The beneficial role of GI endoscopy for the prevention, diagnosis, and treatment of many digestive diseases and cancer is well established. Like many sophisticated medical devices, the endoscope is a complex, reusable instrument that requires reprocessing before being used on subsequent patients. The most commonly used methods for reprocessing endoscopes result in high-level disinfection. To date, all published occurrences of pathogen transmission related to GI endoscopy have been associated with failure to follow established cleaning and disinfection/sterilization guidelines or use of defective equipment. Despite the strong published data regarding the safety of endoscope reprocessing, concern over the potential for pathogen transmission during endoscopy has raised questions about the best methods for disinfection or sterilization of these devices between patient uses. To this end, in 2003, the American Society for Gastrointestinal Endoscopy (ASGE) and the Society for Healthcare Epidemiology of America collaborated with multiple physician and nursing organizations, infection prevention and control organizations, federal and state agencies, and industry leaders to develop evidence-based guidelines for reprocessing GI endoscopes. 1,2 Since that time, high-level disinfectants, automated reprocessing machines, endoscopes and endoscopic accessories have all evolved. 3-6 However, the efficacy of decontamination and high-level disinfection is unchanged and the principles guiding both remain valid. 7 Additional outbreaks of infection related to suboptimal infection prevention practices during endoscopy or lapses in endoscope reprocessing have been well publicized. A cluster of hepatitis C cases was attributed to grossly inappropriate intravenous medication and sedation practices. 8 In numerous other instances, risk of infection transmission has been linked to less willful, but incorrect, reprocessing as a result of unfamiliarity with endoscope channels, accessories, and the specific steps required for reprocessing of attachments. 9 Recent on-site ambulatory surgery center surveys confirm widespread gaps in infection prevention practices. 10 Given the ongoing occurrences of endoscopy-associated infections attributed to lapses in infection prevention, an update of the multisociety guideline is warranted. This document provides an update of the previous guideline, with additional discussion of new or evolving reprocessing issues and updated literature citations, where appropriate. Specific additions or changes include review of expanded details related to critical reprocessing steps (including cleaning and drying), reprocessing issues for various endoscope attachments such as flushing catheters, discussion of risks related to selected periprocedural practices including medication administration, and mention of newly recognized issues for which there are incomplete data with which to guide practice. They include endoscope shelf life or "hang time" (the interval of storage after which endoscopes should be reprocessed before use), the role of microbiological surveillance testing of endoscopes after reprocessing and questions regarding endoscope durability and longevity from the standpoint of infection prevention.
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging