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2007 Endoscope Decontamination Policy
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Decontamination of Fibre Optic Endoscopes

Page updated 27 July 2008

Decontamination of Fibre Optic Endoscopes

Key Points

Infections such as hepatitis B virus and tuberculosis have been shown to be transmitted on endoscopes

All precautions will be taken to reduce this risk

The mainstay of decontamination is cleaning (should be done in an automated washer)

Glutaraldehyde has been phased out and should not be used (DoH and HSE recommendations)

High level disinfection is possible with a number of other products

These may be efficient disinfectants but they may also be more damaging to endoscopes and their accessories

Final rinsing should be done with sterile pyrogen-free water

Patient-endoscope and endoscope accessory tracking should be instituted

Single patient-use disposable accessories should be used where possible

Introduction

A wide variety of fibre-optic endoscopes is used, ranging from naso-pharyngoscopes of relatively simple design, to ultrasound endoscopes of complicated design, some with video imaging. Fibre-optic endoscopes are made from heat sensitive materials and their design incorporates long narrow channels. Both these factors make them very difficult to decontaminate. Endoscopes have been associated with the transmission of infection from one patient to another so it is essential that the recommended procedures are followed when disinfecting or sterilizing these instruments. This policy contains recommendations concerning decontamination of various fibre-optic endoscopes.

General Points to Consider

High Risk Patients

It is impracticable to identify all high-risk individuals. Thus an adequate antimicrobial decontamination process must be used for all endoscopes at all times, rather than adopting a two-tier approach, depending upon the perceived risk that any particular patient presents. A dedicated "AIDS" endoscope is therefore not necessary.

vCJD

However, a dedicated endoscope will be used for performing upper GI endoscopy procedures on patients known to have variant CJD (See Section on CJD). The commonest indication for such use is insertion of a percutaneous feeding line. A designated gastroscope is available at UCLH for local and National use. All ancillary items must be disposed of.

Tracability / Tracking

A system must be in place so that it will be possible to trace all patients who have a procedure with a particular endoscopes and their reusable accessories. These data should be recorded in the patient's notes.

Decontamination Principles

Decontamination of fibre-optic endoscopic and ancillary equipment is a specialised procedure and should be carried out only by staff who have been properly trained. Manual cleaning with a detergent is an essential prerequisite to any disinfection or sterilisation process, as it physically removes the mucus containing the majority of pathogenic micro-organisms, so allowing subsequent decontamination to be carried out with optimum efficiency. It is the most important part of the decontamination procedure.

Decontamination of the endoscope should take place in a specified area, properly ventilated, near to where the procedure is being performed. The person who is decontaminating the endoscopes should wear a plastic apron, rubber gloves, mask and/or face visor. If a mask is worn, the eyes should be protected with goggles.

The endoscope should be decontaminated before the endoscopy list begins, between patients and at the end of the list.

Brushes and other ancillary equipment must themselves be disinfected or sterilised after each use. (See Section on CJD). Disposable ancilliaries are preferable.

Automated methods of disinfection using an endoscope washer are preferred to manual disinfection because there is more consistency in the process; automated methods are microbiologically more efficient and endoscope washers will minimise staff contact with these chemicals. However, the use of an automated method of disinfection does not remove the need to thoroughly clean the endoscope prior to disinfection.

Gastroscopes, Duodenoscopes, Colonoscopes and Sigmoidoscopes

Read more

Bronchoscopes

Read more

Cystoscopes

Read more

Rigid Endoscopes

Read more

Decontamination of Reusable Endoscope Accessories

Read more

New Disinfectants

Read more

Permit to Work for Endoscopes

Read more

References

Medical Devices Agency Device Bulletin DB(NI)2002/05: Decontamination of Endoscopes. December 2002. (This document contains an extensive reference list).

Working Party of the British Society of Gastroenterology. Cleaning and disinfection of equipment for gastrointestinal flexible endoscope: Interim recommendations of a Working Party of the British Society of Gastroenterology, Gut 1988 Aug;29(8):1134-51.

Working Party of the British Society of Gastroenterology Endoscopy Committee. Cleaning and disinfection of equipment for gastrointestinal endoscopy. Gut 1998;42:585-593.

British Thoracic Society Guidelines on diagnostic flexible bronchoscopy. Thorax 2001;56, suppl 1:i1-i21.

Hansen P J V, Jeffries D J, Collins J V. HIV infection: screens, be clean or both? Thorax 1987 Feb;42(2):81-5 .