Sterilization and High-Level Disinfection Update

During the past year, health care clinicians in the United States have reported a number of outbreaks of multidrug-resistant microorganisms, in particular, carbapenemase-producing Enterobacteriaceae (Table 1). Epidemiological investigations at each institution cited no breaches in reprocessing procedures. The source of the outbreaks has been attributed to the inability to adequately clean and high-level disinfect the elevator channel present in endoscopic retrograde cholangiopancreatography (ERCP) duodenoscopes and endoscopic ultrasound with linear array endoscopes. Processing the endoscope elevator channel presents unique challenges to ensure the mechanism has been thoroughly precleaned at the point of use, cleaned, disinfected, and thoroughly dried before storage.1