Guideline for processing flexible Endoscopes 2016

Endoscopy is useful for investigating a wide range of anatomical structures within the human body. These areas include the Gastrointestinal tract,Respiratory tract,Ear,Urinary tract,Female reproductive tract,and through a small incision- abdominal or pelvic cavity.The reasons for performing an endoscopy fall into one of the three categories Investigation,Confirmation or Treatment.Infections are what one needs to stay alert to in endoscopy procedures. Infections related to endoscopy procedures usually occur due to endogenous micro organisms on mucosal surfaces of the gastrointestinal or respiratory tract and gain access to the bloodstream or other sterile tissues as a consequence of the procedure. Endoscopy procedures also lead to infections which are transmitted from previous patients or inanimate environment.

In 2016, The Association of PeriOperative Registered Nurses (AORN) Advisory Board published a Guideline for Processing Flexible Endoscopes. The guideline became effective on February 1, 2016. The main recommendations of the guideline are:-

1. Flexible endoscopes should be processed in an area designed and constructed to support processing activities (Alvarado & Reichelderfer, 2000; "Guidelines for design and construction", 2014; "ANSI/AAMI ST91", 2015; Health Service Executive Advisory Group [HSE], 2012; "Clarification", 2012; "Infection control in endoscopy", 2010; Society of Gastroenterology Nurses and Associates, 2013; Hookey et al., 2013; Du Rand et al., 2013; World Gastroenterology Organization/World Endoscopy Organization, 2015).


2. Flexible endoscopes should be processed in an area controlled and maintained to support processing activities (Alvarado & Reichelderfer, 2000; "Guidelines for design and construction", 2014; "ANSI/AAMI ST91", 2015; HSE, 2012; "Clarification", 2012; "Infection control in endoscopy", 2010; Society of Gastroenterology Nurses and Associates, 2013; Hookey et al., 2013; Du Rand et al., 2013; World Gastroenterology Organization/World Endoscopy Organization, 2015; "Choice framework", 2013).


3. Flexible endoscopes and accessories should be precleaned at the point of use.


4. After precleaning at the point of use, contaminated flexible endoscopes and accessories should be transported to the endoscopy processing room.


5. Flexible endoscopes designed to be leak tested, should be leak tested after each use, after any event that may have damaged the endoscope, and before use of a newly purchased, repaired, or loaned endoscope.


6. After leak testing and before high-level disinfection or sterilization, flexible endoscopes should be manually cleaned.


7. Flexible endoscopes, accessories, and associated equipment should be visually inspected for cleanliness, integrity, and function before use, during the procedure, after the procedure, after cleaning, and before disinfection or sterilization.


8. After manual cleaning and inspection, flexible endoscopes and endoscope accessories should be high-level disinfected or sterilized (Rutala & Weber, 2008).


9. Flexible endoscopes and endoscope accessories should be stored in a manner that minimizes contamination and protects the device or item from damage (Alvarado & Reichelderfer, 2000; "ANSI/AAMI ST91", 2015; HSE, 2012; Society of Gastroenterology Nurses and Associates, 2013; ASGE Quality Assurance In Endoscopy Committee et al., 2011; Rutala & Weber, 2008; Rudy, Adams, & Waddington, 2012; Clemens et al., 2010).


10. The health care organization should maintain records of flexible endoscope processing and procedures.


11. Personnel with responsibility for processing flexible endoscopes should receive initial and ongoing education and complete competency verification activities related to processing flexible endoscopes.


12. Policies and procedures for processing flexible endoscopes should be developed, reviewed periodically, revised as necessary, and readily available in the practice setting in which they are used.


13. The health care organization's quality management program should evaluate processing of flexible endoscopes.

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