Decontamination
Tick-tock: keeping up with the reprocessing clock
Flexible endoscope reprocessing is about speed and efficiency. The timespan between pre-cleaning, manual cleaning and high-level disinfection should be as short as possible to ensure that bacteria is effectively removed from an endoscope. However, time management can be a huge hurdle to navigate, as Kerry Dolan explains.
Endoscope reprocessing is essentially a race against the clock to remove harmful bacteria from drying on the scope and developing into a potentially dangerous biofilm which can be detrimental to patient safety. Multi-society guidelines recommend that reprocessing should take place within a particular time period, yet the time stated to complete reprocessing varies widely throughout the world. Is the current system efficient enough and is there a way to make time constraints in reprocessing more standardised?
When an endoscope is removed from the patient immediately after the procedure, pre-cleaning should commence. Pre-cleaning is a critical step for patient safety which can sometimes be overlooked. The pre-clean removes gross debris from the scope to avoid the formation of biofilm, in preparation for the endoscope’s onward reprocessing journey. From here, the endoscope must go to manual cleaning within a particular time limit, if this does not happen a delayed reprocessing protocol must be followed, as per endoscope manufacturer’s IFU.
Conflicting advice on timing In the UK, the British Society of Gastroenterology (BSG) and the NHS Health Technical
Territory United Kingdom Europe Global USA Australia Table 1. Institution British Society
Gastroenterology ESGENA / ESGE
World Gastroenterology Organisation
ASGE, AAMI ST-91, AORN
GESA
Memorandum 01-06 (HTM) advocate that the decontamination process should commence as soon as the endoscope has been removed from the patient. The cleaning stage of decontamination should be completed and the endoscope washer disinfector (EWD) cycle commenced within 3 hours of completion of the procedure as best practice.1,2 However, other World guidelines have varying
recommendations for flexible endoscope reprocessing timing, (see table), which highlight inconsistencies in the current reprocessing workflow management. The European Society for Gastrointestinal Endoscopy (ESGE) states
Current time limit on reprocessing
Within 3 hours of completion of the procedure
Manual reprocessing steps should be performed within 30 minutes of patient examination.
Within 30 minutes
Within 60 minutes 45 minutes
15 minutes – 1 hour
that for safe and effective reprocessing, it is essential to follow all the steps of the reprocessing workflow in a thorough and timely manner. The clinical service provider must document and explain any deviation from their specific reprocessing workflow. The ESGE recommends that the time that elapses between manual cleaning and reprocessing in the EWD should not exceed the time of one EWD cycle. They go on to say that some national guidelines recommend all manual reprocessing steps should be performed within 30 minutes after completion of the patient examination.3
The World Gastroenterology
Organisation follows the same guidelines, stating that it is essential that the endoscope is not allowed to dry prior to further cleaning, as this will make removal of organic matter difficult or impossible. Endoscopes should be processed without delay, within 30 minutes.4 The US has conflicting opinions about the time between pre-cleaning and completion of the reprocessing cycle. The Society for Gastroenterology Nurses and Associates (SGNA) states that all steps of the reprocessing protocol should be completed sequentially and that it is important to follow the manufacturer’s time limit but does not stipulate a specific time. They also recommend that a process must be in place to record the procedure end time and the manual cleaning start time which will allow healthcare staff to determine whether routine reprocessing within the manufacturer’s recommended time frame is achievable.5
The
American Society for Gastrointestinal Endoscopy (ASGE) shares a similar recommendation, along with the Association for the Advancement of Medical Instrumentation’s (AAMI) ST-91 guidelines, in that endoscope reprocessing should be within 60 minutes.6,7 However, the Association for Operating Room
Nurses (AORN) flexible endoscope reprocessing guidelines say that withdrawal of the scope from the patient to storage in the cabinet reprocessing time should be roughly 45 minutes.8
February 2025 I
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