endoscope can be disinfected in an automated washer/disinfector. If this
process is done manually, steps 3 and 4, described previously under 'At
the start of the day', should be followed. Once completed all channels
must be rinsed with bacteria-free water in the same manner. Air may be
blown through the channels at this stage to expel excess fluids which
might otherwise dilute the disinfectant (44,45).
9. The endoscope is now ready for disinfection. The instrument must be fully
immersed in disinfectant for the correct contact time, ensuring that all
channels are filled with disinfectant. A timer will ensure immersion times
10. The instrument is rinsed as in steps 7 and 8 'At the start of the day'.
11. The relevant work surfaces, such as the top of the endoscopy trolley,
should be wiped clean between patients, usually with an alcohol wipe, in
accordance with local hospital policy. Once the endoscope has been
disinfected, rinsed and dried, fresh valves should be inserted and the
instrument placed on the clean surface ready for use.
Cleaning and Disinfection of endoscopes: after the last case
1. Endoscopes used during the list should be leak-tested, cleaned and
disinfected. When 2% glutaraldehyde is used the contact time should be
20 minutes, while for peracetic acid and chlorine dioxide this should be for
2. Endoscopes should be dried before storage. Seventy per cent alcohol
may be aspirated through the channels to assist drying. Thorough drying
reduces the risk of subsequent microbial proliferation.
3. Endoscopes should then be stored hanging vertically in a designated
ventilated cupboard, not in their transit cases.
4. All valves used during the list should, after disinfection and rinsing, be
dried with a cotton wool bud and lubricated with silicone oil as instructed
by the manufacturer. They should not be replaced in the endoscope case
Cleaning and Disinfection of Accessories
Accessories require the same attention to detail. Some accessories are single
use and, where access for cleaning is difficult or the item is heat sensitive, their
use should be encouraged. Cytology brushes, polypectomy snares, injection
needles and some ERCP accessories may be purchased as single use The risk
of transfer of infection by re-using possibly contaminated items must be weighed
against the cost of single-use accessories Many accessories are autoclavable
and their use should be encouraged; these include water bottles, biopsy forceps,
dilators and guidewires. During ERCP, disposable accessories should be used
whenever possible or if reusable there should be sufficient autoclavable
accessories to allow one per case with no requirement to disinfect during a list.
The Medical Devices Agency Bulletin DB 9501 advises on potential hazards,
both clinical and legal, associated with reprocessing and reusing medical devices
intended for single use (46). Users who disregard this information, and prepare
single use items for re-use without due precautions, may be transferring legal
liability for the safe performance of the product from the manufacturer to