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Guidelines for Decontamination of Equipment for Gastrointestinal Endoscopy

Updated by: Dr Helen Griffiths (Nurse Consultant) - BSG Endoscopy Committee –January 2014

Flexible endoscopes are complex reusable instruments that require unique consideration with respect to decontamination. In addition to the external surface of endoscopes, their internal channels for air, water, aspiration and accessories are exposed to body fluids and other contaminants. In contrast to rigid endoscopes and most reusable accessories, flexible endoscopes are heat labile and cannot be autoclaved.

The Health Act was published in 2006 and updated in 2010. This stipulates the roles of decontamination leads and decontamination programmes. It emphasises the need for staff to be trained in decontamination processes and to hold appropriate competencies for their role. It decrees the need for monitoring systems to ensure that decontamination processes are fit for purpose and meet required standards. Finally it requires that there are systems in place for tracking reusable medical devices (such as endoscopes and reusable accessories) through decontamination processes, not only to assist with assuring their quality, but also to enable the identification of patients on whom the medical devices have been used.

The guidelines have been updated to take into account recent changes to decontamination practice and national and European policy changes. These are awaiting ratification by the relevant expert bodies and are expected to be published in April 14. These guidelines are designed to provide information and guidance to those working within endoscopy services in England and will signpost readers to the relevant guidance in the devolved nations.

In the interim CFPP 01-06 guidance can be accessed for up to date information and advice on the decontamination of endoscopic equipment (see link below).

Choice Framework for Local Policy and Procedures CFPP 01-06

These documents offer best practice guidance on the management and decontamination of flexible endoscopes. They consist of five documents covering operational management, design and installation, testing methods, validation and verification and policy and management. These are large documents that will be subject to periodic updates and therefore it is recommended that rather than download all or part of the guidance the link is made available on endoscopy desktops. These guidelines are designed to provide information and guidance to those working within endoscopy services in England, please see the link below for relevant guidelines for Scotland, Wales and Northern Ireland.

Audit

Audit is key to understanding and ensuring that the decontamination environment and the processes within it are safe and effective. The MHRA (August 12) talks about the legal implications if there are failures in both understanding and practices in decontamination. The CFPP 0106 reminds us that the Health Act Code of Practice (2006) recommends that healthcare organisations comply with guidance establishing Essential Quality Requirements (EQR) and demonstrate that a plan is in place for progression to Best Practice (BP). There are a number of audit tools available for use within endoscopy to demonstrate compliance with EQR and allow planning to achieve BP. The Infection Prevention society has developed comprehensive audit tools to sit alongside the guidance in CFPP 01-06. These tools are now recommended by the member committees of the Professional Expert Communication Forum (PECF): Decontamination of medical devices as the UK wide audit tool of choice.

Access IPS audit tools here

Access list of member organisations of the Professional Expert Communication Forum (PECF) here

"Transmissible Spongiform Encephalopathy Agents: Safe Working and the Prevention of Infection"

As part of its remit for the whole of the UK the Department of Health ACDP TSE Risk Management Subgroup produces the guidance document Transmissible spongiform encephalopathy agents: safe working and the prevention of infection. The aim of the guidance is the minimisation of the risk of transmission of CJD, and vCJD.

Read the entire updated document on the Department of Health's 'Advisory Bodies' website:

BSG Update to Endoscopy Service on vCJD risk reassessment

In 2012 the Department of Health published the Choice Framework for local Policy and Procedures CFPP 01-06, a technical document that replaces HTM 2030. The vCJD risk reassessment is discussed in this. It is no longer necessary to quarantine endoscopes following procedures in most patients at risk of vCJD (including blood product recipients) provided that national recommendations on decontamination practice are scrupulously adhered to. There has been a further recent update to these guidelines (January 2014). A précis of the documents with their links is found below. It is strongly recommended that endoscopy teams review review these documents, in light of the changes including the identification of a newly described human prior disease, Variably Protease - Sensitive Prionopathy (VPSPr), whose transmissibility characteristics are still under investigation.

MHRA Guidelines

View documentation "Top ten tips" revised 2012 on MHRA website: