High-Level Disinfection Monitoring and Endoscopes

Pre-Disinfection Inspection and Leak Testing

In the sterile processing department, the technician's role encompasses cleaning, decontamination, inspection, assembly, packaging, sterilization, and storage of medical instruments. Every task must strictly adhere to the manufacturer's instructions for use and facility policy. Before a flexible endoscope can undergo high-level disinfection, technicians must first ensure its physical integrity and cleanliness in the decontamination area.

Leak testing is a critical diagnostic step that detects damage and punctures in an endoscope's internal channels and outer sheath. This test must always be performed prior to immersing the endoscope in manual cleaning and decontamination solutions. If an endoscope with an undetected leak is submerged, fluid can enter the interior structure and cause severe, costly damage to its delicate internal components. Leak testing can be carried out using either manual pressure manometers or automated leak testing systems.

When performing a wet leak test, the technician pressurizes and submerges the endoscope into water according to the manufacturer's instructions, watching carefully for continuous bubbles that indicate a leak. During this wet leak test, the technician must articulate the bending section as directed by the endoscope manufacturer to reveal hidden stress tears. If an endoscope fails a leak test, it must be removed from service immediately and handled, decontaminated, and routed for repair by following the manufacturer's instructions and facility policy.

After point-of-use pre-cleaning and leak testing, manually clean the endoscope as directed by its instructions for use before high-level disinfection, unless the endoscope and AER manufacturers’ instructions expressly authorize a validated AER process to replace specified manual cleaning steps. The technician must brush and flush all channels exactly as specified by the endoscope manufacturer. Prior to disinfection, visually inspect the flexible endoscope for residual soil and damage, using magnification when required by the manufacturer's instructions or facility policy. Any device found to have residual soil must be returned for complete recleaning.