Effectiveness of endoscope processing: An update

BACKGROUND: Investigation of endoscopy-associated outbreaks has underscored the importance of ensuring that reusable endoscopes are clean, intact, and dry to prevent pathogen survival and transmission. METHODS: Researchers compiled evidence from recent peer-reviewed articles, standards, and reports from governmental agencies, including adverse event reports, safety communications, and inspection reports by state health departments. Researchers created narratives, tables, and figures to illustrate issues with endoscope processing effectiveness. These included sterile processing breaches found during outbreak investigations and the proportion of endoscopes with visible defects, residual soil or microbes, or retained fluid. RESULTS: Nonadherence with standards for endoscope processing is widespread, and inadequate quality assurance has been linked to outbreaks of infection and other adverse outcomes. High-level disinfection did not reliably eliminate microbes, and studies found most patient-ready endoscopes in real-world settings were damaged and dirty. CONCLUSIONS: To improve processing outcomes and reduce the risk of patient exposures and infections, routine audits and quality assurance steps including cleaning verification tests and visual inspection, are needed. Sterilization may offer a greater margin-of-safety than high-level disinfection because it is capable of a larger reduction in microbial load, utilizes automated systems, has embedded quality indicators, and provides an endoscope that is packaged and protected from contamination.