How long can endoscopes that have been reprocessed by high level disinfection (HLD) remain safe to use when stored properly? This is not an easy question to answer. Guidelines from multiple societies are published to guide facilities in every step of reprocessing and some venture to guess at hang time duration (hang time is the interval of storage after which endoscopes should be reprocessed before additional use) post-HLD. Here are some sample recommendations:1
- Multisociety Guideline on Reprocessing Flexible GI Endoscopes:2 Unresolved issue. “Although reuse of endoscopes within 10 to 14 days of high-level disinfection appears to be safe, data are insufficient to provide a maximal duration for use of appropriately cleaned, reprocessed, dried, and stored flexible endoscopes.”
- AORN (Association of Operating Room Nurses): 5 days
- APIC (Association of Professionals in Infection Control and Epidemiology): 7 days
- Gastroenterological Society of Australian Infection Control Guidelines: 12-72 hours
- Guideline for Disinfection and Sterilization in Healthcare Facilities3 (Centers for Disease Control and Prevention): No recommendations
- Society of Gastroenterology Nurses and Associates: No recommendations due to lack of scientific evidence
An article published in Gastrointestinal Endoscopy aimed to demonstrate whether duodenoscopes, gastroscopes, and colonoscopes could be stored for as long as 21 days without microbial colonization by potential pathogens.4 This study is important because it is the first study to evaluate possible scope contamination up to 21 days after HLD. Assumptions must be made when assessing safe storage:
- Endoscopes were properly reprocessed and allowed to dry thoroughly
- Correct storage by hanging vertically in a clean, well ventilated cabinet
- Endoscopes should not have caps or valves attached
What was the impact of storing scopes for up to 21 days?
- No negative effect on patient safety if all reprocessing protocols for cleaning and disinfection are strictly followed
- Cost savings due to decreased use of reprocessors and chemicals
- Less waste produced
- Minimized delays in facilities with limited scope inventory
At this point, we cannot be certain that 21 days is the correct interval. Could it be longer? Should it be shorter? Will another research team duplicate these results? In the provocative atmosphere of scope reprocessing and reported outbreaks, we need to have evidence based guidelines on all aspects of scope management.
How long do your scopes hang before they are reprocessed? Do you have tags on the scopes so that staff know when they should be reprocessed, per your facility’s policy?
- Greenwald DA. Endoscope hang time: Can we get some clarity? Gastrointest Endosc 2015;81:1150-4. http://www.giejournal.org/article/S0016-5107(15)00144-3/abstract
- Petersen BT, Chennat J, Cohen J, et al. Multisociety guideline on reprocessing flexible gastrointestinal endoscopes: 2011. Gastrointest Endosc 2011;73:1075-84. http://www.asge.org/uploadedFiles/Publications_and_Products/Practice_Guidelines/Multisociety%20guideline%20on%20reprocessing%20flexible%20gastrointestinal.pdf
- Rutala WA, Weber DJ. The Healthcare Infection Control Practices Advisory Committee. Guideline for disinfection and sterilization in healthcare facilities, 2008.http://www.cdc.gov/hicpac/pdf/guidelines/Disinfection_Nov_2008.pdf
- Brock AS, Steed LL, Freeman J, et al. Endoscope storage time: assessment of microbial colonization up to 21 days after reprocessing. Gastrointest Endosc 2015;81:1150-4. http://www.giejournal.org/article/S0016-5107(14)02273-1/pdf