Cleaning and reprocessing flexible endoscopes is a time-consuming, delicate process. Fortunately, there are plenty of tools, solutions, and devices on the market that may make this task easier. Don't hesitate to try new products, but always check with the scope manufacturer first to see what the company recommends.

In this article, we'll review the critical steps of reprocessing endoscopes and suggest some products to help you accomplish each one.

Pre-Cleaning
Pre-cleaning should begin as soon as possible after use to ensure that debris does not harden on the scope and that the high-level disinfection or sterilization steps will be effective. To pre-clean thoroughly, wipe the debris from the body of the scope with a soft cloth or sponge. Next, immerse the tube in an enzymatic detergent, and suction solution and air (always finish with air) through all the channels until they are free of debris.

There are a number of enzymatic detergents that will help you make pre-cleaning and manual cleaning more effective by breaking down debris immediately. Three of note:

Terg-A-Zyme from Alconox is a concentrated enzymatic solution that is made from a protease enzyme. It breaks down and removes organic soils such as tissue, blood and body fluids. Add 2 1/2 tablespoons or 1 1/4 ounce of Terg-A-Zyme to one gallon of cold or warm water, preferably below 130? F. One pound makes 13 gallons of cleaning solution. For more information or a free sample call (914) 948-4040 or visit www.alconox.com.

Ecolab offers a few varieties of enzymatic solutions, including ASEPTI-zyme and RAPID-zyme. ASEPTI-zyme is a low-foam agent that is effective in cold water. You can use it for manual or automated reprocessing. For manual cleaning, add one ounce of ASEPTI-zyme to one gallon of water. Presoak for approximately five minutes or as needed. RAPID-zyme is an enzyme cleaner formulated to dissolve and remove fat and other organic material from orthopedic and arthroscopic instruments. Add one ounce to one gallon of water (no hotter than 140? F) and soak. For more information on these call (651) 306-4279.

The Ruhof Endozime Sponge comes saturated with enzymatic cleaner and packed for one-time use. The sponges are simple to use, and according to the company, the contoured shape is designed to thoroughly clean all scope surface areas. For more information call (800) 53RUHOF.

Leak Testing
Before proceeding with cleaning, test whether the scope has sustained any punctures or other damage with a leak tester. These hand-held units attach to the endoscope on the air vent located on the scope light guide. After disconnecting light source, attaching the leak tester, and pressurizing the scope to the level on the tester gauge, submerge the scope in a liquid bath. If you see bubbles, this may indicate cracks in the insertion tube.

Here are a few leak testers on the market. Endoscopy Support Services, Inc., offers the ATT-01 Series, Air Tight Leakage Tester, which is compatible with the following brands of endoscopes: the ATT-O1 from Olympus, the Pentax ATT-P1, the ATT-F1 Fujinon 2000 Series endoscope, and the Fujinon Seven Series ATT-F7. It lists for $195.00 and comes with a one-year warranty. For more information call Endoscopy Support Services, (845) 277-1700 or visit www.endoscopy.com.

ISI Instrument Specialists, Inc also offers its own Manual Leak Tester. It is compatible with the Olympus OES Flexible endoscopes. The ISI model lists for $219. Call for more information (800) 537-1945 or visit www.isisurgery.com.

Manual Cleaning
Disassembling the scope and thoroughly scrubbing it and the accessories inside and out is the next step. The right brushes can really make a difference in this step, helping you to remove every last bit of debris. A few notable products follow:

Endoscopy Support Services offers both disposable and reusable channel cleaning brushes. The DCB-5 Series disposable nylon brushes fit all endoscope channels 2.7mm in diameter and larger. These brushes are 240 cm long with brush heads at each end. The patented one directional design allows the operator to push the brush completely through to the other end of the scope, pushing the debris out of the channel instead of just dislodging it. The CCB Series reusable channel brushes come in five different sizes, ranging from the 2.0 mm in diameter and 120 cm long through 3.7 mm in diameter and 240 cm long. The brushes are made of nylon, and they list from $35-$40 each. For more information contact Endoscopy Support Services, (845) 277-1700 or visit www.endoscopy.com.

Spectrum Surgical Instruments recently combined several of its scope brushes into one Flexible Scope Cleaning Kit. According to Spectrum, this is the first complete set of brushes for cleaning flexible scopes. The kit includes six brushes: two 240-cm long brushes can reach down into the length of the scope to remove debris; one has a 6-mm diameter, the other a 3-mm diameter. For valve cleaning, the kit also contains 5-mm, 7-mm, 11-mm, and 11.6-mm diameter brushes. The kit lists for $18.95. For more information contact Spectrum Surgical Instruments at (800) 444-5644 or visit www.spectrumsurgical.com.

ISI Instrument Specialists, Inc., offers a line of Reusable Endoscope Channel Cleaning Brushes. They come in seven different sizes from 1.8 mm in diameter and 120 cm long up to 3.2 mm in diameter and 225 cm long. They list for $35 dollars each. Contact ISI at (800) 537-1945 or visit www.isisurgery.com.

High-level Disinfection and Reprocessing
High-level disinfection involves immersing the scope in a solution that kills all viruses, vegetative bacteria, fungi, and mycobacteria. Some centers may elect to take this a step further and immerse the scope for a longer period. When given a longer exposure time, most high-level disinfectant solutions will also kill bacterial spores, effectively sterilizing the scope. The FDA and most professional organizations consider high-level disinfection to be adequate, however.

You may elect to reprocesses your scopes manually or in an automatic flexible endoscope reprocessor. To manually reprocess them, immerse the scopes in a high-level disinfectant solution. Inject the disinfectant into all the endoscope's channels until the solution exits each end of the channel. Then, cover the soaking tray and let the scopes sit in the disinfectant for the time and temperature indicated on the product's label. After soaking, rinse the scope and all the channels, as well as the accessories, with air and water, as indicated on the reprocessing label.

You may find automatic endoscope reprocessors more convenient, especially if you are reprocessing a large number of scopes daily. Two to try:

According to Advanced Sterilization Products, its Automatic Endoscope Reprocessor is compatible with all major brands of flexible endoscopes. The AER allows you to process two endoscopes simultaneously; it has six separate channel connectors to flush out debris. The unit also has a hydrodynamic spray tower to remove external debris and a built in air compressor to dry the scopes. For more information call ASP at (800) 595-0200 or visit www.sterrad.com.

The STERIS SYSTEM 1 is an automated, tabletop device, measuring 40" wide by 24" deep by 32" high. It provides low temperature sterile processing for immersible scopes in 30 minutes. The STERIS SYSTEM 1 consists of the STERIS SYSTEM 1 Processor and the STERIS 20 Sterilant. The entire sterilization process takes place within the processor's environmentally sealed chamber. At the completion of each cycle, the processor prints a list of the process and load information. The STERIS 20 Sterilant (the active ingredient is peracetic acid) was developed exclusively for use in the STERIS 1 Processor. For further information about the STERIS SYSTEM 1, call (440) 354-2600 or visit STERIS online at www.steris.com.

There are four chemicals that can be used as high-level disinfectants; glutaraldehyde is the most common. Given a long enough exposure time, all high-level disinfectants except ortho-phthalaldehyde (Cidex OPA) will kill bacterial spores and sterilize scopes. Here are a few solutions on the market:

Sporicidin Sterilizing Solution contains only 0.95% glutaraldehyde. According to the company, the lower concentration is said to be safer for the endoscopes. It can achieve high level of disinfection in 20 minutes at 25? C. For more information call Sporicidin at (301) 231-7700 or visit www.sporicidin.com.

Metrex offers MetriCide, a high-level disinfectant/sterilant. It is 2.6% glutaraldehyde, and it does not require any mixing or dilution. It can achieve high level of disinfection in 45 minutes at 25? C. For more information call Metrex, (714) 516-7982.

CIDEX OPA Solution, from Advanced Sterilization Products, is a high-level disinfectant alternative to glutaraldehyde. Although it is not FDA approved for sterilization, it is the fastest way to disinfect your endoscopes. It can effectively disinfect in 12 minutes at room temperature (20? C), and it does not require mixing or activation. For more information call (800) 595-0200 or visit www.sterrad.com.

STERIS 20 Sterilant Concentrate, a 35% perocyacetic acid concentrate, was the first glutaraldehyde alternative on the market. It is used in conjunction with the STERIS System 1 automatic endoscope reprocessor. The processor dilutes the concentrate to about 0.2% peracetic acid with a neutral pH, and heats the solution to about 50? C. Disinfection takes approximately 30 minutes. The residues are non-toxic and can go safely down the drain, and since it is contained within the STERIS System 1, there are no hazardous fumes. For more information contact Steris; call (440) 354-2600 or visit www.steris.com.

Another glutaraldehyde alternative is hydrogen peroxide. Sporox II from Sultan Medical uses 7.5% hydrogen peroxide to achieve high-level disinfection in 30 minutes at 20? C. You can use Sporox II to manually reprocess your scopes, or you can use it in automatic reprocessing units. Sporox II emits no hazardous fumes, and unlike peracetic acid, it does not require a special reprocessor. For more information call (800) 424-3733 or visit Sultan Medical's website at www.sultanintl.com.

Drying