SHEA updates scope reprocessing guidelines

Infections rare, outbreaks a concern

The Society for Healthcare Epidemiology of America (SHEA)and the American Society for Gastrointestinal Endoscopy (ASGE) have updated their 2003 joint guideline for reprocessing gastrointestinal endoscopes to reaffirm reprocessing methods and take into account evolved technology and disinfection systems.

The initial guideline, published in 2003, was drafted in collaboration 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 gastrointestinal (GI) endoscopes. ASGE, SHEA and nine other collaborating organizations have updated the previous guideline with additional discussion of new or evolving reprocessing issues and updated literature citations.

"These guidelines ensure that all clinicians are following the most up to date evidence-based methods to help keep patients safe," says Keith Woeltje, MD, PhD, chair of SHEA's Guidelines Committee. "The rare occurrence of transmission via endoscope speaks to the efficacy of reprocessing methods and shows the impact this guidance has in practice."

To date, all published occurrences of pathogen transmission related to GI endoscopy have been associated with failure to follow established cleaning and disinfection/sterilization guidelines or use of defective equipment. Despite strong data regarding the safety of endoscope reprocessing, clinicians' concerns about the potential for pathogen transmission during endoscopy have raised questions about the best methods for disinfection or sterilization of these devices between patient uses. Since the 2003 guideline, 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.

Despite the large number and variety of GI endoscopic procedures performed, documented instances of infectious complications remain rare, with an estimated frequency of 1 in 1.8 million procedures, says Bret Petersen, MD, FASGE, chairman, of the ASGE Quality Assurance in Endoscopy Committee.

"Since the 2003 guideline was published, additional outbreaks of infection related to suboptimal infection prevention practices during endoscopy or lapses in endoscope reprocessing have been well publicized," he adds. "Given the ongoing, but rare, occurrences of endoscopy associated infections attributed to lapses in infection prevention, an update of the multisociety guideline was warranted."

Complete cleaning first

Flexible GI endoscopes should first be completely cleaned and then subjected to at least high-level disinfection -- a recommendation by a wide variety of groups for years. The specific additions or changes published in the SHEA and ASGE "Multisociety guideline on reprocessing flexible gastrointestinal endoscopes: 2011" include:

  • Review of expanded details related to critical reprocessing steps (including cleaning and drying)
  • Review of reprocessing issues for various endoscope attachments such as flushing catheters
  • Distinction between risks related to endoscope reprocessing and those related to periprocedural practices, including medication administration
  • Discussion of related issues for which data are absent or insufficient to guide practice, including:
  • 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
  • Questions regarding endoscope durability and longevity from the standpoint of infection prevention.

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