Decontamination of flexible endoscopes

Flexible endoscopes are complex, delicate, and expensive reusable instruments that require specialist decontamination to prevent transmission of infection. They are manufactured from materials that would be damaged by heat and cannot be steam sterilized, as would be used for most equivalent surgical instruments. They need careful cleaning and disinfection with compatible chemicals, followed by storage that preserves their decontaminated status. Most endoscopes have a variety of narrow internal lumens running the length of the instrument; cleaning and disinfection of these lumens is usually the most challenging element of reprocessing. The stages in endoscope reprocessing are: (1) manual cleaning immediately after use to remove gross soiling, (2) subsequent manual cleaning to a higher standard to remove the majority of remaining soil, (3) reprocessing in an endoscope washer-disinfector to complete the cleaning followed by, chemically disinfection, rinsing, and partially drying of the endoscopes. Endoscopes can then be used shortly after reprocessing or, if longer storage is required, can be kept in cabinets that will irrigate them, internally and externally, with filtered air to dry them thoroughly and preserve their decontaminated status. The facility where endoscopes are reprocessed should facilitate the tracking of individual endoscopes as they move from dirty to a clean environment through the individual steps of decontamination in a validated process. This process should minimize their recontamination and ensure that endoscopes that have not yet been fully decontaminated cannot be issued for use.