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High level disinfection is a process that kills high numbers of all types of vegetative nonspore forming bacteria (Gram-positive and Gram-negative), fungi, all types of viruses (hy‐ drophylic and lipophylic), and mycobacteria (TB), but not necessarily high numbers of bacterial spores in the relatively brief exposure time for disinfection. Sterilization is a proc‐ ess that kills all types of microbes including highly resistant bacterial spores. Sterilization usually requires a much longer exposure time than disinfection. Gastroscopes, colono‐ scopes, urethroscopes, and cystoscopes normally do not break the barrier between non-ster‐ ile areas of the body and sterile areas, and therefore high level disinfection is the commonly accepted practice for these endoscopes. Bronchoscopes are a possible exception as they may enter into the sterile bronchioles, although they make that entrance through the non-sterile nasal passages where they likely become contaminated with the flora of the oral-nasal body cavities. Endoscopists, and certainly patients, all agree that endoscopes and their accessories such as biopsy forceps should be thoroughly cleaned of all body fluids and any possible mi‐ crobes between patients, even if not technically sterilized.

Cleaning, Disinfection and Sterilization of Heat-Sensitive Endoscopes