Is peracetic acid suitable for the cleaning step of reprocessing flexible endoscopes?

Table 6 Practical tips to ensure optimal cleaning of flexible endoscopes

Clinical practice tip	Major advantage	Ref.
Clean promptly after use	No drying of organic material such as blood	[77,207]
Follow the instructions of the endoscope manufacturer as closely as possible (e.g., type of brush or cleaning adapter)	Optimum cleaning of an entire channel
Prefer washer disinfectors with a monitoring system indicating channel blockage	A blocked channel cannot be cleaned adequately and is immediately identified; targeted brush cleaning may be necessary
Do not switch off the monitoring system for detection of blocked channels	Channels may be blocked and inadequately cleaned; personnel may not detect blocked channels with all possible implications for patient safety
Support by gastroenterologist	It is strongly recommended that the clinician fully understands the cleaning and disinfection steps and does not inhibit his or her staff's ability to perform them correctly	[240]
Allow external audits by local health authorities on the quality of processing including cleaning	Implementation of guidelines may be more successful if the local health authorities visit the endoscopy units and compare current practices with the relevant guidelines. This effect seems to be more easily achieved in in-patient rather than in out-patient endoscopy units	[241-243]