The Principles of Medical Device Decontamination

The decontamination process stages for flexible endoscopes

The decontamination process itself can be split into five parts: bedside clean, leak test, manual clean, automated reprocessing, drying and storage as shown in Table 7.1. All parts of the decontamination process must be undertaken by staff with demonstrable and validated competencies for the roles that they undertake. Best practice is that endoscopes should be fully reprocessed within three hours of withdrawal from the patient 2 . Therefore, out of hours decontamination services should be in place to support the endoscopy service and prevent delays in reprocessing of equipment. 1. Bedside Clean Bedside cleaning must be performed immediately after the instrument is withdrawn from the patient. This process includes a visual inspection for damage, thorough wiping of the shaft, and flushing of all channels using a low-foaming neutral detergent to remove gross debris and maintain channel patency. The endoscope should then be securely transported to the decontamination facility, clearly labelled as contaminated. If there is any delay in manual cleaning or reprocessing, appropriate measures must be in place to keep the instrument moist and prevent protein fixation. 2. Leak test Leak testing is a critical step in reprocessing. It detects damage and fluid invasion into the working components of the endoscope. Left undetected a leak can pose a risk for the transmission of infection and can damage the endoscope and incur large repair bills. Leak testing must be carried out as per manufacturers’ instructions using appropriate equipment that is fit for purpose, ensuring complete manipulation of all angulating endoscope parts. There should be an agreed written procedure for action in the event of a leak being detected.

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