Skip to main content Accessibility help

Disinfection of Endoscopes: Review of New Chemical Sterilants Used for High-Level Disinfection

  • William A. Rutala (a1) and David J. Weber (a1)
  • Please note a correction has been issued for this article.


Chemical sterilants are used to high-level disinfect heat-sensitive semicritical items such as endoscopes. Most endoscopes have been reprocessed between each patient use with glutaraldehyde (>2%) or the Steris System 1. Several new chemical sterilants have been developed recently, including 7.5% hydrogen peroxide, 0.08% peracetic acid plus 1.0% hydrogen peroxide, and 0.55% orthophthalaldehyde. In order to aid the infection control professional in choosing the appropriate disinfection methodology, this article reviews the characteristics, advantages, and disadvantages of high-level disinfectants intended for reprocessing endoscopes.


Corresponding author

547 Burnett-Womack Bldg, CB #7030, Division of Infectious Diseases, UNC at Chapel Hill, Chapel Hill, NC 27599-7030


Hide All
1. American Society for Gastrointestinal Endoscopy. Reprocessing of flexible gastrointestinal endoscopes. Manchester, MA: American Society for Gastrointestinal Endoscopy; 1995.
2. Spach, DH, Silverstein, FE, Stamm, WE. Transmission of infection by gastrointestinal endoscopy and bronchoscopy. Ann Intern Med 1993;118:117128.
3. Martin, MA, Reichelderfer, M. APIC guideline for infection prevention and control in flexible endoscopy. Am J Infect Control 1994;22:1938.
4. Rutala, WA. APIC guideline for selection and use of disinfectants. Am J Infect Control 1996;24:313342.
5. Rutala, WA. Disinfection, sterilization and waste disposal. In: Wenzel, RP, ed. Prevention and Control of Nosocomial Infections. Baltimore, MD: Williams & Wilkins; 1997:539594.
6. Society of Gastroenterology Nurses and Associates, Inc. Standards for infection control and reprocessing of flexible gastrointestinal endoscopes. Chicago, IL: Society of Gastroenterology Nurses and Associates, Inc; 1997.
7. Muscarella, LF. High-level disinfection or “sterilization” of endoscopes? Infect Control Hosp Epidemiol 1996;17:183187.
8. Rutala, WA, Clontz, EP, Weber, DJ, Hoffmann, KK. Disinfection practices for endoscopes and other semicritical items. Infect Control Hosp Epidemiol 1991;12:282288.
9. Burns, S, Edwards, M, Jennings, J, Jolly, D, Kovach, S, Leithauser, D, et al. Impact of variation in reprocessing invasive fiberoptic scopes on patient outcomes. Infect Control Hosp Epidemiol 1996;17(suppl):P42. Abstract.
10. Fuselier, HA, Mason, C. Liquid sterilization versus high level disinfection in the urologie office. Urology 1997;50:337340.
11. Rutala, WA, Weber, DJ. FDA labeling requirements fpr disinfection of endoscopes: a counterpoint. Infect Control Hosp Epidemiol 1995;16:231235.
12. Bond, WW. Endoscope reprocessing: problems and solutions. In: Rutala, WA ed. Disinfection, Sterilization and Antisepsis in Health Care. Champlain, NY: Polyscience Publications; 1998:151163.
13. Alfa, MJ, Sitter, DL. In-hospital evaluation of orthophthalaldehyde as a high level disinfectant for flexible endoscopes. J Hosp Infect 1994;26:1526.
14. Chu, N, McAlister, D, Antonoplos, PA Natural bioburden levels detected on flexible gastrointestinal endoscopes after clinical use and following manual cleaning. Gastrointest Endosc 1998;48:137142.
15. Chan-Myers, H, McAlister, D, Antonoplos, P. Natural bioburden levels detected on rigid lumened medical devices before and after cleaning. Am J Infect Control 1997;25:471476.
16. Silvis, SE, Nebel, O, Rogers, G, Sugawa, C, Mandelstam, P. Endoscopic complications: results of the 1974 American Society for Gastrointestinal Endoscopy survey. JAMA 1976;235:928930.
17. Mandelstam, P, Sugawa, C, Silvis, SE, Nebel, OT, Rogers, BHG. Complications associated with esophago-gastroduodenoscopy and with esophageal dilation. Gastrointest Endosc 1976;23:1619.
18. Bronowicki, JP, Venard, V, Botte, C, Monhoven, N, Gastin, I, Chone, L, et al. Patient-to-patient transmission of hepatitis C virus during colonoscopy. N Engl J Med 1997;337:237240.
19. Agerton, T, Valway, S, Gore, B, Pozsik, C, Plikaytis, B, Woodley, C, et al. Transmission of a highly drug-resistant strain (strain Wl) of Mycobacterium tuberculosis . JAMA 1997;278:10731077.
20. Alvarado, CJ, Stolz, SM, Maki, DG. Nosocomial infections from contaminated endoscopes: a flawed automated endoscope washer. An investigation using molecular epidemiology, Am J Med 1991;91(suppl 3B):272S280S.
21. Babb, JR, Bradley, CR, Ayliffe, GAJ. Sporicidal activity of glutaraldehydes and hypochlorites and other factors influencing their selection for the treatment of medical equipment. J Hosp Infect 1980;1:6375.
22. Scott, EM, Gorman, SE. Glutaraldehyde. In Block, SS, ed. Disinfection, Sterilization, and Preservation. 4th ed. Philadelphia, PA: Lea & Febiger; 1991:596614.
23. Weber, DJ, Rutala, WA. Occupational risks associated with the use of selected disinfectants and sterilants. In: Rutala, WA, ed. Disinfection, Sterilization and Antisepsis in Health Care. Champlain, NY: Polyscience Publications; 1998:211226.
24. American Conference of Governmental Industrial Hygienists. 1998 threshold limit values (TLvs) for chemical substances and physical agents and biological exposure indices (BEIs). ACGIH: Cincinnati, OH; 1998.
25. Association for the Advancement of Medical Instrumentation. Safe use and handling of glutaraldehyde-based products in healthcare facilities. Arlington, VA: AAMI; 1995.
26. Castelli, M, Qizilbash, A, Seaton, T. Postcolonoscopy proctitis. Am J Gastroenterol 1986;81:887. Abstract.
27. Wardle, MD, Renninger, GM. Bactericidal effect of hydrogen peroxide on spacecraft isolates. Applied Microbiology 1975;30:710711.
28. Bilotta, JJ, Waye, JD. Hydrogen peroxide enteritis: the “snow white” sign. Gastrointest Endosc 1989;35:428430.
29. Jonas, G, Mahoney, A Murray, J, Gertler, S. Chemical colitis due to endoscope cleaning solutions: a mimic of pseudomembranous colitis. Gastroenterology 1988;95:14031408.
30. Greene, DF, Urban, VL, inventors; Sterling Drug Ine, assignee. Hydrogen peroxide disinfecting and sterilizing compositions. US patent 4,518,585. May 21, 1985.
31. Monticello, MV, inventor; Eastman Kodak Company, assignee. Hydrogen peroxide composition. US patent 5,376,387. December 27, 1994.
32. Reckitt & Colman. Sporox sterilant and high-level disinfectant technical report. Montvale, NJ: Reckitt & Colman; 1997:112.
33. Sattar, SA. Effect of liquid chemical germicides on mycobacteria including multi-drug resistant isolates of Mycobacteria tuberculosis. Abstracts of the 37th Interscience Conference on Antimicrobial Agents and Chemotherapy; September 28-October 1, 1997; Toronto, Ontario, Canada; September 28-October 1, 1997. E166.
34. Sattar, SA, Taylor, YE, Paquette, M, Rubino, J. In-hospital evaluation of 7.5% hydrogen peroxide as a disinfectant for flexible endoscopes. Can J Infect Control 1996;11:5154.
35. Vesley, D, Norlien, KG, Nelson, B, Ott, B, Streifel, AJ. Significant factors in the disinfection and sterilization of flexible endoscopes. Am J Infect Control 1992;20:291300.
36. Olympus Corporation. Technical Report. Compatibility testing of Sporox with Olympus flexible endoscopes. Melville, NY: Olympus Corp; 1998.
37. Block, SS. Peroxygen compounds. In: Block, SS, ed. Disinfection, Sterilization, and Preservation. 4th ed. Philadelphia, PA: Lea & Febiger; 1991:167181.
38. Mannion, PT The use of peracetic acid for the reprocessing of flexible endoscopes and rigid cystoscopes and laparoscopes. J Hosp Infect 1995;29:313315.
39. Bradley, CR, Babb, JR, Ayliffe, GAJ. Evaluation of the Steris System 1 peracetic acidendoscope processor. J Hosp Infect 1995;29:143151.
40. Seballos, RJ, Walsh, AL, Mehta, AC. Clinical evaluation of a liquid chemical sterilization system for the flexible bronchoscope. Journal of Bronchology 1995;2:192199.
41. Wallace, CG, Agee, PM, Demicco, DD. Liquid chemical sterilization using peracetic acid: an alternative approach to endoscope processing. ASAIO J 1995;41:151154.
42. Alfa, MJ, Olson, N, DeGagne, P, Hizon, R. New low temperature sterilization technologies: microbicidal activity and clinical efficacy. In: Rutala, WA, ed. Disinfection, Sterilization and Antisepsis in Health Care. Champlain, NY: Polyscience Publications; 1998:6778.
43. Babb, JR, Bradley, CR. Endoscope decontamination: where do we go from here? J Hosp Infect 1995;30(suppl):543551.
44. Middleton, AM, Chadwick, MV, Gaga, H. Disinfection of bronchoscopes, contaminated in vitro with Mycobacterium tuberculosis, Mycobacterium avium-intracellulare and Mycobacterium chelonae in sputum, using stabilized, buffered peracetic acid solution (“Nu-Cide”). Hosp Infect 1997;37:137143.
45. Holton, J, Nye, P, McDonald, V. Efficacy of selected disinfectants against mycobacteria and Cryptosporidia. J Hosp Infect 1994;27:105115.
46. Holton, J, Shetty, N. In-use stability of Nu-Cidex. J Hosp Infect 1997;35:245248.
47. Advanced Sterilization Products. Cidex PA—Peracetic Acid Solution. Irvine, CA: ASP; 1998:19.
48. Olympus Corporation. Technical Bulletin, Compatibility of Cidex PA solution with Olympus flexible endoscopes. Melville, NY: Olympus Corp; 1998.
49. Walsh, SE, Maillard, J-Y, Russell, AD. Effects of testing method on antibacterial activity of high level disinfectants. Society for Applied Microbiology; October 22, 1997. Poster.
50. Bruckner, NI, Gordon, MD, Howell, RG, inventors; Surgikos, Ine, assignee. Odorless aromatic dialdehyde disinfecting and sterilizing composition. US patent 4,851,449. July 25, 1989.
51. Bruckner, NI, Gordon, MD, Howell, RG, inventors; Johnson & Johnson Medical, Inc, assignee. Odorless aromatic dialdehyde disinfecting and sterilizing composition and method of using the same. US patent 4,971,999. November 20, 1990.
52. Roberts, DG, Chan-Myers, H. Mycobactericidal activity of dilute ortho-phthalaldehyde solutions. American Society for Microbiology; May 21, 1998. Poster.
53. Reckitt & Coleman. Sporox. FDA 510(k) Submission.
54. Hanson, PJV, Gor, D, Clarke, JR, Chadwick, MV, Nicholson, G, Shah, N, et al. Contamination of endoscopes used in AIDS patients. Lancet 1989;2:8688.
55. Hanson, PJV, Gor, D, Clarke, JR, Chadwick, MV, Gazzard, B, Jeffries, DJ, et al. Recovery of the human immunodeficiency virus from fibreoptic bronchoscopes. Thorax 1991;46:410412.
56. American Public Health Association. Public Policy Statement 9417: Establishment of clearly defined performance standards for between-patient processing of reusable endoscopic instruments and accessories. Am J Public Health 1995;85:449450.
57. Ad Hoc Committee on Disinfection of the American Society for Gastrointestinal Endoscopy. Reprocessing of flexible gastrointestinal endoscopes—an American Society for Gastrointestinal Endoscopy White Paper. Gastroenterology Nursing 1996;19:109112.
58. Working Party of the British Society of Gastroenterology. Cleaning and disinfection of equipment for gastrointestinal flexible endoscopy: interim recommendations of Working Party of the British Society of Gastroenterology. Gut 1988;29:11341151.
59. Recommended practices for use and care of endoscopes. AORN J 1998;67:256262.
60. Emergency Care Research Institute. Evaluation: liquid disinfecting and sterilizing reprocessors used for flexible endoscopes. Health Devices 1994;23:212251.
61. Emergency Care Research Institute. Evaluation update: liquid disinfecting and sterilizing reprocessors used for flexible endoscopes. Health Devices 1994;23:477481.
62. American Society for Testing and Materials. Standard practice for cleaning and disinfection of flexible fiberoptic and video endoscopes used in the examination of hollow viscera. Designation F1518-94. Philadelphia, PA: ASTM; 1994.
63. Fantry, GT, Zheng, Q-X, James, SP Conventional cleaning and disinfection techniques eliminate the risk of endoscopic transmission of Helicobacter pylori . Am J Gastroenterol 1995;90:227232.
64. Barbee, AL, Weber, DJ, Sobsey, MD, Rutala, WA. Inactivation of Cryptosporidium parvum oocyst infectivity by disinfection and sterilization processes. Gastrointest Endosc. In press.
65. van Klingeren, B, Pullen, W. Glutaraldehyde resistant mycobacteria from endoscope washers. J Hosp Infect 1993;25:147149.
66. Stanley, P. Destruction of a glutaraldehyde-resistant mycobacterium by a peroxygen disinfectant. Am J Infect Control 1998;26:185.


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

A correction has been issued for this article: