Prevention Strategies

International Infection Prevention Week 2020: GI Societies’ Recommendations on Reprocessing Endoscopes

While COVID-19 is primarily a respiratory disease, many patients have developed gastrointestinal symptoms, which may result in the disease being present on gastrointestinal endoscopes.

The novel coronavirus pandemic has cast a spotlight on infection control measures across the healthcare spectrum as infection preventionists work to curb the spread of the disease.

The Association for Professionals in Infection Control and Epidemiology is celebrating the “invaluable role protecting frontline healthcare workers and patients from COVID-19” during International Infection Prevention Week 2020.

Preventing the spread of COVID-19 extends to infection prevention measures in the endoscopy suite. That’s why six gastroenterological societies issued guidelines for reprocessing gastrointestinal endoscopes – while COVID-19 is primarily a respiratory disease, many patients have developed gastrointestinal symptoms, which may result in the disease being present on gastrointestinal endoscopes.

In addition, varying types of endoscopes are typically all reprocessed in the same suite in the hospital. This may include bronchoscopes used to treat COVID-19 patients.

In their guidelines, the organizations said that standard reprocessing procedures are enough to eliminate traces of SARS-CoV-2.

“Based on available evidence, standard manual cleaning followed by high-level disinfection (HLD) should be effective at eradicating SARS-CoV-2,” the guidelines read. “At this time no changes to the reprocessing of GI endoscopes are recommended.”

Of course, researchers are constantly reevaluating recommendations as we learn more about COVID-19. Epidemiologist Cori L. Ofstead noted in a recent paper that reprocessing technicians need to be extra cautious of cross-contamination in the reprocessing suite during the pandemic.

“The presence of gastrointestinal pathogens found in bronchoscopes and [bronchoalveolar lavage] samples suggests the possibility of cross-contamination caused by intermingling bronchoscopes and gastrointestinal endoscopes during reprocessing,” Ofstead, an epidemiologist with more than 25 years of experience, wrote in a recent paper.

Many elective endoscopy procedures were postponed beginning in March, at the recommendation of the American Society of Gastroenterology (ASGE), Society of Gastroenterology Nurses and Associates (SGNA), the American College of Gastroenterology (ACG), the American Gastroenterological Association (AGA), and the American Association for the Study of Liver Diseases (AASLD). If unused endoscopes were properly cleaned and dried after their last use, no additional measures are needed before safe reuse, according to the updated reprocessing guidelines.

“Reuse of endoscopes within 21, and perhaps even 56 days of appropriately reprocessed, dried, and stored flexible endoscopes appears to be safe,” the guidelines state.

For reprocessing equipment sitting idle, like automated endoscope reprocessors, the guidelines recommend consulting manufacturer instructions for use for a safe return to reprocessing endoscopes.

The societies suggest institutions do take special precautions to protect reprocessing staff, however. These steps include:

  • Strict adherence to personal protective equipment policies
  • Provide N95 respirators in reprocessing room, when available
  • Reprocessing technicians should put endoscopes in full enclosed and labeled containers for transport

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