A Reminder of HTM Decontamination recommendations for ERCP procedures
Following our recent article - Duodenoscope Contamination - Surveillance Studies - one of our authorising engineers suggested reiterating the UK position (Appendix 2; Page 20: HTM 01-06).
Appendix 2: Decontamination recommendations for ERCP procedures and on-table bile duct exploration
Although flexible endoscopes are used in these two procedures, their decontamination requirements are different.
ERCP procedures Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure to diagnose and treat problems in the bile duct or pancreatic duct using a flexible endoscope, appropriate single-use accessories and an x-ray detectable dye.
Decontamination requirements Because the endoscope is passed down through the mouth, it does not need to be provided as sterile.
The endoscope should go through a bedside clean followed by a manual decontamination process, paying particular attention to the elevator mechanism and the recess surrounding the elevator mechanism. During this process, the distal cover should be removed and the elevator should be raised and lowered throughout the manual cleaning process to allow brushing of surfaces that may be obscured by the raiser bridge (see the British Society of Gastroenterology’s guidelines).
Following the manual process, the duodenoscope should be reprocessed through an EWD using appropriate chemistries and adhering to the endoscope manufacturer’s instructions. Ensure the EWD is capable of decontaminating endoscopes with wire carrying channels.
On-table bile duct exploration On-table biliary explorations are done in a theatre environment that involves intraabdominal surgical intervention by a surgeon. It is either performed under aseptic conditions using a flexible choledochoscope passed via the cystic duct or performed as a choledochotomy either laparoscopically or at open surgery.
Decontamination requirements Since the choledochoscope has to enter sterile tissue, the scope needs to be provided as sterile. This is achieved with: a. a manual cleaning process; b. then reprocessing through an EWD; and c. sterilization using low temperature sterilization procedures (for example, ethylene oxide or hydrogen peroxide).
Please contact us to find out more about endoscope decontamination.