Hostname: page-component-8448b6f56d-mp689 Total loading time: 0 Render date: 2024-04-19T12:58:48.570Z Has data issue: false hasContentIssue false
  • English
  • Français

High-Level Disinfection or “Sterilization” of Endoscopes?

Published online by Cambridge University Press:  02 January 2015

Lawrence Freed Muscarella
Lawrence Freed Muscarella*
Affiliation:
Custom Ultrasonics, Inc, Buckingham, Pennsylvania
*
Director of Research and Development, Custom Ultrasonics, Inc, PO Box 850, Buckingham, PA 18912
Get access Rights & Permissions [Opens in a new window]

Abstract

Controversy has surrounded the use of liquid chemical germicides to reprocess medical instruments that are damaged by heat sterilization. A review of the literature was performed to assess and compare the efficacy of disinfection and sterilization processes. The results of this review demonstrate that high-level disinfection of thoroughly cleaned endoscopes is not associated with a higher infection rate than is “sterilization.” While there may be a theoretical distinction between the highest level of disinfection and sterilization, thorough cleaning eliminates clinical differences between the two. High-level disinfection is quick, effective, inexpensive, and recommended whenever heat sterilization is not feasible. A low-temperature sterilization process should be considered only if it is comparable in cost to disinfection or if it offers demonstrated advantages without damaging the instrument. Neither disinfection nor sterilization is likely to be effective if the instrument is not cleaned thoroughly after use.

Type
Readers' Forum
Information
Infection Control & Hospital Epidemiology , Volume 17 , Issue 3 , March 1996 , pp. 183 - 187
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1996

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Burns, RT. Adjusting to new methods of instrument sterilization. Infection Control & Sterilization Technology 1995;1:39.Google Scholar
2.Rutala, WA. APIC guidelines for selection and use of disinfectants. Am J Infect Control 1990;18:99–117.Google Scholar
3.American Society for Testing and Materials. Standard practice for cleaning and disinfection of flexible fiberoptic and video endoscopes used in the examination of hollow viscera. In: Designation: F 1518-1594;1994:854–859.Google Scholar
4.Martin, MA, Reichelderfer, M. APIC guidelines for infection control practice: APIC guidelines for infection prevention and control in flexible endoscopy. Am J Infect Control 1994;22:19–38.Google Scholar
5.Rutala, WA, Clontz, EP, Weber, DJ, et al. Disinfection practices for endoscopes and other semi-critical items. Infect Control Hosp Epidemiol 1991;12:282–288.Google Scholar
6.Garner, JS, Favero, MS. CDC guidelines for the prevention and control of nosocomial infections: guideline for handwashing and hospital environment control, 1985. Am J Infect Control 1986;14:110–126.Google Scholar
7.Spaulding, EH. Chemical disinfection of medical and surgical materials. In: Lawrence, CA, Block, SS, eds. Disinfection, Sterilization, and Preservation. 4th ed. Philadelphia, PA: Lea and Febiger; 1968:517–531.Google Scholar
8.The Association of Operating Room Nurses. Proposed recommended practices for chemical disinfection. AORN J 1994;60(3):463–466.Google Scholar
9.Hughes, CE, Gebhard, Rl, Peterson, LR, et al. Efficacy of routine fiberoptic cleaning and disinfection for killing Clostridium difficile. Gastrointest Endosc 1986;32(1):7–9.Google Scholar
10.Rutala, WA, Gergen, MF, Weber, DJ. Inactivation of Clostridium difficile spores by disinfectants. Infect Control Hosp Epidemiol 1993;14(1):36–39.Google Scholar
11.Dyas, A, Das, BC. The activity of glutaraldehyde against Clostridium difficile. J Hosp Infect 1985;6:41–45.Google Scholar
12.Volyes, CR, Sanders, DL, Simons, JE, et al. Steam sterilization of laparoscopic instruments. Surg Endosc 1995;5:139–141.Google Scholar
13.Clappison, RA. Cross contamination control and the dental handpiece. J Prosthet Dent 1995;73:492–494.Google Scholar
14.Cafruny, WA, Brunick, A, Nelson, DM, et al. Effectiveness of ultrasonics cleaning of dental instruments. Am J Dent 1995;8(3):152–156.Google Scholar
15.Parker, HH, Johnson, RB. Effectiveness of ethylene oxide for sterilization of dental handpieces. J Dent 1995;23:113–115.Google Scholar
16.Andersen, HK, Frost, L, Hansen, DB, et al. Decontamination of dental equipment: a validation of three devices designed for cleaning, disinfecting, and lubricating of dental high-speed turbines and handpieces. Intern J Hygiene Environ Med 1995;196:437–443.Google Scholar
17.Daschner, F. Steris System 1 in Germany. Infect Control Hosp Epidemiol 1994;15(5):295–296. Letter.Google Scholar
18.American Public Health Association. Establishment of clearly defined performance standards for between-patient processing of reusable endoscopic instruments and accessories. Am J Public Health 1995;85:449–450.Google Scholar
19.Pappas, SA, Schaff, DM, DiCostanzo, MB, et al. Contamination of flexible fiberoptic bronchoscopes. Am Rev Respir Dis 1983;127:391–392. LetterGoogle Scholar
20.Vesley, D, Norlien, KG, Nelson, B, et al. Significant factors in the disinfection and sterilization of flexible endoscopes. Am J Infect Control 1992;20:291–300.Google Scholar
21.Bradley, CR, Babb, JR, Ayliffe, GAJ. Evaluation of the Steris System 1 peracetic acid endoscope processor. J Hosp Infect 1995;29:143–151.Google Scholar
22.Mannion, PT. The use of peracetic acid for the reprocessing of flexible endoscopes and rigid cystoscopes and laparoscopes. J Hosp Infect 1995;29:313–315. Letter.Google Scholar
23.Gurevich, I, Qadri, SMH, Cunha, BA. False-positive results of spore tests from improper clip use with Steris chemical sterilant system. Am J Infect Control 1993;21:42–43. Letter.Google Scholar
24.Bond, WW. Biological indicators for a liquid chemical sterilizer: a solution to the instrument reprocessing problem? Infect Control Hosp Epidemiol 1993;14:309–312.Google Scholar
25.Kaczmarek, RG, Moore, RM, McCrohan, J, et al. Multi-state investigation of the actual disinfection/sterilization of endoscopes in healthcare facilities. Am J Med 1992;92:257–261.Google Scholar
26.Gorse, GJ, Messner, RL. Infection control practices in gastrointestinal endoscopy in the United States: a national survey. Infect Control Hosp Epidemiol 1991;12:289–296.Google Scholar
27.Reynolds, CD, Rhinehart, E, Dreyer, P, et al. Variability in reprocessing policies and procedures for flexible fiberoptic endoscopes in Massachusetts hospitals. Am J Infect Control 1992;20:283–290.Google Scholar
28.The American Society for Gastrointestinal Endoscopy. Transmission of infection by gastrointestinal endoscopy. Gastrointest Endosc 1993;39:885–888.Google Scholar
29.Prakash, UB. Does the bronchoscope propagate infection? Chest 1993;104:552–559.Google Scholar
30.Spach, DH, Silverstein, FE, Stamm, WE. Transmission of infection by gastrointestinal endoscopy and bronchoscopy. Ann Intern Med 1993;118:117–128.Google Scholar
31.Hanson, PJV, Gor, D, Clarke, JR, et al. Contamination of endoscopes used in AIDS patients. Lancet 1989;2:86–88.Google Scholar
32.Hanson, PJV, Jeffries, DJ, Collins, JV. Viral transmission and fiberoptic endoscopy. J Hosp Infect 1991;18(suppl A):136–140.Google Scholar
33.Bond, WW, Favero, MS, Petersen, NJ, et al. Inactivation of hepatitis B virus by intermediate to high-level disinfectant chemicals. J Clin Microbiol 1983;18:535–538.Google Scholar
34.Hanson, PJV, Gor, D, Jeffries, DJ, et al. Elimination of high titre HIV from fiberoptic endoscopes. Gut 1990;31:657–659.Google Scholar
35.Nakahara, SA, Becker, L, Biggerstaff-Pearson, A, et al. Standardizing glutaraldehyde use in a regional group of ten major medical centers. Am J Infect Control 1994;22:50–60.Google Scholar
36.Hanson, PJV, Chadwick, MV, Gaya, H, et al. A study of glutaraldehyde disinfection of fibreoptic bronchoscopes experimentally contaminated with Mycobacterium tuberculosis. J Hosp Infect 1992;22:137–142.Google Scholar
37.Mbithi, JN, Springthorpe, S, Sattar, SA, et al. Bactericidal, virucidal, and mycobactericidal activities of reused alkaline glutaralhdeyhde in the endoscopy unit. J Clin Microbiol 1993;31:2988–2995.Google Scholar
38.Rutala, WA, Weber, DJ. FDA labeling requirements for disinfection of endoscopes: a counterpoint. Infect Control Hosp Epidemiol 1995;16:231–235.Google Scholar
39.Holton, J, Nye, P, McDonald, V. Efficacy of selected disinfectants against mycobacteria and Cryptosporidia. J Hosp Infect 1994;27:105–115.Google Scholar
40.The American Society for Gastrointestinal Endoscopy. Infection control during gastrointestinal endoscopy: guidelines for clinical application. Gastrointest Endosc 1988;34(suppl):37S–40S.Google Scholar
41.Weller, IVD. Cleaning and disinfection of equipment for gastrointestinal flexible endoscopy: interim recommendations of a Working Party of the British Society of Gastroenterology. Gut 1988;29:1134–1151.Google Scholar
42.Woodcock, A, Campbell, I, Collins, JVC, et al. Bronchoscopy and infection control. Lancet 1989;07 29:270–271.Google Scholar
43.Babb, JR, Bradley, CR. The mechanics of endoscope disinfection. J Hosp Infect 1991;18(suppl A):130–135.Google Scholar
44.Rutala, WA, Gergen, MF, Weber, DJ. Sporicidal activity of chemical sterilants used in hospitals. Infect Control Hosp Epidemiol 1993;14:713–718.Google Scholar
45.Muscarella, LF. Automatic flexible endoscope reprocessors: their advantages and limitations. Am J Infect Control. In press.Google Scholar
46.Association of Operating Room Nurses. Letters. AORN J 1995;61(1):19.Google Scholar
47.Ayliffe, GAJ, Babb, JR, Bradley, CR. ‘Sterilization’ of arthroscopes and laparoscopes. J Hosp Infect 1992;22:265–269.Google Scholar
48.Corson, SL, Dole, M, Kraus, R, et al. Studies in sterilization of the laparoscope: II. J Reprod Med 1979;23(2):57–59.Google Scholar
49.Corson, SL, Block, S, Mintz, C, et al. Sterilization of laparoscopes: is soaking sufficient? J Reprod Med 1979;23(2):49–56.Google Scholar
50.Duppler, DW. Laparoscopic instrumentation, videoimaging, and equipment disinfection and sterilization. Surg Clin North Am 1992;72(3):1021–1032.Google Scholar
51.Armstrong, RW, Bolding, F. Septic arthritis after arthroscopy: the contributing roles of intraarticular steroids and environmental factors. Am J Infect Control 1994;22:16–18.Google Scholar
52.Johnson, LL, Shneider, DA, Austin, MD, et al. Two percent glutaraldehyde: a disinfectant in arthroscopy and arthroscopic surgery. J Bone Joint Surg 1982;64A(2):237–239.Google Scholar
53.Geiss, HK. Reprocessing of anesthetic and ventilatory equipment. J Hosp Infect 1995;30(suppl):414–420.Google Scholar
54.Frank, UK, Daschner, FD. Endoscope and device-related infections. Curr Opinion Infect Dis 1992;5:524–529.Google Scholar
55.Loffer, FD. Disinfection versus sterilization of gynecologic laparoscopy equipment. The experience of the Phoenix Surgicenter. J Reprod Med 1990;25:263–266.Google Scholar
56.Muscarella, LF. Question and Answer. Infection Control & Sterilization Technology 1995;1(9):10.Google Scholar
57.Babb, JR, Bradley, CR. Endoscope decontamination: where do we go from here? J Hosp Infect 1995;30(suppl):543–551.Google Scholar
58.Muscarella, LF. Sterilizing dental equipment. Nature Medicine 1995;1:1223–1225.Google Scholar
59.Muscarella, LF. The difficulty of reprocessing reusable rigid endoscopic instruments: are disposables the solution? J Gynecol Surg 1994;10:121–123.Google Scholar
60.Rothstein, RI, Littenberg, B. Disposable, sheathed, flexible sigmoidoscopy: a prospective, multicenter, randomized trial. Gastrointest Endosc 1995;41:566–572.Google Scholar
61.Association for the Advancement of Medical Instrumentation (AAMI) Standards Committee, Reusable Devices Resterilization Working Group. Designing, testing, and labeling reusable medical devices for reprocessing in health care facilities: a guide for device manufacturers. Technical Information Report 12-1994. Arlington, VA: AAMI; 1995.Google Scholar