Disinfection Practices for Endoscopes and Other Semicritical Items

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Abstract
Objective: To determine the disinfection practices employed by North Carolina hospitals for endoscopes and other semicritical patient care items and to discuss minimally acceptable disinfection procedures for these items. Design: A survey questionnaire was mailed to all North Carolina hospitals to identify their disinfection practices, and a literature review was conducted to ascertain studies that evaluated disinfection techniques for certain semicritical items. Participants: Questionnaires were returned by 107 of 167 (64%) North Carolina acute-care hospitals. ResultS: Most hospitals (91%) used a glutaraldehyde-based disinfectant (59%, 2% glutaraldehyde; 29%, 0.13% glutaraldehyde-0.44% phenol-0.08% phenate; 3%, either); half (51%) of the hospitals immersed the endoscope into disinfectant for ≥ 20 minutes, but 44% immersed for ≤ 10 minutes; nearly all hospitals (97%) disinfected endoscopes at room temperature. Hospitals rinsed the endoscope with sterile water (16%), tap water (54%), tap water followed by alcohol rinse (27%), or other (2%); 58% of the hospitals treated endoscopes from patients infected with human immunodeficiency virus (HIV), hepatitis B virus (HBV), or Mycobacterium tuberculosis differently (81%, ethylene oxide [ETO] sterilization; 10%, increased exposure time; 10%, other). Twenty percent of the hospitals used an automated washer for processing endoscopic instruments. Rigid endoscopes (e.g., arthroscopes, laparoscopes) were primarily high-level disinfected (57%), ETO sterilized (17%), or either (13%). The disinfection strategies for other semicritical items (e.g., applanation tonometers, cryosurgical instruments, and diaphragm fitting rings) were highly variable for the responding hospitals. Conclusions: This survey indicated the presence of a wide variety of practices for handling semicritical patient care items, many of which are inconsistent with current recommendations. To help establish minimally acceptable disinfection procedures for some patient care instruments (e.g., arthroscopes, laparoscopes, tonometers), the scientific literature was reviewed and recommendations were made.