How to Disinfect an Endoscope

Technician Prepared for Endoscope Sterilization

An endoscope is a flexible tube equipped with a light and a camera that is passed through the gastrointestinal tract by a physician. Most often used for colonoscopies, it also allows the physician to take tissue samples, stop bleeding and remove polyps non-surgically. Endoscopes are sophisticated, durable instruments that are re-used. The American Society for Gastrointestinal Endoscopy has established strict reprocessing and infection control guidelines, which has reduced the risk of infection transmission to 1 in 10 million. Statistics have shown that infection is typically due to breach of these established protocols.

Things You'll Need

• Protective Gear: Gloves, Eyewear, Respiratory Mask, Gown
• Manufacturer recommended cleaning materials: Detergent, Brushes, Solvents, Water
• Basin/Tub for soaking
• Timer
• Specialty cleaning brushes designed by manufacturer
• Disinfectant
• Isopropyl or ethyl alcohol
• Forced-air dryer
• Manufacturer guidelines
• Endoscope to be cleaned

Instructions

Pre-Cleaning

1. Familiarize yourself with manufacturer's instructions. Each endoscope requires a specific FDA approved enzymatic detergent, has a pre-determined soak time and has specifically designed cleaning adapters. This ensures that the device is properly disinfected without damage.

2. Obtain gloves, gown, eyewear and respiratory protection device. Wear during entire cleaning process. These protect workers from exposure to biohazards or harsh chemicals.

3. Remove all biomaterial from the endoscope and its parts by wiping it down with manufacturer-approved detergent and cloths. This should be done as soon after the procedure as possible. When this biomaterial is not removed immediately after a procedure, it will dry and harden, This material will be a barrier that will prevent the penetratration of disinfecting agents and may inactivate them. Patient biomaterial is a nutrient source that will promote the growth of potentially pathogenic organisms.

Mechanical Cleaning

1. Disassemble endoscope completely, if not done during pre-cleaning.

2. Obtain enzymatic detergents as recommended by the manufacturer. Dilute and mix per instructions.

3. Place detergent in a basin measuring at least 16 by 8 inches. Submerge endoscope and its parts in detergent completely. Add additional diluted detergent or disinfectant if it is not.

4. Set timer according to the manufacturer's instructions. Failure to soak long enough will prevent the detergent or disinfectant from fully removing biomaterial. Oversoaking may lead to endoscope damage.

5. Remove endoscope and its parts from the basin after the exact manufacturer's recommended soaking time. Studies indicate that mechanical cleaning alone reduces the bioburden by an average of 99.99 percent.

6. If using an automated endoscope reprocessor, follow the manufacturer's instructions for loading the endoscope into the basin.

Cleaning the Channels

1. Use the manufacturer designed cleaning adapters according to instructions to clean channels. These tools have been properly validated. Failure to use them will result in incomplete disinfection.

2. Use the specially designed cleaning brushes to clean channels. Some endoscopes have unique channels such as an auxillary water jet channel that must be cleaned with specialty brushes.

3. Ensure that the brushes make contact with the channel surface. Failure to do so will prevent removal of all biomaterial.

4. Rinse the endoscope thoroughly with fresh water. Residual detergent may react with and

   inhibit the disinfectant or sterilant solution. This reaction may also result in insertion tube staining

   or peeling.

5. Discard all water used for soaking or rinsing in a safe way. Do not reuse any of the water.

Disinfection/Sterilization

1. Disinfect the endoscope with an FDA-cleared, high-level disinfectant according to manufacturer's instructions. The exposure time and temperature for disinfecting varies among the manufacturers. This step is is listed as a requirement in all guidance documents.

2. Rinse the endoscope and flush the channels with sterile, filtered or tap water to remove disinfectant. Discard rinse water. Failure to thoroughly rinse the disinfectant can result in adverse reactions in patients and potentially anaphylaxis.

3. Flush the channels with 70 to 90 percent of ethyl or isopropyl alcohol.

4. Dry the endoscope using forced air. This greatly reduces the possibility of recontamination of the endoscope by waterborne microorganisms.

5. Hang the endoscope vertically to store. Remove caps, valves and other detachable components according to manufacturer's directions.

Tips & Warnings

• Strictly follow all manufacturer's instructions and use all accompanying cleaning devices. Every part and piece of the endoscope must be disinfected even if it was not used or did not appear to come in contact with biomaterial. Note that most enzymatic detergents are meant for single use only and should be discarded after each use to avoid cross-contamination. Ensure that the disinfectant/sterilizing solution is not expired. Some have shelf-lives as short as 14 days.

References

• American Society of Gastrointestinal Endoscopy: Endoscopic Reprocessing and Infection Control
• "Infection Control and Hospital Epidemiology"; Multi-society Guideline for Reprocessing Flexible Gastrointestinal Endoscopes; Douglas B. Nelson, MD et. al; July 2003
• "Managing Infection Control"; Reprocessing Flexible Endoscopes; Bradley Catalone, PhD, George Koos; June 2005