Challenging endoscopy reprocessing guidelines: a prospective study investigating the safe shelf life of flexible endoscopes in a tertiary gastroenterology unit.

Abstract

Professional prac−
tice guidelines for endoscope reprocessing re−
commend reprocessing endoscopes between
each case and proper storage following repro−
cessing after the last case of the list. There is lim−
ited empirical evidence to support the efficacy of
endoscope reprocessing prior to use in the first
case of the day; however, internationally, many
guidelines continue to recommend this practice.
The aim of this study is to estimate a safe shelf
life for flexible endoscopes in a high−turnover
gastroenterology unit.
Materials and methods: In a prospective obser−
vational study, all flexible endoscopes in active
service during the 3−week study period were mi−
crobiologically sampled prior to reprocessing be−
fore the first case of the day (n = 200). The main
outcome variables were culture status, organism
cultured, and shelf life.
Results: Among the total number of useable
samples (n = 194), the overall contamination rate
was 15.5 %, with a pathogenic contamination rate
of 0.5 %. Mean time between last case one day
and reprocessing before the first case on the
next day (that is, shelf life) was 37.62 h (SD
36.47). Median shelf life was 18.8 h (range 5.27±
165.35 h). The most frequently identified organ−
ism was coagulase−negative Staphylococcus, an
environmental nonpathogenic organism.
Conclusions: When processed according to es−
tablished guidelines, flexible endoscopes remain
free from pathogenic organisms between last
case and next day first case use. Significant re−
ductions in the expenditure of time and
resources on reprocessing endoscopes have the
potential to reduce the restraints experienced by
high−turnover endoscopy units and improve ser−
vice delivery.