ABSTRACT
CONTENTS 10.1 Introduction ............................................................................................. 178 10.2 The Principles of Practice: Where Do They Come From? ............... 179
10.2.1 Introduction ............................................................................... 179 10.2.2 Standards, Recommended Practices, Guidelines,
and Statements .......................................................................... 179 10.2.2.1 Standards................................................................... 180 10.2.2.2 Recommended Practice........................................... 180 10.2.2.3 Guidelines ................................................................. 180 10.2.2.4 Statements ................................................................. 180
10.2.3 Development and Use of Recommended Practices ............ 181 10.2.4 Flexible Endoscope Reprocessing Practices ......................... 182
10.3 Flexible Endoscope Structure=Function.............................................. 184 10.3.1 Introduction ............................................................................... 184 10.3.2 External Features ...................................................................... 186 10.3.3 Removable Components.......................................................... 186 10.3.4 Channel Configurations........................................................... 188
10.3.4.1 Suction=Biopsy System ........................................... 188 10.3.4.2 Air=Water System.................................................... 190 10.3.4.3 Auxiliary Water System.......................................... 190 10.3.4.4 CO2 System ............................................................... 193 10.3.4.5 Elevator Guide Wire System.................................. 193
10.3.5 Importance of Understanding Flexible Endoscope Design .................................................................... 194
10.4 Endoscopy-Related Contamination Outbreaks.................................. 194 10.4.1 Introduction ............................................................................... 194 10.4.2 GI Endoscopy-Related Outbreaks ......................................... 195
10.4.2.1 Case Review.............................................................. 195 10.4.2.2 Suspected Causes: Summary ................................. 201
10.4.3 Bronchoscopy-Associated Outbreaks .................................... 202 10.4.3.1 True Outbreaks ........................................................ 202 10.4.3.2 Pseudo-Outbreaks.................................................... 206 10.4.3.3 Suspected Causes: Summary ................................. 210
10.4.4 Summary of Suspected Causes of Outbreaks ...................... 210 Acknowledgment............................................................................................... 211 References ........................................................................................................... 211
The use of flexible endoscopes in minimally invasive procedures has increased dramatically since the early 1960s. As with most fields of practice, the development, use, and reprocessing standards for flexible endoscopes have evolved through time. Some key highlights of this evolution include
. The first clinical report of flexible fiberoptic endoscopy was published in 1961 [1]. At first, the endoscope was prepared for the next usage by a variety of methods, typically flushing the channels with fluid (sometimes just water) and wiping the exterior.
