6 Reprocessing of Endos

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Reprocessing of Endoscopy

Endoscopy Instruments

A lighted optical instrument that is used to get a deep look inside the body. An endoscope, which may
be rigid or flexible, can be used to examine organs, such as the throat or esophagus. Specialized
endoscopes are named for where they are intended to look.
Healthcare facilities should have a reliable, high-quality system for
endoscope reprocessing which minimizes infection risks. To achieve
this goal, all reprocessing programs must have an infrastructure that
supports training and competencies, quality measurement, and
management.
Record Keeping
Documentation for all endoscopes must be maintained with all the
decontamination equipment to ensure that the correct decontamination
process is being used. To ensure that all endoscopes can be tracked
throughout the decontamination process and traced to the patients
upon whom they were used, the documentation log includes the
following:
• Procedure name
• Patient medical record number
• Endoscopist who has performed the procedure
• Serial number or identifier of the endoscope used
• Proof of the decontamination procedure and the equipment and method used
Staff Health
All personnel working in an endoscopy unit must be educated
about the biological, chemical, and environmental hazards.
Staff are required to:
• Be immunized against hepatitis B
• Wear PPE
- Wear gloves and a disposable waterproof gown with sleeves
- Use gloves for short contact time (15–20 min); nitrile gloves can be worn for
longer contact times
- Change gloves and wash hands between tasks
- Use eye protection to protect from splashes
PPE:
Rigid Endoscopes

The rigid endoscope is a fixed-length and fixed-geometry instrument that


usually has several viewing angles available (0, 30, and 70 degrees to the
long axis of the endoscope).
Semi Rigid Endoscope
Rigid and Semi-Rigid Guidelines for
decontamination

 Remove the light source adaptors.


 Use a neutral-PH enzymatic as manufacture IFUs.
 Hand wash the endoscope using a soft cloth.

 Use the brushes for channel as manufacture IFUs.


 Rinse the endoscope with treated water and flush
the channel to remove the enzymatic solution.
 Dry the outside of the scope with a clean, lint-free
cloth and dry working channel as manufacture IFUs.
Resectoscope Arthroscopy Instrument

Disassembled Laparoscopic instrument


Inspect Insulation for Damage or Wear
Flexible Fiberoptic Endoscope

an optic instrument that transmits light and carries images back to the observer
through flexible (about 10 mcm) transparent fibers, and used to inspect and treat interior portions
of the body.
Steps in Endoscope Processing
• Pre-cleaning
• Leak Test
• Manual clean
• Rinsing
• Drying/air
• Disinfection
• Rinsing
• Drying/air
• Storage
• High-Level Disinfect or Sterilize
• Dry
• Store
1.Pre-clean

Pre-clean is the removal of gross debris from the endoscopes external


surfaces and internal channel .
the insertion tube or shaft should be wiped with an enzymatic detergent
solution approved by endoscope manufacturer. following the device
manufacturer’s instructions for use (IFU).
2.Leak Testing

• Detects leaks that can compromise the safety


of the scope.
• Scopes that fail a leak test should immediately
shipped to the manufacture or authorized repair
company
Type of Leak Testing

 Dry Leak Testing .


 attach the leak tester and pressurize the scope do
not place the scope in water.
 follow the IFU of endoscope.
 Wet Leak Testing.
3.Manual clean
Removes organic matter by brushing accessible channels and
flushing all channels—this stage also allows the detection of
channel blockages

4.Rinsing
Removes detergent residues that may affect the—performance
of the disinfectant.

5.Drying/air
Expels excess fluid that may dilute the disinfectant
6. Disinfection Eradicates potentially pathogenic microorganisms, i.e. bacteria,
including mycobacteria and viruses

7. Rinsing Removes disinfectant residues that could be harmful to patients

8. Drying/air Expels excess fluid before use on the patient or—storage

9. Storage Flexible endoscopes are stored, preferably hung, to allow


drainage of channels in a dust-free environment. Lockable storage
cabinets are available. Some are described as drying cabinets as they
feed HEPA filtered air down the channels to allow for prolonged storage,
some validated up to 30 days. These cabinets must comply with the
requirements
 Scopes must be dry when stored.

 Do not kink or bend.


Automatic Endoscope Preprocessors
(AERs)

Automated equipment designed to clean,


disinfect, and rinse flexible endoscopes
Advantages of AERs

 Process consistency
 Reduced staff exposure to chemicals
 Timed cleaning
 Consistent exposure to the cleaning agent
 Timed contact with liquid disinfectants
 An air flush cycle to remove excess moisture
 Use of copious and consistent amounts of rinse
water
When using AERs:

 Follow manufacturer’s instructions to connect the


scope to the AER.
 Place removable parts in the AER if possible.

 Attach channel cleaning connectors to all


channels.
 Follow manufacturer’s instructions for using
disinfectants.
 Set the machine for the recommended time.
Sterilization of Flexible Endoscopes

 package and sterilize the endoscope following the


manufactures IFUs flexible scope sterilized using low-
temperature sterilization may require a venting cap
during sterilization
Liquid Chemical Processing Systems

Liquid chemical sterilization (LCS) is used to liquid


chemically sterilize heat-sensitive, immiscible,
reusable medical devices. When a device is liquid
chemically sterilized, it is completely immersed in an
active sterilant solution(ex: ortho-Phthalaldehyde or
OPA) for a prescribed period of time at a controlled
temperature and concentration
Example of damage caused by improper use include :
 Cuts in a flexible endoscope shaft caused by placing sharp objects on it.
 Damage caused by shaver blades contracting a rigid endoscope during
arthroscopy.
 Laser damage.
 Scope being dropped.
 inserting the endoscope through a sheath or bridge where the sheath or
bridge are bent.
 Inserting an instrument improperly through a working channel.
 Excessive force used by the physician.
 Stacking instrument or other scopes on top of scopes.
 allowing gross soil to dry on the scope.
 No securing the scope prior to transporting.
Documentation
Maintain documentation of adherence to these essential
steps each time an endoscope is reprocessed.
Documentation is essential for quality assurance purposes
and for patient tracing in the event a look back is necessary
Thanks

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