Bronchoscopes: to sterilize or not to sterilize?

Is sterilization of bronchoscopes and cystoscopes necessary?

Letter to the Editor from Dr. Thomas W. Fengler, Cleanical GmbH, Augusta Hospital, Scharnhorststr. 3, 10115 Berlin, Germany, and Bruno Amann, CSSD Manager, Leopoldina Krankenhaus, Gustav-Adolf- Str. 8, 97422 Schweinfurt, Germany, on: H. Martiny, O. Leiß  Is sterilization of bronchoscopes and cystoscopes necessary?. Zentr Steril 2019; 27 (2): 110–113.

Important aspects of the German regulation for reprocessing flexible endoscopes have thankfully been collated and presented in the order of their importance in this publication. The current version of the German Medical Device 0perator Regulation (MPBetreibV), 67 pages of the KRINKO Recommendation from 2012 (with eight annexes and in Annex 8, dealing with endoscopy, eight further appendices) point to the need for a guide [1]. The publication also cites personal statements made by various manufacturers while listing the types of damage that can occur. While these appear plausible, in this form they cannot naturally be verified.

How critical is the, as generally “semi-critical” classified, use of heat-sensitive flexible endoscopes? That question has preoccupied the specialist organizations and many authors since the documented cases of infection caused by contaminated and therefore infectious, i.e. inadequately reprocessed, duodenoscopes in the USA. Unfortunately, to our knowledge there are only very few scientific epidemiological and comprehensive studies which are not case studies or single case reports.

We have learned about these incidents linked to the use of flexible endoscopes only thanks to the fact that such painstaking documentation and meticulous tracking were used in the cases described, bringing them to the attention of the courts and leading to convictions. Such routine investigations tend to be rare on a global scale since endoscopy generally involves short hospital visits where the patient and their problem disappear from sight after the examination, with the link between it and any infection going undetected.

The following remark, I do not understand:

“The aforementioned statements regarding material damage and interactions with disinfectants have of course no implications if instead (?) of disinfection only (?) sterilization is carried out, as is often (?) the case outside Germany.”

[...]

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