immersion in glutaraldehyde or 5 minutes in peracetic acid or chlorine
dioxide is recommended.
7. Microbiological studies show that 20 minutes of exposure to 2%
glutaraldehyde destroys most organisms, including Mycobacterium
tuberculosis. The Working Party concludes therefore that 20 minute
endoscope immersion in 2% glutaraldehyde is sufficient for endoscopy
involving patients with AIDS and other immunodeficiency states or
pulmonary tuberculosis. Similarly, 20 minutes immersion time is
recommended at the start of the list and between cases for ERCP when
high level disinfection is required.
8. Cleaning and disinfection of endoscopes should be undertaken by trained
staff in a dedicated room. Thorough cleaning with detergent remains the
most important and first step in the process.
9. Automated washer/disinfectors have become an essential part of the
Endoscopy Unit. Machines must be reliable, effective, easy to use and
should prevent atmospheric pollution by the disinfectant if an irritant agent
is used. .Troughs of disinfectant should not be used unless containment or
exhaust ventilated facilities are provided.
10. A detailed cleaning and disinfection regime is preferred and this is
11. Whenever possible 'single use' or autoclavable accessories should be
used. The risk of transfer of infection from inadequately decontaminated
reusable items must be weighed against the cost. Re-using accessories
labelled for single use will transfer legal liability for the safe performance of
the product from the manufacturer to the user or his/her employers and
should be avoided unless Department of Health criteria are met.
Manufacturers are encouraged to produce more reusable items which are
readily accessible for cleaning and are autoclavable.
12. Health surveillance of staff is mandatory and should include a preemployment
enquiry regarding asthma, skin and mucosal sensitivity
problems and lung function by spirometry. Occupational health records
must be retained for 30 years.
13. Those involved in endoscopic practice should be vaccinated against
hepatitis B, should wear gloves and appropriate protective clothing, and
should cover wounds and abrasions.
14. Increased funding is necessary for capital purchases of endoscopic
equipment, including more endoscopes, washer/disinfectors, exhaust
ventilation equipment and single use accessories.
Members of the working party
Dr R E Cowan (Chairman)
Dept of Gastroenterology
Colchester General Hospital
Essex CO4 5JL