Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Exp Med. Feb 20, 2015; 5(1): 33-39
Published online Feb 20, 2015. doi: 10.5493/wjem.v5.i1.33
High-level disinfection of gastrointestinal endoscope reprocessing
King-Wah Chiu, Lung-Sheng Lu, Shue-Shian Chiou
King-Wah Chiu, Lung-Sheng Lu, Shue-Shian Chiou, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
King-Wah Chiu, Lung-Sheng Lu, Shue-Shian Chiou, College of Medicine, Chang Gung University, Kaohsiung 833, Taiwan
Author contributions: Chiu KW and Lu LS contributed equally to this work; Chiu KW, Lu LS and Chiou SS designed the research; Chiu KW and Lu LS performed the research; Chiu KW and Chiou SS analyzed the data; and Chiu KW, Lu LS and Chiou SS wrote the paper.
Supported by:The gastrointestinal endoscopy unit of Kaohsiung Chang Gung Memorial Hospital, Taiwan.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: King-Wah Chiu, MD, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, 123 Ta-Pei Road, Niao-Sung, Kaohsiung 833, Taiwan.
Telephone: +886-7-7317123 Fax: +886-7-7336856
Received: August 4, 2014
Peer-review started: August 6, 2014
First decision: September 16, 2014
Revised: September 19, 2014
Accepted: November 17, 2014
Article in press: November 19, 2014
Published online: February 20, 2015

High level disinfection (HLD) of the gastrointestinal (GI) endoscope is not simply a slogan, but rather is a form of experimental monitoring-based medicine. By definition, GI endoscopy is a semicritical medical device. Hence, such medical devices require major quality assurance for disinfection. And because many of these items are temperature sensitive, low-temperature chemical methods, such as liquid chemical germicide, must be used rather than steam sterilization. In summarizing guidelines for infection prevention and control for GI endoscopy, there are three important steps that must be highlighted: manual washing, HLD with automated endoscope reprocessor, and drying. Strict adherence to current guidelines is required because compared to any other medical device, the GI endoscope is associated with more outbreaks linked to inadequate cleaning or disinfecting during HLD. Both experimental evaluation on the surveillance bacterial cultures and in-use clinical results have shown that, the monitoring of the stringent processes to prevent and control infection is an essential component of the broader strategy to ensure the delivery of safe endoscopy services, because endoscope reprocessing is a multistep procedure involving numerous factors that can interfere with its efficacy. Based on our years of experience in the surveillance of culture monitoring of endoscopic reprocessing, we aim in this study to carefully describe what details require attention in the GI endoscopy disinfection and to share our experience so that patients can be provided with high quality and safe medical practices. Quality management encompasses all aspects of pre- and post-procedural care including the efficiency of the endoscopy unit and reprocessing area, as well as the endoscopic procedure itself.

Keywords: Automated endoscope reprocessor, Bacterial culture, Gastrointestinal endoscopy, High-level disinfection, Liquid chemical germicide

Core tip: High-level decontamination processes to ensure iatrogenic infection prevention in the delivery of high-quality gastrointestinal (GI) endoscopy services are essential. There are three important steps that must be highlighted: manual washing, automated endoscope washer reprocessing and adequate drying/storage after rinsing. Our experimental data demonstrated that surveillance culture monitoring that can detect unsuccessful decontamination provides a much greater assurance of quality control for high level disinfection. This monitoring should be taken into account in order to ensure safety when a patient receives GI endoscope service. Randomized surveillance culture monitoring of the reprocessing process in each month is important for quality control and in ensuring patients’ safety.