect on or within the endoscope .
Drying cabinets have connectors that force air through each endoscope channel . The endoscopes can be stored either vertically or horizontally . These storage cabinets use forced irrigation of endoscope channels with warm , filtered air during storage to achieve complete drying of the channels . This reduces the proliferation of Pseudomonas aeruginosa ; however , these cabinets ’ importance for keeping endoscopes free of contamination remains incompletely defined .
Conventional cabinets require endoscopes to hang vertically , and active or passive ventilation with filtered air helps prevent moisture from forming on or within endoscopes . Passive cabinets without airflow directed into all channels are not sufficient for drying the endoscope from a wet state .
Endoscope cabinets should be in a secure location that is near but not in the procedure rooms . Care and maintenance of the cabinet should be performed according to the cabinet IFU and the cabinets should be routinely inspected for damage and cleaned on a routine basis ( and when soiled ) with an Environmental Protection Agency – registered hospital disinfectant . This guideline does not provide a specific amount of time that endoscopes can be stored before being considered contaminated . It is recommended that Endoscopy units evaluate the available literature , perform an assessment regarding benefits and risks around the optimal storage time for endoscopes , and then develop a policy and procedure specific to their unit on endoscope storage time .
The multi-society guideline also addresses recommendations regarding the use of simethicone . It is recommended that the Endoscopy unit follow the manufacturer ’ s IFU on its addition in water bottles and irrigation devices , including cleaning and disinfection of endoscopes after its use .
The guideline also recommends that documentation be put into place to provide traceability of endoscopes , including those that are loaned .
This article has provided some highlights of the updated Multisociety guideline on reprocessing flexible GI endoscopes and accessories . The complete guideline is available on the ASGE website at
www . asge . org ( under the “ ASGE guidelines ” and the “ Newly Published ” tab ).
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