Ongoing Discovery of High-Level Disinfection of Endoscope Practices and the Use of Performance Improvement Methodologies to Improve Processes

Preventing health care–associated infections, regardless of the setting (hospital, ambulatory, office-based), has become a priority. This focused attention can be attributed to leaders motivated to improve the quality of care with highly reliable, repetitive, evidence-based process practices; patient expectations of an uncomplicated health care experience; increased awareness of reported infections; and financial implications (positive and negative) to the organization. A topic that has recently become a main concern is high-level disinfection (HLD) and endoscopes used for endoscopic retrograde cholangiopancreatography (ERCP) procedures, as represented in the Food and Drug Administration (FDA) Safety Communication in February 2015.¹ Increased infection risk may reflect the complexity of the endoscope device, which contains many small working parts with hidden, often difficult to reach, crevices, and/or reprocessing errors, which can occur during any of the steps for precleaning, manual cleaning, HLD process, and endoscope storage.