Use of flexible endoscopes for NOTES: sterilization or high-level disinfection?
- First Online:
- 319 Downloads
Natural orifice translumenal endoscopic surgery (NOTES) involves the use of flexible endoscopes to perform intra-abdominal or intra-thoracic surgeries. Surgery in the operating room usually involves sterile instrumentation, whereas in the endoscopy suite high-level disinfection seems to be sufficient. Our objective was to assess the necessity for endoscope sterilization for clinical NOTES and to develop an endoscope processing protocol based on a score for the available processing options.
Score and processing protocol development for clinical NOTES endoscopes was based on a comprehensive review of the available relevant literature. Options for sterilization for flexible endoscopes in the Good Samaritan Hospital, Legacy Health in Portland, Oregon, were analyzed for patient safety, potential for recontamination, cost, and validation.
Literature survey indicated that there is controversy surrounding the necessity for sterilization of surgical endoscopes. However, standard of practice seems to call for sterile instrumentation for surgery and it is possible to terminally sterilize flexible endoscopes. Within our institution, a score was created to rank the available sterilization options. We successfully introduced a protocol for sterilization of endoscopes for use in clinical NOTES procedures. The protocol involved mechanical cleaning and high-level disinfection per Multi-Society Guidelines, with subsequent terminal sterilization using a validated peracetic acid protocol.
It remains controversial whether sterile instrumentation is truly needed for surgery. It is difficult but possible to terminally sterilize flexible endoscopes. We recommend sterile instrumentation for clinical NOTES until well-designed, randomized, clinical trials are available and guidelines are published.
KeywordsNatural orifice translumenal endoscopic surgery NOTES Flexible endoscope Sterilization High-level disinfection
- 1.Rutala WA, Weber DJ Guideline for disinfection and sterilization in healthcare facilities. www.cdc.gov/ncidod/dhqp/pdf/guidelines/Disinfection_Nov_2008.pdf. Accessed 2 July 2009
- 9.American Society for Gastrointestinal Endoscopy (2003) Multi-Society Guideline for reprocessing flexible gastrointestinal endoscopes. Gastrointest Endosc 58(1):1–8Google Scholar
- 10.Nelson DB, Jarvis WR, Rutala WA, Foxx-Orenstein AE, Isenberg G, Dash GP, Alvarado CJ, Ball M, Griffin-Sobel J, Petersen C, Ball KA, Henderson J, Stricof RL (2004) Multi-Society Guideline for reprocessing flexible gastrointestinal endoscopes. Dis Colon Rectum 47(4):413–420 discussion 420–421CrossRefPubMedGoogle Scholar
- 12.Patterson P (2009) CDC sterilization, disinfection guideline. OR Manager 25(1):14–16Google Scholar
- 16.Sullivan JB, Krieger GK (2001) Clinical environmental health and toxic exposures, environmental health hazards of business, industry, sites, and locations. Lippincott Williams & Wilkins, Philadelphia, p 602Google Scholar
- 17.Steris. System 1 Sterile Processing System (2009) http://www.steris.com/products/view.cfm?id=29. Accessed 10 August 2009
- 18.Abraham JB, Abdelshehid CS, Lee HJ, Box GN, Deane LA, Le T, Jellison F, Borin JF, Manipon A, McDougall EM, Clayman RV (2007) Rapid communication: effects of Steris 1 sterilization and Cidex ortho-phthalaldehyde high-level disinfection on durability of new-generation flexible ureteroscopes. J Endourol 21(9):985–992CrossRefPubMedGoogle Scholar