ESGE–ESGENA guideline: Cleaning and disinfection in gastrointestinal endoscopy

Abstract

1. Introduction2. Definition of terms3. Endoscopy-related infections4. Principles of infection control5. Chain of infection6. Health and safety of endoscopy personnel7. General requirements7.1. Classification of endoscopic equipment7.2. Aims of the reprocessing procedure7.3. Staff requirements7.4. Reprocessing room7.5. The reprocessing procedure7.6. Manual versus automated reprocessing8. Process chemicals8.1. Detergents8.1.1. Detergents with enzymatic boosters8.1.2. Detergents with alkaline boosters8.1.3. Detergents with enzymatic and alkaline boosters8.1.4. Detergents containing antimicrobial active substances8.2. Disinfectants8.2.1. Glutaraldehyde8.2.2. Orthophthalaldehyde (OPA)8.2.3. Peracetic acid (PAA)8.2.4. Chlorine dioxide8.2.5. Electrolytically generated disinfectants8.3. Rinse aid8.4. Combination of products from different manufacturers8.5. Change of products9. Reprocessing of endoscopes9.1. Manual cleaning9.1.1. Pre-cleaning in the endoscopy room9.1.2. Manual cleaning in the reprocessing room9.2. Reprocessing in washer-disinfectors9.2.1. Definition and process basics for washer-disinfectors9.2.2. Process specifications for washer-disinfectors9.2.3. Specific recommendations for washer-disinfectors9.2.4. Advantages and disadvantages of washer-disinfectors9.3. Reprocessing in automated disinfection devices9.3.1. Definition and process basics for automated disinfection devices9.3.2. Process specifications for automated disinfection devices9.3.3. Specific recommendations for automated disinfection devices9.3.4. Advantages and disadvantages of automated disinfection devices9.4. Manual reprocessing of endoscopes9.4.1. Definition and process basics for manual reprocessing9.4.2. Process specifications for manual reprocessing9.4.3. Advantages and disadvantages of manual reprocessing9.5. Drying, storage and reuse of endoscope10. Quality assurance10.1. Documentation10.2. Maintenance of washer-disinfectors and automated disinfection devices10.3. Process validation and microbiological surveillance10.4. Outbreak management11. Reprocessing of endoscopic accessories11.1. General recommendations11.2. Process specifications11.2.1. Manual cleaning11.2.2. Reprocessing in washer-disinfectors11.2.3. Manual reprocessing11.2.4. Sterilization11.2.5. Storage11.3. Specific recommendations11.3.1. Biliary and pancreatic procedures11.3.2. Injection needles11.3.3. Biopsy forceps11.3.4. Water bottle and its connectors12. AppendicesAppendix 1: Manual cleaning of flexible endoscopesAppendix 2: Reprocessing of flexible endoscopes in washer-disinfectors and automated disinfection devicesAppendix 3: Manual reprocessing of flexible endoscopesAppendix 4: Manual reprocessing of reusable endoscopy accessoriesAppendix 5: Reprocessing of endoscopic accessories in washer-disinfectors and automated disinfection devices13. References