Reprocessing Recommendations

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Additional Recommendations, Cleaning, HLD & Sterilization,

Additional Reprocessing for Duodenoscopes*

This page includes summaries that should not be used to create policies and procedures. Please refer to the original source documents for exact language. Links can be found here.

Multisociety, 2016

Not determined. FDA advisory panel states that HLD may be inadequate, but sterilization modalities (eg, low-temp ethylene oxide) are currently expensive,potentially toxic to personnel, and not widely available. Closely follow manufacturer's guidance for cleaning the distal tip elevator of duodenoscopes.

HICPAC, 2016

Not determined. Insufficient evidence to determine benefits versus consequences at this time.

AORN, 2016

"When possible and practical, flexible and semi-rigid endoscopes should be sterilized due to the greater margin of safety built into sterilization." (pg. 2 )Semi-critical devices are currently HLD, but guidance is also given here for "liquid chemical sterilization" with peracetic acid, and gaseous sterilization with ethylene oxide (EO), hydrogen peroxide (HP) gas, and ozone. Use any modality only if compatible with endoscope's IFUs.

ANSI/AAMI ST91, 2015

"When possible and practical, flexible and semi-rigid endoscopes should be sterilized due to the greater margin of safety built into sterilization." (pg. 2 )Semi-critical devices are currently HLD, but guidance is also given here for "liquid chemical sterilization" with peracetic acid, and gaseous sterilization with ethylene oxide (EO), hydrogen peroxide (HP) gas, and ozone. Use any modality only if compatible with endoscope's IFUs.

APIC/JCR, 2017

Some experts are now recommending that endoscopes be sterilized. Outbreaks have been associated with duodenoscopes and bronchoscopes, even when all protocols were properly followed. Infection preventionists should follow this issue closely in order to best advise their organizations about any changes in recommended practice.

CMS, 2016

Not addressed.

TJC Booster Pak, 2015

Not addressed.

Guideline Details

*eg, repeating HLD, quarantining until receiving microbiologic culture results, liquid chemical sterilant processing systems, ethylene oxide sterilization, low-temperature sterilization