Endoscope disinfection

INTERVENTIONS AND PRACTICES CONSIDERED

Endoscope cleaning using ultrasonic techniques, detergents
Endoscope disinfection using disinfectants (e.g., glutaraldehyde, orthophthalaldehyde, peracetic acid, electrolyzed acid water); manual disinfection; automatic reprocessing .

Endoscope Cleaning

General Procedures
Endoscope cleaning consists of the mechanical cleaning of internal and external surfaces. This includes brushing and flushing of internal channels with sterile, filtered or drinking-quality water and detergent.

If some of the above steps are not feasible due to limited resources, consider the following alternatives:

• cleaning very carefully with soap and water of acceptable quality as the minimum standard

using sterile, filtered, drinking-quality or boiled water

Do not use tap water unless it is of drinking-water quality

Ultrasonic Cleaning
Ultrasonic cleaning of reusable endoscopic accessories and components may be needed to remove material from hard-to-clean areas. The same detergent must be used for ultrasonic cleaning as for manual cleaning. The recommendations are as follows:

• a non-foaming detergent should be used which is appropriate for both manual cleaning and ultrasonic cleaning

• enzymatic detergent solutions should preferably be used

• the specific contact time recommended by the manufacturer for enzymatic detergents should be observed

•  inhalation of enzyme-containing detergent aerosols and thus the risk of anaphylactic reactions should be minimized by covering the detergent container

Detergents may contain the following substances with properties supporting the cleaning action:

• surfactants which reduce surface tension thus facilitating removal of debris
• activated H2O2 which effectively loosens debris at room temperature
• proteases which break protein debris into smaller, more soluble subunits
• amylase which catalyses the breakdown of starch
• lipase which breaks up fat-containing debris
• quaternary ammonium compounds, biguanidine, alcohols or aldehydes

Other active substances recommended for cleaning include amine compounds or glucoprotamine, peracetic acid and hydrogen peroxide.

Endoscope Disinfection

General Procedures
Disinfection of endoscopes should be performed in dedicated rooms by trained staff at the beginning and at the end of each patient list, as well as between patients.

Manual Disinfection
In manual disinfection the endoscope and endoscope components should be completely immersed in high-level disinfectant/sterilant, ensuring that all channels are perfused.

Automatic Reprocessing
In automatic endoscope reprocessing (AER) the endoscope and endoscope components are placed in the reprocessor, and all channel connectors attached according to AER and endoscope instructions.

Reference:
World Gastroenterology Organisation (WGO-OMGE); 2005 Dec 14. 23 p.