Flexible endoscope covers: the benefits and drawbacks

Single use flexible endoscope covers are always ready to use, have a long expiry date and fit on many different brands of ENT flexible endoscopes. But is it the best solution for reprocessing of flexible endoscopes?

From an infection control point of view, an endoscope cover is never replacing a high level disinfection process. A small hole or a minor tear in the cover, even if not visible for the eye, is always a risk for cross-contamination.

Another weak point of the endoscope cover is the flexible endoscope handle: this is the most “dirty” part of the endoscope. Why? Because it is incredibly complicated to disinfect since the handle has a difficult surface to clean. Think about this: if during a procedure, you accidentally switch hands or the endoscope handle comes in contact with other instruments, there is a risk of cross-contamination. Of course, it is possible to wipe the handle with alcohol or enzymatic solution, but this serves as a compromise and does not guarantee that the flexible endoscope is clean of infections.

From the doctor’s point of view, the flexible endoscope cover is a fast and convenient solution. However there are some important points:

The cover increases the diameter of the insertion tube: this can be uncomfortable and painful for the patient.
It reduces the degree of angulation: which makes it less comfortable for the doctor to perform the examination.
A “foggy” image is present at the beginning of the examination and sometimes reduces the sharpness of the image.
When you are working with multiple types of flexible endoscopes, for example a Nasopharyngoscope, it could be confusing to choose the right cover. It can happen that one examination you have chosen the wrong model cover by mistake. Then you need to open a new cover because the first cover is too tight, too loose, or just doesn’t fit at all, resulting in expensive waste.
If you still decide to use a cover that is too tight, it could become difficult to remove the cover. This often ends with expensive damage to the endoscope.

In terms of costs: the cover is one of the most expensive solutions for processing flexible ENT endoscopes, and becomes even more expensive due to human error. Think about it: if you open the wrong cover by mistake (and you need to open another one) or the flexible scope inflicted damage while removing the cover. Your cost for each cycle will become significantly higher.

The one advantage of the flexible endoscope cover is to protect and provide a sterile insertion tube for the patient (but not to the complete endoscope).

In urgent cases or special occasions that require a sterile endoscope, the single use endoscopes are always the better solution.