There are two rules of thumbs (among others), in particular, that are apropos to questions about whether a flexible “ENT” endoscope, like any other type of flexible endoscope, may be only partially immersed in or wiped with a disinfectant, instead of being fully immersed in a high-level disinfectant, to prevent disease transmissions after each of the instrument’s clinical uses.

First, virtually every guideline, including my article in the American Journal of Infection Control entitled “Prevention of Disease Transmission during Flexible Laryngoscopy” (click here to read this article), recommends that the flexible endoscope be completely immersed in the high-level disinfectant after its thorough cleaning. I write in this article in “step 3[b]” on p. 540: “3.b. Immerse the laryngoscope in the detergent solution. Use a soft brush and sponge or wipe to wash manually the exterior of the laryngoscope, including its body, insertion tube, and umbilical cable. *Completely immerse* the laryngoscope during the cleaning process.”

The instructions provided by the manufacturer of the flexible endoscope would provide the same advice, unless, perhaps, a protective sheath were used to cover the endoscope during the clinical exam. In this latter case, the CDC and I (but not necessarily the FDA; see below) recommend reprocessing the flexible endoscope as if no sheath were used (i.e., high-level disinfecting the entire endoscope after its cleaning and prior to its terminal drying).

For more of a discussion on this topic, read another of my articles entitled “Recommendations to Resolve Inconsistent Guidelines for the Reprocessing of Sheathed and Unsheathed Rigid Laryngoscopes” (Muscarella LF. Infect Control Hosp Epidemiol 2007 Apr;28(4):504-6).

The CDC’s and my recommendation notwithstanding, some other articles have suggested that complete immersion of the flexible “ENT” endoscope may not be necessary, provided that, at the very least, its distal tip is immersed in the high-level disinfectant. Further, the FDA has adopted the stance that intermediate-level disinfection (which would be achieved, for example, by wiping the instrument with 70% alcohol, not immersing it completely in a high-level disinfectant) may be appropriate if a protective sheath were used to cover the flexible endoscope (e.g., a flexible “ENT” laryngoscope) during the clinical exam.

I discuss this controversy and the FDA’s stance in more detail, along with my recommended  “action,” in Topic #1 on p. 16 in an article I wrote in my newsletter: click here to read this article. Again, I recommend that not just its distal tip, but the entire flexible endoscope be immersed in a high-level disinfectant to prevent disease transmission, no matter whether a sheath was used to cover the instrument during the clinical examination.

Second, if the flexible endoscope (especially a gastrointestinal endoscope) cannot be completely immersed because of its age or design, then guidelines recommend it be removed from service and replaced with an updated model that, indeed, can be completely immersed. Inventory should be stocked only with fully immersed flexible endoscopes. Failure to properly reprocess, and to completely immerse in the high-level disinfectant, a flexible endoscope has been directly linked to disease transmission with associated patient morbidity and mortality.

Blog by: Lawrence F. Muscarella, Ph.D. on December 10, 2012

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