How Does COVID-19 Impact Endoscope Reprocessing?

Infection Prevention

By: Joe Paone

Published: 8/10/2020

Share:

Now's the time to reemphasize the importance of meticulous cleaning and high-level disinfecting.


The proper cleaning and high-level disinfecting of flexible endoscopes has been under increased scrutiny because their long, narrow channels make it difficult for reprocessing techs to access or see contaminants stuck deep inside lumens during manual cleaning. If bacteria remain in scopes after manual cleaning, high-level disinfecting won't be effective and the risk of cross-contamination increases.

Right now, however, the only infection on most people's minds is COVID-19, which can reside in both the respiratory and the gastrointestinal tracts — where endoscopes travel. If a patient is COVID-19 positive, the virus can very likely be present in the scope used during the procedure. The pandemic has caused many patients to postpone colonoscopies, among other elective procedures, for fear of being exposed to the coronavirus.

It's a legitimate concern. Or is it?

"Standard cleaning and disinfection should eliminate any viral particles," says Robert Lim, MD, FACS, FASMBS, vice chair of education at Oklahoma University School of Medicine in Tulsa. Other experts express similar sentiments. "Our reprocessing has stayed pretty much the same," says Muriel Moyo, MS, BSN, RN, CCRN-K, NE-BC, clinical director of OPSC, PACU & Endoscopy at PIH Health Downey (Calif.) Hospital, which regularly cultures its scopes to check for residual contaminants. Monjur Ahmed, MD, an assistant professor of gastroenterology at Jefferson University in Philadelphia, told us that after speaking with his scope vendor, he's satisfied that current cleaning and HLD processes with proper adherence to instructions for use (IFUs) will eliminate traces of the coronavirus in scopes.

POLICY UPDATE
Proper Endoscope Care During the Pandemic
GEAR UP It's vital for the safety of your reprocessing techs that they are outfitted in proper PPE.

In mid-April, six medical societies jointly issued best practice recommendations for the proper handling, reprocessing and storage of endoscopes during the COVID-19 pandemic (osmag.net/AA6Hvv). "Based on available evidence, standard manual cleaning followed by [HLD] should be effective at eradicating SARS-CoV-2," the organizations stated. "No changes to the reprocessing of GI endoscopes are recommended." The organizations said at the time some of the suggestions in the document might need updating as more evidence emerged, but they remained the same as of late July.

The organizations, nonetheless, added "specific new guidance." They suggested facilities consider limiting the number of reprocessing staff who handle scopes and limiting reprocessing to experienced staff members with documented competency. For enhanced safety, they also reminded centers of their existing recommendation that all endoscopes undergo full standard reprocessing before they're returned to the manufacturer for maintenance. Among other points the organizations stressed:

  • Pre-cleaning should commence in the procedure room per protocol, by staff already in the room.
  • Reprocessing staff should don gloves, gowns, face shields and masks. The data doesn't support a requirement for the use of N95 respirators, but the organizations said their use should be considered, depending on availability.
  • Use fully enclosed and labeled containers to transport scopes to the decontamination room, as per institutional policy.
  • There is no evidence that endoscopes used in known COVID-19 positive patients require special handling.
  • No changes are recommended to the handling and storage of fully reprocessed scopes after HLD. However, the groups emphasized the importance of keeping scopes dry to prevent outbreaks of waterborne organisms, suggesting use of drying verification systems.
  • Dry the scope exteriors using a clean lint-free cloth, and the interiors with a prolonged flow of medical-grade air through all accessible channels for at least 10 minutes. Staffers transferring reprocessed scopes to storage or a drying cabinet should wear clean gloves.
  • Perform "meticulous cleaning" of endoscopy rooms after each procedure, including disinfection of all surfaces. Staff who clean rooms should wear head covers, gowns, surgical masks, eye protection and gloves.
  • Ensure high-efficiency particulate air (HEPA) filters in reprocessing rooms are replaced as per instructions for use. Confirm all routine maintenance is up to date and ensure ample supplies of detergents and accessories are always on hand.
  • If you're reopening a center after the shutdown, the groups say that reuse "within 21, and perhaps even 56 days of appropriately reprocessed, dried and stored flexible endoscopes appears to be safe."

The essential message is this: If you're cleaning and high-level disinfecting your scopes properly, residual COVID-19 should not be an issue.

— Joe Paone

JUST CHECKING\
JUST CHECKING Small-diameter borescopes are one way to check lumens for residual bacteria after high-level disinfection.  |  Penn State Milton S. Hershey Medical Center

You might have expected the spread of the coronavirus to require altering your scope cleaning and HLD protocols in some way. Professional societies have recommended some minor changes (see "Proper Endoscope Care During the Pandemic" on the previous page), but for the most part, COVID-19 simply serves as a very loud wakeup call for you to revisit proper manual cleaning and HLD techniques, and reeducate your reprocessing techs on the importance of following the multiple steps involved in the processes.

With that in mind, make sure you have, and that your staff fully understands, the specific IFUs for each type of scope in your fleet. Are your IFUs up to date? Are all of the cleaning and care steps being followed?

Dr. Lim suggests checking in with your scope vendor, if you haven't already, to find out if the IFUs for your fleet of scopes have been updated since the COVID-19 outbreak. His vendor reported that COVID-19 doesn't require any changes to its scopes' cleaning regimen. "I talked to them directly about it," says Lim. "Their stance is, as long as you follow what you're supposed to do, there should be no problem. What they publicly say, and what their data says, is that as long as you're cleaning scopes the way they tell you to do it, there's no risk of transmission."

None of Dr. Lim's patients have turned up positive or transmitted the virus while in his care. "But we're currently performing procedures only on COVID-negative patients. At this point, I would be really reluctant to accept a COVID-positive patient for an elective endoscopy." OSM

Related Articles