Endoscope Reprocessing: Why Each Step Is Essential to Patient Safety

Endoscope reprocessing involves as many as 100 steps, depending on the IFU for your endoscopes. While there is no strong evidence for the efficacy of some steps, industry leaders agree that each step plays an important role in reducing the risk of harm to patients. Thus, once an endoscope reaches its hang-time limit, it’s time to remove it from use and begin the reprocessing process.

In this article, we examine why following the reprocessing steps set forth by leading professional organizations and the manufacturer’s IFU is critical to the health of your patients. 

Pre-Cleaning

Immediately after endoscope removal, the scope is wiped with a detergent solution. The channels are flushed with the solution, followed by an air purge. This is a quick process meant to remove organic material efficiently before transport. 

Rationale: 

Pre-cleaning reduces the risk of biofilm build-up. Biological material is easier to remove while moist, making subsequent cleaning more successful. 

Transport 

Immediately after pre-cleaning, the scope is transported to the reprocessing room in a closed container. It is good practice to label the container with the pre-cleaning completion time. 

Rationale: 

Some endoscope IFUs require that reprocessing begins within a specific time frame after pre-cleaning, or staff will be required to perform additional cleaning steps before proceeding with reprocessing. A closed container prevents exposure of staff, patients, and visitors to infectious material. Rapid transport followed by leak testing and manual cleaning prevents bioburden from drying on the scope. As noted above, debris is easier to remove while moist. 

Leak Testing

Technicians perform a leak test before initiating manual cleaning. The scope is visually inspected during leak testing to identify obvious signs of damage or debris.

Rationale: 

Leak testing can identify damaged areas that may:

• harbor biofilm,
• create small tears in mucous membranes, providing microorganisms present in the endoscope access to the bloodstream, as reported in an article published in OR Today, or
• allow detergents used in cleaning and disinfecting to leak into internal components, causing costly damage.

Manual Cleaning

Following the manufacturer’s instructions for use (IFU), the endoscope is cleaned, including the elevator channel. Technicians should use appropriately sized brushes and non-abrasive cloths, as instructed by the IFU.  

Rationale: 

Manual cleaning is a critical step in reprocessing. Disinfection disinfects surfaces but may not remove any remaining debris. Organic material remaining on the scope after manual cleaning may become a source of infection for the next patient. 

Rinse and Dry

Endoscopes are rinsed thoroughly with clean water before inspection. The channels are purged with forced air, and the endoscope wiped with a lint-free cloth to remove any remaining liquid. 

Rationale: 

Any remaining water or detergent can:

• obstruct the technician’s view during visual inspection, and
• dilute the disinfectant used during high-level disinfection, potentially rendering the disinfectant too weak to perform the job of inactivating microorganisms.

Visual Inspection

Technicians look for cracks, scratches, debris, rust, or discolored areas. Strong lighting and magnification are essential tools to help technicians identify areas of concern. 

Rationale: 

Visually verify that the scope and channels are clean to reduce the risk of retained debris or overlooked damaged areas. 

High-Level Disinfection

Whether performing high-level disinfection (HLD) manually or via an automated reprocessor, follow the manufacturer’s IFU. Some automated reprocessors (AER) perform a cleaning cycle before disinfection. However, it is best practice to manually clean and inspect all endoscopes before disinfection to ensure no debris remains in or on the scopes. 

Rationale: 

HLD is the gold standard in endoscope reprocessing. HLD kills or inactivates microorganisms that may transmit infectious diseases. However, disinfection is only as good as the steps that preceded it.

Second Rinse

After high-level disinfection, remove any remaining disinfectant by thoroughly rinsing the scope with clean water. 

Rationale:

A final rinse removes any remaining disinfectant residue that could cause damage to delicate membranes.

Drying

Scopes and their channels must be thoroughly dried using forced instrument air. 

Rationale: 

A moist environment may contribute to the development of biofilm, a sticky substance composed of living organisms. 

Storage

Endoscopy units may use conventional or drying cabinets. Drying cabinets force filtered air through endoscope channels and throughout the cabinet. Endoscopes stored in drying cabinets remain dry, both inside and out. 

Rationale: 

Moisture retention leading to biofilm build-up remains a serious concern for endoscopy centers. Utilizing a storage method that maintains dry scopes, like a drying cabinet, may help prevent retained moisture that can promote the development of biofilm. 

Documentation

As each endoscope is reprocessed, document all endoscope reprocessing steps digitally, or at minimum, in a manual logbook. This step helps maintain patient safety and ensures your endoscopes are “audit ready”.

Specific Rationale:

Documentation of all reprocessing steps is essential for:

• quality control,
• communication among staff, 
• prompt identification of safety issues, and
• patient tracking in the event of an infectious outbreak.

A digital logbook streamlines documentation, improves operational efficiency, and ensures traceability. Tracking hospital assets such as endoscopes improves patient outcomes and reduces overall cost.

Key takeaway:

Failure to follow best practice guidelines published by leading professional organizations in addition to the endoscope manufacturer’s IFU may result in disease transmission during endoscopic procedures. 

Additional Article References:

• https://www.aorn.org/outpatient-surgery/article/2022-July-endoscope-reprocessing
• https://www.asge.org/docs/default-source/default-document-library/multisociety-guideline-reprocessing-gi-endoscopes.pdf
• https://ortoday.com/endoscope-reprocessing-challenges/
• https://www.cdc.gov/hicpac/media/pdfs/essential-elements-508.pdf
• https://www.sgna.org/Portals/0/SGNA%20Standards%20of%20infection%20prevention%20in%20reprocessing_FINAL.pdf