High-level disinfection of gastrointestinal endoscope reprocessing

Table 1 Disinfection classification of gastrointestinal instruments

Category	Lever of disinfection	Gastrointestinal device
Critical	High-level	Argon plasma coagulation device
		Aspiration Biopsy Needles
		Banding ligation device
		Biopsy forceps
		Biopsy valves
		Cytology curettes
		Dilation balloon
		Distal attachments
		Electrical knife
		Foreign body retrieval
		Injection needle
		Manometery device
		Mouthpieces
		Snare
		Spray catheter
Semicritial	Intermediate-level	Gastroendoscope
		Small intestinal scope
		Colonoscope
		Sigmoidoscope
		Endoscopic ultrasonography scope
		Endoscopic retrograde cholangiopancreatography scope
		Naso-gastroendocope
Noncritical	Low-level	Cautery plates
		Electrodes
		Stethoscopes
		Vital sign monitor

Table 2 High-level disinfection of gastrointestinal endoscope reprocessing in Kaohsiung Chang Gung Memorial Hospital

Procedure room	Manual washing
	Precleaning (Enzymatic detergent cleaning)
	Wipe the outer surface by gauze
	Cleaning the channel by suction
	Cleaning (Brushing working channels) (Figure 1)
	Long brush cleaning inner channels
	Immersion detergent solution
Disinfection room	High-level disinfection
	Leak test (Figure 2)
	Automated endoscope reprocessor
	Normal relief valve pressure is 1.85 ± 0.05 kgf/cm2
	Water supply is 17 liter/minute
	Liquid chemical germicide
	Rising
Store room	Drying
	Flushing 75% ethanol
	Storage by vertical hanging

Table 3 Positive surveillance culture after automatic endoscope reprocessor with high-level disinfection

Gastrointestinal instrument	Positive rate	Ref.
Colonoscope1	71.40%	[24]
Colonoscope	20.8%	[17]
Small intestinal scope, anal route	19.2%	[16]
Gastroendoscope	10.7%-14.3%	[17,24]
Small intestinal scope, oral route	12.9%	[16]
AER reprocess to gastroendoscope2	2%	[17,27]
AER reprocess to colonoscope3	0.8%	[17,27]

¹AER was damaged in reprocessing;

²case size was 6/300;

³case size was 1/120. AER: Automatic endoscope reprocessor.