Disinfection of Endoscopy and Reusability of Accessories

Abstract

Corona viruses are a group of medium-sized positive-sense single-stranded RNA viruses with crown-like structure due to projections noted over the surface of the virus. The infection has been declared as a pandemic by the world health organization (WHO) in March 2020. Health care professionals in endoscopy are at high risk of infection by novel corona virus disease 2019 (COVID-19) from inhalation of droplets, conjunctival contact, feces, and touch contamination. Upper gastrointestinal (GI) endoscopy is considered to be a high-risk aerosol-generating procedures (AGPs) and the live virus has been found in patient stool. Flexible endoscopes when contaminated have been considered as the vector for transmission of infections. Infections related to the side viewing endoscopes and endoscopic ultrasound scopes are more frequent than upper GI scope and colonoscopes. Stratifying patients needing endoscopy and deferral of elective procedures will help to decrease the virus spread. Planning and revision of workflows is necessary for safety of patient and staff and to successfully provide infection prevention and control measures, for this a “three zones and two passages” concept should be followed. Manual cleaning followed by high-level disinfection (HLD), effectively eliminates nearly all microorganisms from endoscopes during reprocessing. Transmission of viral infections during endoscopy is quite rare and, it is usually the result of noncompliance from the essential steps of reprocessing. Reuse of any disposable GI endoscopic device is strongly discouraged. Environmental decontamination is essential to reduce the risk of fomite transmission. Noncritical environmental surfaces frequently touched by hands (e.g., bedside tables and bed rails) and endoscopy furniture and floor should be considered heavily contaminated in patients with intermediate or high risk of COVID-19 and should be thoroughly disinfected at the end of each procedure. If available, negative pressure rooms are preferred for endoscopy, as has been advised by Centers for Disease Control and Prevention (CDC). Staff involved in reprocessing and the cleaning of endoscopy rooms should utilize personal protective equipment (PPE) including N95 mask. Reprocessing staff should undergo necessary training and ongoing annual assessment of competency.

Environmentally Sustainable Endoscopy Practices

“…Sterilization is required for reusable accessory that breaches mucosal contact like biopsy forceps. 35 Innovation in equipment design and sterilization techniques is the need of the hour as this may help to facilitate waste minimization.…”

Guidelines for Robotic Flexible Endoscopy at the Time of COVID-19

“…Current endoscopic procedures rely on PPE (enhanced during COVID-19), comprehensive room and equipment cleaning and of course air circulation ( Garbey et al, 2020 ) which can vary for endoscopy suites. Despite concerns around patient exposure to the virus due to contaminated endoscopes, evidence suggests that reprocessing agents with viricidal activity will remove the SARS-CoV-2 virus ( Kampf et al, 2020 ; Rai, 2020 ). In the past, certain bacteria were not successfully removed from duodenoscopes ( Rauwers et al, 2018 ; Balan et al, 2019 ), starting a push for disposable endoscopes.…”

Consumers’ preferences for endoscopes: a discrete choice experiment

“…Cross-contamination is evident not only in the USA but also in Europe (Larsen et al , 2021). The recent pandemic of corona virus further exposes the risk of infection to the user (Rai, 2020).…”