Flexible video endoscope reprocessing is a major practice for clinicians who frequently use endoscopic equipment.
However, in order to ensure infection control and prevent the spread of disease, it is important for one to understand how to properly reprocess endoscopes.
The following recommended steps as endorsed by the Centre for Disease Control (CDC) should be adhered to for successful flexible endoscope reprocessing:
It is important to always pre-clean flexible endoscopes as well as accessories before use, following the manufacturers prescriptions.
Perform pre-cleaning immediately after completing an endoscopy procedure to help prevent the formation of a biofilm on the device.
Remove major organic residues from the video endoscope‘s insertion tube using a lint–free cloth moistened with a cleaning solution.
Place and tighten the sealing cap for the video connector on the power supply plug. Disconnect endoscope from the power supply units.
Immerse distal end in a basin with cleaning solution and alternately actuate suction and air/water valves.
Check channels for patency and functionality and then empty the channel system.
Place and tighten the sealing cap for the video connector on the supply plug.
Disconnect the endoscope from the supply units.
2. Leakage Testing:
Some endoscopes require you to perform leak testing on them before manual cleaning.
This process helps detects damage to the external surfaces and internal channels of the endoscope that can lead to inadequate disinfection and further damage of the endoscope.
Connect leakage tester, and increase pressure until the indicator is within the blue range of the manometer (approx. 160 mmHg).
The pressure must stay constant for 3 to 5 minutes – During the test, bend the endoscope to the maximum in all directions.
If the leakage test is positive (evidence of perforation/leakage), do not continue reprocessing the endoscope.
Clean the outside of the insertion tube. If the channel system is leak-tight, additionally rinse the channels.
3. Manual Cleaning:
In order to properly clean the instruments manually, remove all valves and immerse them in the active cleaning solution before performing high-level disinfection (HLD) or sterilization.
Completely immerse video endoscope in the cleaning solution, avoiding the formation of bubbles.
Next, clean carefully using a soft, disinfected or single-use brush under the solutions surface, ensuring to flush all channels and ports.
Clean the outer sheath of the endoscope using a lint-free single-use cloth or a disinfected sponge.
Clean channel and valve seats, the distal end and steering wheels using a soft brush or a sponge.
Connect all channels to device-specific adaptors and rising adaptors (according to manufacture`s instructions), and rinse with cleaning solution.
To neutralize any cleaning agent residues, thoroughly rinse the endoscope and accessories (valves and cleaning brushes) as well as the internal channel system with water of at least drinking water quality.
4. Visual inspection:
Once the manual cleaning process is completed, visually inspect the endoscope and its accessories.
Visual inspection provides extra assurance that the endoscope and its accessories are clean and free of defects.
Complex devices such as flexible endoscopes may require the use of lighted magnification or additional methods to assist with the inspection process.
5. Sterilization or Disinfection :
Another very important step in endoscope reprocessing is the sterilization/disinfection step.
After having cleaned and visually inspected the endoscope, perform HLD or sterilization in accordance with the manufacturer’s IFU.
Carefully review and adhere to the endoscope manufacturer’s reprocessing instructions and to the IFU for chemicals or sterilants and any equipment (e.g., automated endoscope reprocessors) used.
Completely immerse the cleaned endoscope and accessories in the disinfection solution, ensuring that the entire device is immersed.
Next, using device-specific adaptors and rinsing adaptors, fill all channels with disinfection solution.
Ensure that there are no air bubbles in the channel system.
Then cover the basin with tightly closing lid.
Next, thoroughly rinse the outer surface of the endosope and all channels with microbiologically suitable/sterile water, and completely remove any remaining disinfectant from any inner and outer surfaces.
Document the process.
6. Automated Endoscope Reprocessing:
First of all document the process.
Next, place the video endoscope in the insertion basket/unit of the cleaning and disinfection machine (AER) for endoscopes following manufacturer`s instructions.
Connect the endoscope to the appropriate system using device-specific adaptors and rinsing adaptors (information available from manufacturer of the endoscope or of the AER).
7. Maintenance and Storage:
After sterilization and reprocessing has been completed, maintaining and storing endoscopes and accessories in a manner that prevents recontamination helps to protect the equipment from damage, and promotes drying.
Carefully dry all channels using medical-grade compressed air (pressure limited to 0.5 bar).
Dry exterior surfaces using a lint-free-single-use cloth. Check endoscope functionality in accordance with instructions for use.
For storage, suspend endoscopes in a dust-free and dry location (Preferably in a dry-cabinet). Do not insert valves (store separately).
Cabinets for storage should have hanging storage, be ventilated with air inlet louvers and also have clips for fixing the tubes (insertion and supply tube).
Store processed flexible endoscopes in a cabinet that has either of the following characteristics:
- of sufficient height, width, and depth to allow flexible endoscopes to hang vertically without coiling and without touching the bottom of the cabinet, OR
- designed and intended by the manufacturer for horizontal storage of flexible endoscopes
Now that you know the best practices in endoscope reprocessing and how you can properly reprocess endoscopes, to know more about endoscopy solutions from Karl Storz offered by Crown Healthcare, please call Akunna on +234 703-699-8222 or send an email to firstname.lastname@example.org.
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