Guidelines for Decontamination of Equipment for Gastrointestinal Endoscopy
February 2008
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 BSG first published recommendations on endoscope decontamination practice in 1988, and the recommendations from the fourth working party appeared in Gut in 1998 (1). In 2002 a fifth working party reconsidered the recommendations for decontamination of endoscopes and their devices, prompted by the following developments:
- A Health and Safety Executive report that safer alternatives to glutaraldehyde should be used within health care settings.
- Emergence of variant Creutzfeld Jakob Disease (vCJD) as an important pathogen in man.
- Publication of an updated Medical Devices Agency (MDA) Device Bulletin DB2002 (05) on decontamination of endoscopes.(2)
In 2004 a review of endoscope decontamination practice was undertaken in Northern Ireland in response to an incident where stained fluid was seen to emerge from an auxiliary endoscope channel, the existence of which was not known to staff. This report recommended that the updated BSG Guidelines should give special emphasis and advice on the decontamination of elevator wire and auxiliary water channels (3).
The Health Act was published in 2006. 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 6th Working Party met in October 2006 to consider new developments and recommendations, including (a) the optimal modes for decontaminating water bottles and endoscope valves (pistons); (b) the latest recommendations for reducing the risks of endoscopic transmission of vCJD, including the tracking of equipment; and (c) updated recommendations on drying and storage of endoscopes, given the evolving range of purpose-built chambers designed for this purpose.
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2010: Joint Advisory group (the JAG) Standards for GI Endoscope Decontamination
This is the third edition of The JAG standards, prepared in order to facilitate internal audits of decontamination practice. The Standards may be referred to during JAG visits of endoscopy units. For further information please visit www.jagvisits.org.uk
BSG Guidance: April 2008
Decontamination of Equipment for GI Endoscopy and vCJD Issues – Some Good News at Last!
Since the last hard copy distribution of the BSG guidelines in 2003 there have been significant developments in decontamination practice, and revised guidance on endoscopy in patients at risk of variant CJD (vCJD). There is also good news in that endoscope manufacturers will shortly be in a position to offer centrally funded refurbishment of some endoscopes in quarantine. This ring-fenced funding will also make it less likely that “invasive” endoscopy (such as biopsy and diathermy) will be denied to patients at risk of vCJD (for example patients with haemophilia and related disorders).
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"Transmissible Spongiform Encephalopathy Agents: Safe Working and the Prevention of Infection"
Guidance from theDoH Advisory Committee on Dangerous Pathogens and the Spongiform Encephalopathy Advisory Committee
This guidance replaces the edition issued in March 1998.
The identification of variant Creutzfeldt-Jakob Disease (vCJD) in March 1996, and the suggested link with consuming bovine spongiform encephalopathy (BSE)-infected beef, led the Advisory Committee on Dangerous Pathogens to review all of its guidance on work with the agents of transmissible spongiform encephalopathies (TSEs). This led to the publication in August 1996, of general occupational guidance for those such as abattoir workers who might be incidentally exposed to the BSE agent. Following the establishment of the Advisory Committee on Dangerous Pathogens (ACDP)/ Spongiform Encephalopathy Advisory Committee (SEAC) Joint Working Group on TSEs, another guidance document aimed at laboratory and Health Care Workers was published in April 1998, entitled "Transmissible spongiform encephalopathy agents: Safe working and the prevention of infection".
Read the entire updated document on the Department of Health's 'Advisory Bodies' website:
MHRA Guidelines
View documentation on MHRA website: