Best practices for flexible endoscope high-level disinfection-an integrative review

Abstract

Background: Flexible endoscopes have a complicated design which includes several small lumen channels intended to facilitate the flow of fluids, tissue, and tools through the length of the device. This complex design leads to reprocessing challenges for high-level disinfection (HLD) to ensure endoscopes are free from contaminants that could lead to hospital-acquired infections. The aim of this project was to identify optimal strategies and obstacles for each stage of flexible endoscope HLD through an integrative review with the goal of achieving reprocessing excellence. Methods: A literature search was conducted using PubMed/Medline and CINAHL databases. A total of 32 articles and six guidelines were included in the review. Results: Ten elements with best-practice recommendations of flexible endoscope HLD have been identified. The HLD elements that received the most literature support include quality assurance/process monitoring and manual cleaning/decontamination. Several barriers to the adequate performance of HLD elements were also identified. Conclusion: This integrative review applied varying levels of rigour to identify and synthesize best practices for the following HLD elements: point-of-use treatment, transport, leak testing, manual cleaning/decontamination, visual inspection, manual or automated HLD, rinsing/drying, storage/hang time, record keeping, and quality assurance/process monitoring.