APIC Guidelines Set Endoscopy Standards

Special report

Source: Alvarado CJ, Reichelderfer M. The 1997, 1998, and 1999 APIC Guidelines Committees. APIC guideline for infection prevention and control in flexible endoscopy. Am J Infect Control 2000;28:138-155.

The association for professionals in infection Control and Epidemiology (APIC) recently published minimum standards of care for infection prevention during endoscopy procedures. While facilities may wish to adopt more stringent criteria, APIC urges that these basic recommendations be followed for all patients, regardless of whether they are suspected or known to be infected. The APIC recommendations are summarized as follows:

• Meticulous cleaning of the endoscope with an enzymatic detergent recommended by the endoscope manufacturer should be performed immediately after use. All of the channels should be irrigated and brushed, if accessible, to remove particulate matter. Irrigation adapters should be used to facilitate cleaning of all channels. All immersible parts of the endoscope should then be rinsed with water. Detergent solutions should be discarded after each use. Cleaning brushes should be disposable or thoroughly cleaned and receive high-level disinfection or sterilization after each use.

• Leak testing is recommended for flexible endoscopes before immersion.

• Endoscopes that pass through normally sterile tissue should be subjected to a sterilization procedure before each use; if this is not feasible, they should receive at least high-level disinfection. Disinfection should be followed by a rinse with sterile water.

• Endoscopes that come in contact with mucous membranes are classified as semicritical items and should receive at least high-level disinfection.

• An FDA-cleared sterilant/disinfectant should be used for sterilization or high-level disinfection.

• Products and methods for cleaning and disinfection/sterilization should be compatible with the endoscopic equipment and design. Contact instrument manufacturer(s) to confirm compatibility.

• If glutaraldehyde is used, all immersible internal and external surfaces should be in contact with the disinfectant for not less than 20 minutes to achieve high-level disinfection.

• Personnel assigned to reprocess endoscopes must receive device-specific reprocessing instructions to ensure proper cleaning and disinfection or sterilization.

• After chemical disinfection, endoscopes must be rinsed with sterile water or with tap water followed by a 70% ethyl or isopropyl alcohol rinse.

• The instrument and its channels should be thoroughly air-dried. A final drying step that includes flushing all channels with alcohol followed by purging the channels with air greatly reduces the possibility of recontamination of the endoscope by waterborne microorganisms.

• Endoscopes should be stored in a manner that will protect the endoscope and minimize the potential for accumulation of residual moisture. They should not be stored coiled in cases that cannot be properly cleaned. Endoscopes should be hung in a vertical position to facilitate drying.

• Reusable accessories that penetrate mucosal barriers (e.g., biopsy forceps, cytology brushes) should be mechanically cleaned (i.e., by ultrasonics) and then steam sterilized between each patient or used once and discarded. Sterile water should be used to fill the water bottle. The water bottle and its connecting tube should be sterilized or receive high-level disinfection at least daily.

• Flexible endoscopes that cannot withstand the processes described in these guidelines because of age, design, or damage should not be used.

• A log should be maintained indicating for each procedure the patient’s name and medical record number, the procedure, the endoscopist, and the serial number or other identifier of the endoscope used.

• In the setting of an outbreak caused by a suspected infectious or chemical etiology, the investigation should be performed according to standard methods of outbreak investigation.

• Endoscopy-related infection or pseudoinfection should be reported to: persons responsible for institutional infection control and risk management; Food and Drug Administration; state health department; Centers for Disease Control and Prevention; and the manufacturer(s). (This special report was written by Gary Evans, editor of Hospital Infection Control.)