Detergent choices for endoscope reprocessing

He addresses the two different classes of detergents available – enzymatic and non-enzymatic – and considers, by way of risk assessment, the advantages and disadvantages of each.

There are two types of standard endoscope – rigid and flexible. Both types have two major risk factors relating to their use. The first is that a perforation, or a tear can occur as the device is used. The second is from the risk of infection caused by cross-contamination. The most common cause of infection arises from a failure to clean, disinfect or store the device in a satisfactory manner. The level of risk differs according to the type of device. Rigid endoscopes can be sterilised and the risk of failure is very low; whereas flexible endoscopes require manual or semi-automated cleaning and disinfection. This is not a straightforward process and cleaning flexible endoscopes is both difficult, time consuming and presents a higher potential risk.1 Cleaning and disinfection is a two-step process involving both detergents (which ‘clean’) and disinfectants (which remove or eliminate microorganisms). Detergents are cleaning agents which remove ‘soil’ from a surface – including blood, secretions, drug residues, human tissues, water and chemicals. The removal of soil is an important step prior to the application of a disinfectant. The greater the degree of soiling remaining on a surface, then the lesser the effectiveness of disinfection.2 Thus, the effective removal of such material will allow disinfectants like hydrogen peroxide or chlorhexidine to work more effectively and kill microorganisms.

Contamination risks