Challenges in achieving high-level endoscope disinfection

Editor's Note

In this review article, Cori L. Ofstead, MSPH, and associates highlight the reasons endoscope reprocessing is often ineffective and microbes frequently remain on endoscopes after high-level disinfection.

Among the reasons:

• non-adherence to guidelines
• use of damaged endoscopes
• use of insoluble products during endoscopy
• insufficient cleaning
• contaminated rinse water
• inadequate drying before storage.

After analyzing the literature, interviews with frontline personnel, and evidence from their previous studies, the research team found that reusable high-level disinfectants commonly failed tests for minimum effective concentration before their maximum use periods. Minimum effective concentration tests also found failures linked to single-use high-level disinfectants that did not fully deploy.

Recognizing the need for quality improvement in association with high-level disinfectants is growing, and infection preventionists should build on this momentum and collaborate with manufacturers, endoscopists, and reprocessing personnel to improve high-level disinfection effectiveness, the researchers say.