Communications

Reprocessing of Flexible Endoscopes

For the Attention of Hospital CEOs, Chiefs of Staff, Chief Nursing Officers, Infection Control and Risk Management Practitioners, and OHA Board of Directors

From: Rosalind Smith
Vice President, Member & Professional Relations

Over the past 18 months eight health care facilities in California have reported situations involving inadequate reprocessing of flexible endoscopes. Five of these situations were discovered by observing reprocessing technicians during performance improvement reviews. Although these situations primarily involved endoscopes used in gastroenterology procedures, similar problems have been observed with bronchoscopes and cystoscopes.

Some of the problems identified included failure to:

  • Recognize the presence of auxiliary channels (suction and air) in newly purchased equipment;
  • Manually clean auxiliary channels prior to disinfection or sterilization;
  • Record the concentration of the disinfectant daily or more frequently depending on the volume of procedures performed;
  • Change the disinfectant according to manufacturer’s recommendations or when the concentration falls below acceptable levels;
  • Assure that automated endoscope reprocessor (AER) channel attachments were appropriate to the scope being reprocessed and were connected properly;
  • Change water and other filters on AERs as specified by the manufacturer;
  • Assure that the AER was functioning according to the manufacturer’s specifications (i.e., there is no obstruction or valve failure to reduce or prevent the flow of the disinfectant through the endoscope channels);
  • Educate and observe that reprocessing technicians consistently follow facility specific procedures; and
  • Develop, implement and periodically assess the competency of reprocessing technicians.


These reports led the California Department of Health Services to issue new reprocessing guidelines which stress:

    • The requirement to review and follow manufacturers’ instructions on reprocessing precisely and specifically, in regards to the use of both cleaning and high level disinfecting solutions. For example, facilities are reminded to discard used solutions according to manufacturers' recommendations and that the practice of "topping off" a basin of solution whose concentration may have become diluted does not extend the reuse life of the solution.
    • The need for facilities to train and develop competencies for healthcare workers dealing with endoscope reprocessing on proper techniques, and ensure that they are following those requirements including preventive maintenance, documentation and the reporting of reprocessing deficiencies.


These guidelines - Immediate Assessment of Endoscope Reprocessing Procedures and Event Notification - are provided to Ontario hospitals as a reminder and can be found at the following link: http://www.dhs.ca.gov/ps/dcdc/disb/disbindex.htm under the "Disease Investigations Section" heading. For further information, please contact Helen Zulys at hzulys@oha.com