• transfer contaminated devices immediately after usage to the reprocessing procedure
• transport contaminated devices in a closed container from the endoscopy room to the reprocessing room, paying attention to protective measures concerning staff and environment

• before starting the reprocessing, put on protective clothing as appropriate:
  - chemically resistant gloves
  - protective glasses / visor
  - protective face masks
  - special examination gown or coat (long-sleeved, moisture-resistant) or plastic aprons arms

• disconnect and dismantle accessories as far as possible
• immerse accessories in enzymatic detergent solution immediately after usage
• clean the single components of the devices externally by using soft cloth, sponge and brushes
• perform brushing / cleaning under the water surface in order to avoid sprinkling of contaminated liquids
• inject detergent solution into all accessible channels and lumen to remove secretion and debris
  (at least 10-20ml solution in each channel)
• ensure that all lumen are flushed completely to avoid air blockage
• remove the instruments from the detergent solution

• Only special trained personnel should carry out the reprocessing of endoscopic equipment, this applies both to routine as well as emergency endoscopy.
• Enzymatic type detergent solutions are recommended for cleaning endoscopy accessories
• Enzymatic detergents require a specific contact time, according to the manufacturer's instructions
• Aldehydes must not be used for cleaning steps because they denature and coagulate protein, fixing it and this may impair cleaning
• Cleaning must take place before disinfection.
• The water quality available in the endocopy unit should be specified.

• use a medical grade ultrasonic cleaner with a frequency range over 30 kHz (38 to 47 kHz) and a max. operation temperature of 45^oC, following manufacturer's instructions
• use the same solution for the ultrasonic cleaner as for cleaning step
• ensure that the detergent used is a non-foaming solution, compatible for manual cleaning as well as for ultrasonic cleaning
• renew the cleaning solution at least daily or sooner if the solution is contaminated
• ensure that the tray is large and deep enough to allow for complete immersion of the devices
• load the basket / tray of the ultrasonic cleaner with the dismantled and pre-cleaned accessories
  (maximum 10 devices per cycle and tray)
• avoid any ultrasound "shadows" /dead spaces where ultrasound waves cannot act
  therefore do not overload the tray
• the instrument should be coiled with a diameter of not less than 15-20 cm, in accordance to manufacturer's instructions
• flush again all channels and lumen completely with at least 10 ml detergent solution, to avoid air blockage
• follow the instructions of both the ultrasonic cleaner manufacturer and the devices manufacturer
• cover the ultrasonic cleaner with a lid
• leave the accessories in the ultrasonic cleaner and complete the recommended contact time for ultrasonically cleaning, following the manufacturer's instructions for devices, ultrasonic cleaner and detergents (recommended ultrasonic cleaning: 30 min)
• remove the accessories from the ultrasonic cleaner
• flush all channels with air to displace excess fluid

• During ultrasonic cleaning the temperature can arise from 40 to 60^o C. Using enzymatic detergents ensure that the temperature should not be over 43^oC compatible with detergent efficacy
• The temperature in the ultrasonic cleaner should be monitored.

• transfer the cleaned accessories to a bowl or tray, containing drinking quality water without contamination and renew it after each rinsing cycle
• flush all channels completely and thoroughly in the water to remove detergent residuals, flush the channels with at least 20ml water
• rinse external surfaces thoroughly using drinking quality water to remove chemical residues
• remove the devices from the water
• drain or aspirate all channels with air to express residual rinse water

• dry the external surfaces with a non-shedding cloth and compressed medical air
• dry each channel completely with compressed air.
• dry all coiled accessories in a hanging position to support the drying procedure
• compose the accessories and check the correct functioning

5. Sterilisation:

• put the instruments into sterile packaging for special instruments
• select the adequate sterilisation procedure for the thermal stabile and thermal labile instruments in accordance with the manufacturer's instructions (pre-vacuum, 134^oC, 5 minutes or equivalent cycles) and according to national laws
• after completion of the sterilisation cycle, ensure all cycle stages and parameters have been achieved
• check the sterile packaging for any damage and the sterilisation indicators

• store sterilised instruments in the sterile packaging in a closed cupboard, protected from dust, humidity and temperature fluctuation
• follow instructions concerning the durability of the respective sterile packaging

Table 2:

As an additional step, an automated washer-disinfectors may be used. Before this is done, pre-cleaning, ultrasonic cleaning and rinsing have to be computed. Follow articles 1 to 3 of the "Standard of manual reprocessing of endoscopic accessories" (see table 1).

• after thorough cleaning as described above, load the basket, immersion trays or tank of the machine, in accordance manufacturer's recommendations
• attach channel connectors to ensure complete and thorough irrigation of all lumens
• ensure that all channels are connected, the specific design of the machine must be taken into account

• handles, coils or wires must be fitted into a special basket
• remove the gloves and close the machine

• select and start the cycle
• after completion of the automated cycle, ensure that all cycle stages and parameters have been achieved
• open the machine and remove the accessories
• dry the accessories if necessary, with non-shedding cloth
• dry each channel with compressed air

To complete the cycle, follow article 6-7 of the "Standard of manual reprocessing of endoscopic accessories" (see table 1).