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The American Society for Gastrointestinal Endoscopy (ASGE) and the Society for Healthcare Epidemiology of America (SHEA) have issued an updated Multisociety Guideline on Reprocessing Flexible GI Endoscopes. Members of the ASGE Quality Assurance in Endoscopy Committee explain that, "All published occurrences of pathogen transmission related to GI endoscopy have been associated with the 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 ASGE and SHEA 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. Since that time, high-level disinfectants, automated reprocessing machines, endoscopes, and endoscopic accessories have all evolved; however, the efficacy of decontamination and high-level disinfection is unchanged, and the principles guiding both remain valid, the guideline authors say, adding, "Given the ongoing occurrences of endoscopy-associated infections attributed to lapses in infection prevention, an update of the multisociety guideline is warranted."
The updated guidance document provides 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. The guideline was published electronically in Infection Control and Hospital Epidemiology on May 2, 2011.
Reference: Bret T. Petersen, Jennifer Chennat, Jonathan Cohen, Peter B. Cotton, David A. Greenwald, Thomas E. Kowalski, Mary L. Krinsky, Walter G. Park, Irving M. Pike, Joseph Romagnuolo. Multisociety Guideline on Reprocessing Flexible GI Endoscopes. Infect Control Hosp Epidem. Published ahead of print on May 2, 2011.Â