Improving Quality and Safety in the Endoscopy Unit (On-Demand) | October 2024-ASGE

ASGE_multisociety reprocessing guideline

Pdf Summary

The American Society for Gastrointestinal Endoscopy (ASGE) and multiple other societies have released guidelines on the reprocessing of flexible gastrointestinal endoscopes to ensure patient safety by minimizing infection risks. This document highlights the crucial need for meticulous cleaning and reprocessing of these complex medical devices according to the manufacturer's instructions to prevent exogenous infections—those acquired from contaminated devices. Flexible GI endoscopes, due to their intricate design, especially duodenoscopes, have been involved in infection outbreaks despite adherence to current protocols, emphasizing a need for improved and standardized disinfection methods. The guideline discusses the Spaulding classification system, categorizing medical devices by infection risk, thus dictating the level of necessary decontamination.<br /><br />A key part of the guideline development included evidence synthesis using the GRADE framework which evaluates the strength and quality of recommendations. It addresses critical reprocessing steps like cleaning, manual and high-level disinfection (HLD), the role of drying, and storage protocols to maintain hygiene. To enhance safety, it recommends automated processes for HLD, rigorous drying using filtered air, and periodically conducting microbiological surveillance to detect bacterial contamination. Additionally, it emphasizes staff training, competency appraisal, and design considerations in endoscopy units for optimal infection control practices.<br /><br />Guidelines extend to the maintenance of endoscopes, considering staff training, layout optimization of endoscopy units to prevent contamination, and handling instances like using loaner scopes. The guideline further explores innovations in endoscopic technologies, including the transition towards single-use devices to eliminate cross-contamination risks. With COVID-19 in consideration, no specific changes to existing reprocessing protocols are required since current practices involving manual cleaning and HLD are capable of eliminating SARS-CoV-2.<br /><br />The document also identifies research gaps requiring further exploration, such as optimal drying durations and assessments, efficacy of new reprocessing technologies, and the safety and environmental implications of transitioning to disposable endoscopes. Overall, these guidelines serve as a comprehensive protocol to enhance patient safety by ensuring rigorous and effective reprocessing of flexible GI endoscopes.

Keywords

ASGE

gastrointestinal endoscopes

infection prevention

reprocessing guidelines

Spaulding classification

high-level disinfection

microbiological surveillance

endoscope maintenance

single-use devices

COVID-19 protocols