chapter  10
38 Pages

Reprocessing Flexible Endoscopes: Origin of Standards, Overview of Structure=Function, and Review of Recent Outbreaks

WithTerri A. Antonucci, Nicole Williams, Nancy A. Robinson

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.