The length of time that flexible endoscopes which have undergone reprocessing with high-level disinfection can safely be stored before use: a systematic review protocol

Review question/objective How long (in days) do flexible endoscopes that have undergone reprocessing with high-level disinfection (HLD) maintain the same level of disinfection and remain safe to use when stored as recommended by the manufacturer? The objective of this review is to systematically review the best available evidence related to the safe hang time or storage time (in days) of flexible endoscopes that have undergone reprocessing with high-level disinfection in order to determine when they can be safely used without posing any risk of contamination from pathogens. Inclusion criteria Types of participants This systematic review does not aim to identify and include studies that have involved human participants, but rather that have included high-level disinfected endoscopes that are not immediately used. The review’s approach with respect to the type of endoscope is inclusive and with the exception of one kind, studies that have focused on use, reprocessing and storage hang time of any type of endoscope (e.g. gastroscope, bronchoscope, jejunoscope, laryngoscope, colonoscope, etc.) are to be considered for inclusion. The exception endoscope, that will not be considered, is the natural orifice translumenal endoscopy (NOTES). This is because NOTES is an emerging technology where a surgical procedure is performed to gain access to an organ (e.g. kidney, gall bladder) through a natural orifice.24 To be considered for inclusion, the endoscopes must have been cleaned using the recommended reprocessing steps described previously. In addition, the studies must have included reports of negative or positive culture of microorganisms and the specific length of time that cultures were obtained following reprocessing. Phenomena of interest The phenomena of interest of the proposed review is the length of time that endoscopes which have been properly reprocessed and stored can remain in a storage cabinet or closet before reuse without presenting a contamination risk. Types of outcomes This review will consider studies that include the following outcome measures: length of endoscope storage and measure of microorganism growth (e.g. cultures). The studies must also include the type of endoscopes used, as well as the method used to contaminate the endoscopes and specific reprocessing steps (e.g. type of rinse water, specific high level disinfectant, manual or automated reprocessing, method of drying before storage).