Reprocessing Redux

Posted by: admin on: November 18, 2011

Endoscope Reprocessing Revisited; Multisociety Guideline Updated

The American Society for Gastrointestinal Endoscopy (ASGE) and the Society for Healthcare Epidemiology of America (SHEA) have released an update of their 2003 joint guidelines for processing gastrointestinal (GI) endoscopes.


  • Since the 2003 guideline was published, additional outbreaks of infection related to suboptimal prevention practices during endoscopy or lapses in endoscope reprocessing have been well publicized,” said Bret T. Petersen, MD, chairman of the ASGE Quality Assurance in Endoscopy Committee.
  • Given the ongoing, but rare, occurrences of endoscopy-associated infections attributed to lapses in infection prevention, an update of the multisociety guideline was warranted.
  • The new guideline provides a detailed overview of the steps required for cleaning, drying and disinfecting equipment.
  • Overall, the committee of authors made 39 recommendations classified the level of evidence.
  • These guidelines ensure that all clinicians are following the most up-to-date evidence-based methods to help keep patients safe
  • The rare occurrence of transmission of pathogens via endoscope speaks to the efficacy of reprocessing methods and shows the impact this guidance has in practice.
  • Although new high-level disinfectants have come to the market and automated reprocessing equipment has evolved since 2003, the committee found that the efficacy of decontamination and high-level disinfection has not changed and the principles guiding both remain valid.
  • The new guideline fills in some gaps in the previous edition by offering a more thorough description of the many steps involved in reprocessing, including specific details on cleaning and drying.
  • The guideline stresses the importance of infection control in all elements of care, including medication administration, and outlines new reprocessing issues for endoscope attachments, such as flushing catheters, which were not included in the 2003 edition.
  • Failure to adhere to recommendations, whether knowingly or unknowingly, is the only known cause for pathogen transmission in the endoscopy suite.
  • All published reports of infections related to GI endoscopy have been linked to failures to follow established cleaning and disinfection/sterilization guidelines or use of defective equipment, the committee noted.
  • Strict adherence to reprocessing guidelines is necessary to protect the health of our patients and to foster the public’s confidence in our endoscopic services.
  • A handful of highly publicized cases of transmission related to GI endoscopy have been reported since the last guideline
    1. Clusters of hepatitis C infection occurred in Las Vegas in 2007 and New York in 2003.
    2. In 2009, approximately 10,000 veterans treated at hospitals in Augusta, Ga., Miami and Murfreesboro, Tenn., were informed they might have been exposed to infection during colonoscopies or endoscopic procedures because of improperly cleaned equipment.
  • Overall, transmission occurs rarely, with an estimated incidence of one in every 1.8 million GI endoscopic procedures.
  • The authors of the new guideline acknowledged that data are lacking for newer issues in infection management.
  • In particular, significant questions remain about endoscope shelf life or “hang time,” the interval of storage after which endoscopes should be reprocessed before use.
  • The committee could not make a recommendation on hang time due to insufficient data.
  • They said that reuse of endoscopes “within 10 to 14 days of high-level disinfection appears to be safe” but added that the interval needs further study.
  • They also noted that the Association of Peri-Operative Registered Nurses (AORN) and the Association for Professionals in Infection Control and Epidemiology recommend shorter intervals, of five and seven days, respectively.
  • Another unresolved issue is the optimal frequency for replacing clean water bottles and tubing for insufflations, as well as water vacuum canisters and suction tubing.
  • The role of microbiologic surveillance testing of endoscopes after reprocessing also remains uncertain.
  • The committee encouraged further research on the methodology and utility of surveillance cultures or sampling, noting a lack of uniform guidance and standards.
  • They also called for more study into the durability and longevity of endoscopes.
  • The committee highlighted two new technologies for high-level disinfection,
    1. EvoTech (Advanced Sterilization Products)
    2. OER-Pro (Olympus American).
  • These technologies and others warrant further well-designed, peer-reviewed clinical studies.
  • The updated guidelines will help reassure physicians, patients and the public that information about endoscope reprocessing techniques are reviewed regularly and that practitioners remain vigilant about infection control.
  • Infection control issues are an area of great concern for both practitioners and the public.
  • Updating the original 2003 multisociety guidelines is an important step to provide the latest information to ensure both safety and quality during endoscopic procedures.
  • Dr Petersen said health care practitioners must stay up to date on infection control practices and recommended the ASGE Quality Course, which is centered largely on infection control and prevention, as well as the ASGE Endoscopy Unit Recognition Program.
  • These are good ways for physicians and supervisory staff to update themselves on current practices and instil additional quality parameters in the practices of their units.

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