Ultraviolet light disinfection of flexible endoscopes without working channels – a systematic review and assessment of medical and economical aspects

Abstract Introduction The objective of this report was to evaluate the disinfection process of flexible endoscopes without working channels using ultraviolet (UV) light, in comparison to the currently recommended reprocessing method, in a clinical setting. Method A comprehensive search of articles was conducted in November 2024 across Medline, Embase, CINAHL, and CENTRAL databases. Ongoing studies and Health Technology Assessment (HTA) reports were also searched. The selected studies were assessed by at least two independent authors, and inclusion decisions made by consensus. The studies underwent critical appraisal, and relevant data were extracted. Data on the level of disinfection were pooled in a meta-analysis using R software. The certainty of the evidence was evaluated using the GRADE approach. In collaboration with experienced hygiene nurses and a physician involved in the project, organizational issues related to implementation were addressed, and a health economic analysis was conducted. Result Manual pre-cleaning followed by ultraviolet (UV) light disinfection of flexible endoscopes without working channels may offer a slightly higher level of effectiveness compared to the currently employed reprocessing method using an endoscope washer-disinfector. An organizational review indicates that there are benefits to using UVC light, as the disinfection process is faster and requires fewer installations. The health economic analysis supports the use of UV-light disinfection due to lower investment and running costs. Discussion This health technology assessment can be used as a decision basis for a preferred desinfection process at units using flexible endoscopes without working channels.