The images were taken with INSPEKTOR CT

Interior damage in endoscopes found with a borescope

The following images are examples of debris remaining in channelsand lumens aer manual cleaning and prior to high level disinfecon

The AORN, SGNA & CDC all state visual inspecon is a separate step aer manualcleaning and before HLD or sterilizaon..

Naonal Guidelines & Processes on Visual InspeconFor Flexible Endoscopes and Surgical Instruments

The Value ofChannel and Lumen Inspecon

NCI, Inc. - The INSPEKTOR www.inspektor.com

ANSI/AAMIST91: 2015Flexible and semi-rigid endoscope processing in health care facilies states in 12.4.2:“Tools such as video borescopes of an appropriate dimension (length and diameter) may be used to visuallyinspect the internal channels of some medical devices.”

SGNA’s 2016 Standards of Infecon Prevenon in Reprocessing of Flexible Gastrointesnal Endoscopes“Visual inspecon is recommended to make sure the endoscope is visibly clean (AAMI, 2015; Rutala et al., 2008).It is not a guarantee that decontaminaon from manual cleaning is complete, but it can be considered a safetystop or “me out” to ensure the endoscope is visually clean before proceeding to the next step of HLD.a. Visually inspect for condions that could affect the disinfecon process (e.g., cracks, corrosion,disdiscoloraon, retained debris) (FDA, 2009; AAMI, 2015).b. Use magnificaon and adequate lighng to help assist in visual inspecon (AAMI, 2015).c. Repeat manual cleaning step(s) if not clean”

CDC Recommendaons of the Healthcare Infecon Control Pracces Advisory CommieeCDC - June 28, 2017 Visual Inspecona) Aer manual cleaning, visually inspect the endoscope and its accessories. Visual inspecon providesaddional assurance that the endoscope and its accessories are clean and free of defects. Complex devicessuch as flexible endoscopes may require the use of lighted magnificaon or addional methods to assist withthe inspecon prothe inspecon process.

2017 Edion AORNGuidelines for Perioperave Pracces - Flexible Endoscopes ,Recommendaons VII“Flexible endoscopes accessories and associated equipment should be visually inspected for cleanliness,integrity, and funcon before use, during the procedure, aer the procedure, aer cleaning and beforedisinfecon or sterilizaon. VII.c. Lighted magnificaon should be used to inspect endoscopes and accessoriesfor cleanliness and damage. 12.13. 65 [2: High Evidence]An endosAn endoscope that appears clean may harbor debris that cannot be seen without magnificaon. Lightedmagnificaon may increase the ability to idenfy residual soil or damage. VII.c.1. Internal Channels of flexibleendoscopes may be inspected using an endoscopic camera or borescope. [2: High evidence]Endoscopic cameras and borescopes penetrate the lumen and allow for improved visual inspecon.”

FDA/CDC/American Society for MicrobiologyDuodenoscope Surveillance Sampling and Culturing Protocols, February 2018A5.3.1.4 Sampler: Before sampling the duodenoscope, perform a visual inspecon of its distal end for anydebris or other concerns using 10x magnificaon.

IAHCSMM Endoscope Reprocessing Manual, 2017“The most important areas for inspecon are the lumens that run through the endoscope. Lumens pose acleaning challenge because of their narrow structure that prevents visualizaon during the cleaning;therefore, it is important to always check lumens for cleanliness aer cleaning. Visual inspecon of lumens can be accomplished using a borescope, a small flexible fiberopc device that enables visualizaon ofotheotherwise inaccessible areas within endoscope lumens.”

Naonal Organizaons RecommendedProcesses And Guidelines On Visual Inspecon