High-Level Disinfection or “Sterilization” of Endoscopes?

Abstract

Controversy has surrounded the use of liquid chemical germicides to reprocess medical instruments that are damaged by heat sterilization. A review of the literature was performed to assess and compare the efficacy of disinfection and sterilization processes. The results of this review demonstrate that high-level disinfection of thoroughly cleaned endoscopes is not associated with a higher infection rate than is “sterilization.” While there may be a theoretical distinction between the highest level of disinfection and sterilization, thorough cleaning eliminates clinical differences between the two. High-level disinfection is quick, effective, inexpensive, and recommended whenever heat sterilization is not feasible. A low-temperature sterilization process should be considered only if it is comparable in cost to disinfection or if it offers demonstrated advantages without damaging the instrument. Neither disinfection nor sterilization is likely to be effective if the instrument is not cleaned thoroughly after use.

Infection control and its application to the administration of intravenous medications during gastrointestinal endoscopy

“…Periodic review of these practices and procedures to ensure they are up-to-date and account for new and emerging infectious diseases, such as variant Creutzfeldt-Jakob disease and SARS, is recommended. Whereas infection control and aseptic technique in the operating room setting is universally practiced and understood, their application to the GI endoscopy setting, where sterile tissue is not always violated and sterile instruments not always required, 30 is sometimes less clear and not always as strictly enforced or exercised. Indeed, specific violations in aseptic technique have been implicated as the cause of disease transmission during GI endoscopy.…”

“…In general, GI endoscopy does not require either the establishment of a sterile field or that the endoscope, such as a colonoscope or esophagogastroduodenoscope, be wrapped or sterile at time of use. 30 Nor does GI endoscopy ordinarily require use of masks, gowns, or head covers. There are, however, several infection control practices and procedures for the prevention of disease transmission that are as important in the officebased, outpatient GI endoscopy setting as in the operating room setting.…”