Some experts believe it's time to move beyond high-level disinfec-
tion by sterilizing flexible endoscopes. I'm not sure that would be an
effective strategy. Whichever sterilizing technology is used — chemi-
cal sterilants, ethylene oxide, hydrogen peroxide or gas plasma — has
to come in contact with the harmful organisms that reside inside
scopes. If biofilm isn't effectively removed during scope cleaning, as is
often the case, sterilization's effectiveness can be limited.
Sterilization does provide a higher kill rate than high-level disinfec-
tion, but improving cleaning practices is where facilities need to focus
their infection prevention efforts. I contribute to the endoscopy stan-
dards for the Association for the Advancement of Medical
Instrumentation. Many people within the group believe sterilization
has to play a larger role in endoscope reprocessing than it does now,
but none that I have spoken to believe it would solve the problem of
trying to reprocess dirty scopes.
OSM
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Mr. Myers (frmyers@ucsd.edu) is the assistant director of infection prevention
and clinical epidemiology at University of California San Diego Health in San
Diego, Calif.