Evolution of medical devices and clinical diagnostics present significant challenges to teams dedicated to decontamination across the globe. Decontamination methods and systems have evolved to  adapt to the technological progression. Has this evolution been based upon an accurate of assessment of risk and overkill of the process? 

It’s been acknowledged that certain endoscopes present a significant challenge, devices such as duodenoscopes, bronchoscopes, ureteroscopes and cystoscopes have been known to be deemed ‘high infection risk’ to patient. 

The evolution of endoscopes and surgical technology is becoming more complex and often involves making devices smaller to minimize pain for patients. However, this miniaturization creates certain challenges.  

Delicate devices can be difficult to clean effectively using standard decontamination processes. It’s crucial that we do not increase the risk of infection, as patient safety must remain our top priority. 

Should we treat all endoscopes the same, or should we establish a hierarchy of risk based on the procedures they are used for? Should we conduct risk assessments and enhance decontamination standards for devices that access high-risk areas of the body? 

Are the risks a reality? That’s an argument that is often raised. Show us the evidence? Ethically is it incorrect not to use the highest standard of decontamination possible? Spaulding has been our guidance for a generation, is it time for a rethink for decontamination procedures undertaken to reprocess higher risk devices? Based upon the Spaulding assessment, should decontamination levels of devices deemed semi-critical, be the same as for those deemed critical?  

What are the issues with endoscopes and other semi critical devices? Often it is our decontamination systems, should we re-evaluate to look at ways of reducing the hazard that develops, such things as biofilms within such scopes? Do we look at drying the endoscopes and look at redeveloping the cycle configuration of the Endoscope Washer Disinfectors to counteract? 

Are we investigating and testing endoscopes correctly? 

Should we look to redevelop our decontamination systems in the same way we have adapted to robotic surgery? Must the device manufacturers consider the principles of decontamination and put greater emphasis on decontamination protocols? 

Should we work towards sterilization of such ‘higher risk’ endoscopes and is Utopia achievable? What are the obstacles, and can we overcome or is it a culture? 

Are there forgotten areas that we need to re-evaluate decontamination methods for devices deemed ‘semi-critical’ under Spaulding?