In July 2015 the CDC (Centers for Disease Controls) asked HICPAC (Healthcare infection Control Practices Advisory Committee) for their recommendations on how to improve the facility-level training for those using reprocessing endoscopes. A large work group of 14 primary entities was formed to collectively development recommendations for HICPAC to take into consideration. The HICPAC recommendations were finalized and made available in July 2016.

The first sentence in the CDC's Introduction indicates "healthcare facilities should have a reliable, high-quality system for endoscope reprocessing which minimizes infection risks." So the short answer is "Yes".

The prelude to the CDC asking HIPAC to provide this information was due in part to some medical facilities not having the infrastructure in place to be able to support the training necessary to safely utilize, surveil and control healthcare-associated infections. Therefore, included in this their recommended "system" is the instruction that infrastructure must be in place that can properly support the training necessary for clinical and administrative staff to fully comprehend, measure and manage these risks.

A Toolkit of Sample Documents were created for healthcare facilities to incorporate into their flexible endoscope reprocessing infection control strategies.

Those sample documents include:

● Policy Template
● Audit Tool
● Competency Verification Tool
● Inventory and Repair Maintenance Log
● Gap Analysis Tool
● Root Cause Analysis Template

Critical Steps: Flexible Endoscope Reprocessing  

The 7 steps outlined below for endoscope reprocessing were formulated to decrease the risk of infection from endoscopic procedures increasing patient safety. It was recommended that these steps be followed by all staff involved in reprocessing flexible endoscopes.

• Pre-Cleaning
  Following the completion of the medical procedure utilizing an endoscope it is recommended to immediately pre-clean the flexible endoscope and its reusable accessories. Please follow the device manufacturer's exact instructions and recommendations for the device being utilized to assist in preventing the formulation of biofilm.
  
  
• Leak Testing
  Some endoscopes require leak testing. For those that do please use the manufacturer's instructions for use recommendations after each use and prior to manually cleaning the device. Damage to the external surfaces and interior channels can be detected during leak testing. These damages can lead to non-acceptable disinfection and potential damage to the endoscope itself.
  
  
• Manual Cleaning
  When manual cleaning is performed it is recommended to be thorough and include brushing and flushing all channels and ports as prescribed by the manufacturer's instructions for use. Manual cleaning is typically performed prior to HLD (high-level disinfection) / sterilization. The manufacturer's instructions for use should also include a time-frame that the manual cleaning should be performed after use. Please adhere to this recommended time frame as manual cleaning is the most critical step in the disinfection process. By manually removing all residual organic material the effectiveness of the HLD (high-level disinfection) / sterilization will not be impeded.
  
  
• Visual Inspection
  A visual inspection of the endoscope and the endoscope's accessories should be performed after the manual cleaning listed in the prior step. The visual inspection is to make sure there are no additional residual organic material or any defects to the equipment that are visually apparent. If you are using a flexible endoscope, you may need to utilize laminated magnification or other alternative/comparable solutions to properly perform full visual inspection.
  
  
• Disinfection or Sterilization
  After performing the manual cleaning and the visual inspection recommended in the preceding steps it is recommended to perform the HLD (high-level disinfection) / sterilization. The HLD must be performed using the manufacturer's specific instructions for reprocessing and the manufacturer's instructions for use. The instructions for use or instructions for reprocessing may include recommendations for specific chemicals, disinfectants and or equipment. Equipment may include but not be limited to AERs (automated endoscope reprocessors) that are used to reprocess the endoscopes increasing the likelihood that a full disinfection has occurred.
  
  
• Storage
  The method of storing endoscopes is very important. They must be stored in such a way that prevents re-contamination, allows them to easily dry and protects the equipment and or accessories from damage. There are cabinets that are made specifically for storing flexible endoscopes. You may consider contacting the manufacturer of your endoscope to get their recommendations for storage or consult the manufacturer's instructions for use. If you use your own dedicated cabinet for storing your flexible endoscopes it is recommended that you make sure that it has a enough room in it (height, width and depth) to hang vertically without coiling or touching any part of the cabinet. The cabinet should also provide enough space and ventilation that the endoscopes are able to properly dry.
  
  
• Documentation
  It's critical to maintain full documentation of every step taken to reprocess your endoscopes. This documentation should be completed every time the endoscope is used. Full documentation is an essential part of a successful endoscope reprocessing strategy and allows it to be managed and reviewed as necessary going forward.