Even though the use of a flexible endoscope is actually quite a common clinical procedure, it is important that all patients undergoing it are protected from infection. This can occur via three avenues – from patient to patient, from environment to patient, or from organisms within the patient’s body. This is why it is essential that endoscopes are thoroughly cleaned and disinfected after each use and that the guidelines for doing so are strictly followed.
All flexible endoscopes should be checked for faults before they are used. If it has been properly cleaned and disinfected at the end of the previous day, there will be no need to clean it again. It should, however, be put through a disinfecting cycle. The cleaning and disinfection process should also be carried out in a room that is dedicated to this specific purpose.
Before the endoscope is removed from the light source or video processor, the air/water channel should be flushed for at least 15 seconds. This will expel any blood, mucus and other debris that has accumulated. Clean water should then be sucked through the suction channel, allowing you to remove the instrument and wash it in warm, soapy water (it must be fully immersed in the water to ensure adequate cleaning).
The outer surface of the endoscope should be thoroughly cleaned with particular attention paid to the control section, the angulation controls, the distal end and the bridge mechanism. All valves should be removed and clean separately with a soft brush. You can then clean the suction/biopsy channel using a flexible brush, which should be passed through the channel in two directions (the insertion tube and umbilicus), then the biopsy channel.
When the brush appears at the end of the endoscope, it should be cleaned with a toothbrush before being drawn back through. This procedure should be repeated at least three times or until the brush emerges completely clean. Once you have finished, make sure that the brushes are thoroughly cleaned by placing them into an ultrasonic cleaner.
The flexible endoscope should be disinfected in an automatic washing or disinfection unit; the use of trays, bowls and buckets is no acceptable. Whilst glutaraldehyde is the most commonly used disinfectant, it is actually an irritant and sensitiser. Other products are still undergoing field tests, so the use of this disinfectant remains (although regulations have changed).
When the disinfection cycle has finished, the endoscope should be thoroughly rinsed (both internally and externally) using fresh, sterile or filtered water. It should then be drained and flushed with air. To finish, some 70% isopropyl alcohol should be flushed through the instrument to dry the interior before it is reassembled for use.
To further prevent the risk of infection, single-use or autoclavable accessories should be used in conjunction with flexible endoscopes wherever possible. The reuse of accessories that have been labeled for single-use will actually hold you (or your clinic) liable for the legal repercussions of any infection that may occur during the procedure. In the meantime, just make sure that you clean and disinfect the endoscope according to these instructions.