Infection Prevention and Endoscope Reprocessing
Reprocessing is a chain
Flexible endoscopes are semicritical devices and require high-level disinfection. The chain has no weak link: bedside pre-cleaning (wipe the insertion tube, flush channels with detergent) prevents biofilm; leak testing detects damage before immersion; manual cleaning with brushes and enzymatic detergent removes organic soil; rinsing follows; then high-level disinfection with an appropriate agent (glutaraldehyde, ortho-phthalaldehyde, peracetic acid, or others), a final rinse with filtered or sterile water, alcohol flush, forced-air drying, and vertical storage in a drying cabinet.
Duodenoscopes are the highest-risk instrument because of the elevator mechanism and complex channels; they require meticulous manual cleaning, and many programs use disposable elevator components and periodic surveillance cultures. Outbreaks of carbapenem-resistant Enterobacteriaceae and Pseudomonas have been traced to duodenoscopes despite adherence to manufacturer instructions.
Personnel safety matters: glutaraldehyde and ortho-phthalaldehyde are irritants and sensitizers; use adequate ventilation, PPE, and closed systems. Document every reprocessing cycle with scope identifier, date, time, and operator. Single-use components must not be reused.
Traps: skipping bedside pre-cleaning because the scope looks clean, placing leaking scopes in disinfectant, and assuming negative surveillance cultures mean the process is perfect. Standard precautions apply to all patients; there is no need to test patients for hepatitis before endoscopy.
Rule of thumb: if it is not clean, it cannot be disinfected.
Worked example: two patients develop CRE after ERCP; the response includes quarantining duodenoscopes, culturing, reviewing reprocessing steps, and checking the elevator mechanism.