ENDOSCOPE DECONTAMINATION- EDUCATION AND TRAINING COMPETENCY FRAMEWORK

Transcription

1 ENDOSCOPE DECONTAMINATION- EDUCATION AND TRAINING COMPETENCY FRAMEWORK Standardising the manual cleaning and decontamination process of flexible endoscopes throughout Lothian. C:\Users\Scott\Documents\Endoscopy\website docs\decon. NHS Lothian Endoscopy Decontamination Competencies - revised Draft version doc 1

2 Section 1: Professional Accountability -Understanding legal, regulatory national and local policies relating to decontamination. CRITERIA 1. Locate and discuss the Lothian Infection control policy, including the Hand Hygiene Policy. To increase knowledge of infection control/cross infection. To reduce the risk of cross infection. Discuss the protection of the health care worker and the client from cross infection. Consideration given to: Hand hygiene Personal Protective Equipment (PPE) Environmental Decontamination Demonstrate knowledge of appropriate hand hygiene products. Demonstrate effective hand hygiene technique. Select the correct personal protective equipment to perform the decontamination process. Changing of personal protective equipment between clean and contaminated process areas. Understand the role of the environment in cross infection 2. Locate and discuss the C.O.S.H.H. guidelines Demonstrates an understanding of Occupational Health Surveillance. Spillage policy available for COSHH substances C:\Users\Scott\Documents\Endoscopy\website docs\decon. NHS Lothian Endoscopy Decontamination Competencies - revised Draft version doc 2

3 CRITERIA 3. Demonstrate awareness of guidance documents and legal issues relating to endoscope decontamination. Understands the implications of noncompliance to the patient, service and individual staff BSEN ISO parts 1 and 4 HPS guidance on endoscope reprocessing SHTM2030 user responsibility (detail daily and weekly testing including water sampling) maintenance and servicing Glennie Technical Requirements Manufacturers instructions British Society of Gastroenterologists (BSG) Guidance 2007 Ensure equipment in use is compliant as far as is reasonably practicable Competence achieved when the trainee can: Summarise the importance of good infection control practices in decontamination process Relate which COSHH substances are in use locally, and how to manage spillage of these. State where the relevant guidance documents can be located within the department. C:\Users\Scott\Documents\Endoscopy\website docs\decon. NHS Lothian Endoscopy Decontamination Competencies - revised Draft version doc 3

4 Section 2: Understanding, managing and maintaining endoscopes and associated equipment CRITERIA 1. Discuss the structure of the various types of endoscopes and ancillary equipment. Identify the exact number of channels in each endoscope. Identify the correct ancillary equipment with each associated endoscope. To ensure all channels and ancillary equipment are adequately decontaminated and all single use equipment appropriately disposed of. 2. Discuss the visual inspection and leak testing of the endoscope. To identify cracks/damage to the endoscope, which may harbour contaminated material. To ensure the endoscope and ancillary equipment are fit for purpose. To minimise the risk of damage to the endoscope. To ensure the correct procedure and documentation is completed in the event of a damaged endoscope being identified. C:\Users\Scott\Documents\Endoscopy\website docs\decon. NHS Lothian Endoscopy Decontamination Competencies - revised Draft version doc 4

5 3. Identify and understand correct use of leak tester. 4. Identify and understand correct use of endoscope light source and video processor. 4. Discuss Endoscope equipment maintenance and servicing Ensure faulty or broken equipment is promptly identified and appropriate action taken. Ensure that all equipment is used correctly. Ensure endoscopes in use are regularly maintained. Ensure endoscopes are serviced regularly (under contract where applicable). Competence achieved when trainee can: Correctly identify to assessor all channels to be cleaned, in the correct order on all endoscope types in use locally. Demonstrate correct operation of all endoscopy equipment (leak tester, light source and video converter). Summarise correct procedure to follow for broken/faulty equipment. C:\Users\Scott\Documents\Endoscopy\website docs\decon. NHS Lothian Endoscopy Decontamination Competencies - revised Draft version doc 5

6 Local Automated Endoscope Reprocessor (AER) Check List CRITERIA Understand Purpose of AER and associated equipment. Demonstrate working knowledge of AER in local area: (State type ) Basic Functions ;On/off Pre use checks Action required if equipment fails To ensure the operator is competent in the use of equipment used in the department. Demonstrate understanding of decontamination cycle as per manufacturers instructions: Individual cycles (rinsing, disinfectant) Total cycle time Action required if a cycle fails Demonstrate and understand daily care and maintenance of AER: Terminal cleaning Maintenance of ancillary equipment C:\Users\Scott\Documents\Endoscopy\website docs\decon. NHS Lothian Endoscopy Decontamination Competencies - revised Draft version doc 6

7 Section 3: Understanding the process of decontamination CRITERIA 1. Discuss the process of decontamination Understand the endoscope journey through all processes To ensure safe and effective reprocessing of an endoscope and associated ancillary equipment. Demonstrate a knowledge and understanding of the decontamination process Pre-cleaning Leak testing Cleaning Disinfection Draining and drying Storage Sterilisation of associated ancillary equipment 2. Discuss the tracking of an endoscope and its associated accessories. To enable the health care worker to trace/track each endoscope and it s associated accessories to the client and procedure. Identifying the user and recording each stage of the decontamination process. Complies with Health Protection Scotland Endoscope decontamination guidance December Competence achieved when trainee can: Correctly summarise the processes detailed in 1 & 2. C:\Users\Scott\Documents\Endoscopy\website docs\decon. NHS Lothian Endoscopy Decontamination Competencies - revised Draft version doc 7

8 Section 4: Demonstrate ability to effectively decontaminate endoscopes. CRITERIA Step 1: Pre-cleaning Preliminary removal of gross contamination 1. Put on clean PPE. Reduce the risk of cross infection. Reducing the risk of hand irritation 2. Wipe Endoscope insertion tube top to bottom with detergent wipe that is compatible with the manufacturers guidance. from disinfectants used. Preliminary removal of gross contamination. 3. If air/water (blue) valve is attached remove and replace with channel flushing valve. Depress valve for 30 seconds. Remove internal gross debris/soiling To clear any obstruction and remove any gross debris from the channel 4. Allow distal tip to bubble freely 30 seconds. 5. Attach biopsy channel suction attachment. Place distal tip in detergent solution and depress valve for 30 seconds. 6. If suction (red) valve is attached, depress for at least 30 seconds until suction tubing is clear. 7. Switch off video converter before disconnecting endoscope. Replace waterproof cap (where applicable) To prevent damage to video converter. To prevent water damage to the endoscope. C:\Users\Scott\Documents\Endoscopy\website docs\decon. NHS Lothian Endoscopy Decontamination Competencies - revised Draft version doc 8

9 8. Switch off and disconnect suction. Change tubing for every procedure. 9. If water bottle used, disconnect and send to HSDU at the end of list. To avoid back flow of contaminated fluid. To ensure adequate cleaning and sterilization. 10. Dispose of biopsy cap. Reducing the risk of cross contamination. 11.Transfer endoscope to Containing contamination. decontamination area within tray system (if in use) C:\Users\Scott\Documents\Endoscopy\website docs\decon. NHS Lothian Endoscopy Decontamination Competencies - revised Draft version doc 9

10 CRITERIA STEP 2: Leak testing. 1. Fill sink with clean water to line mark. Temperature no greater than 35 C. 2. Remove all buttons/taps from endoscope prior to leak testing (ensure taps are fully dismantled) 3. Switch on air pump. Depress needle valve of leak tester and listen for audible hiss. 4. Attach appropriate leak tester to the end of the endoscope cap. To identify damage and prevent further damage to the endoscope in the decontamination process. To visualise air leaks from the endoscope. Prevent fixing of remaining organic matter. To ensure leak tester is functioning correctly. To ensure the integrity of the outer sheath of the endoscope. 5. Immerse distal end of endoscope, switch on air pump. Rotate handle, curving end tip in all directions. Observe for 30 seconds. 6. Immerse entire endoscope Observe for 30 seconds. Detect air bubbles/leaks within the distal tip of the endoscope. Remove endoscope immediately if continuous bubbles visible. 7. Remove endoscope from water immediately if continuous bubbling detected. Follow agreed arrangements for repair. To prevent further damage to the endoscope. 8. Switch off leak tester, detach MU To reduce the risk of damage to prong from box. Wait 30 seconds. endoscope and leak tester. Ensure leak tester attachment is removed from water prior to disconnection from endoscope. C:\Users\Scott\Documents\Endoscopy\website docs\decon. NHS Lothian Endoscopy Decontamination Competencies - revised Draft version doc 10

11 CRITERIA STEP 3: Manual Cleaning (including rinsing) 1. All solutions used in the cleaning of endoscopes should be used once only. 2. Add correct amount of manufacturer recommended detergent. 3.Immerse entire endoscope and all buttons/ valves. Keep endoscope immersed at all times during cleaning. 4. Wipe down entire endoscope with a disposable cleaning cloth. 5.Clean valves, ensuring cuffs are pulled back and holes are brushed through minimum of 3 times until clean, using appropriate port brush. 6.Brush the biopsy, suction and water channel entrances with appropriate port cleaning brush a minimum of 3 times until visibly clean. To prevent cross infection To ensure correct concentration of water/detergent. Ensure all surfaces come into contact with solution. To reduce risk of aerosolisation of organisms. To ensure removal of organic material from outer surfaces. To ensure valve lumen are free from any obstruction. To ensure channel entrances are free from any obstruction. C:\Users\Scott\Documents\Endoscopy\website docs\decon. NHS Lothian Endoscopy Decontamination Competencies - revised Draft version doc 11

12 CRITERIA 7. Channels should be cleaned in this order: Biopsy Channel Suction Channel Umbilical Channel Insert the cleaning brush through the biopsy port a minimum of 3 times until visibly clean. Clean the brush head each time it emerges from distal end of endoscope prior to pulling back up the channel. To ensure channels are free from any obstruction. To remove tissue debris from the cleaning brush. 8. Ensure that any mechanism at the distal tip of the endoscope is visibly clean and free from debris. 9. Irrigate auxiliary channels if present with detergent solution using 20ml syringe. To ensure mechanism can move freely. To ensure channels are free from any obstruction. 10. Fill rinsing sink if available with fresh clean water no greater than 35 C. Or empty sink, rinse, clean and refill with clean water (as above) To ensure rinse water is free from contamination. 11. Immerse and rinse entire endoscope and accessories. Rinse channels with 20ml syringe. To ensure removal of detergent solution from external endoscope and internal channels of endoscope. C:\Users\Scott\Documents\Endoscopy\website docs\decon. NHS Lothian Endoscopy Decontamination Competencies - revised Draft version doc 12

13 CRITERIA STEP 4: Automated Endoscopic Reprocessor. 1. Place endoscope into AER and ensure all necessary channels and appropriate accessories are connected. To ensure the endoscope will be completely submerged and all channels will be irrigated. 2. Place accessories in wash bag tray ensuring this corresponds to endoscope being processed. To ensure all accessories will be completely submerged. 3. Add appropriate detergent if required. Start AER. 4. On completion of the washer / disinfector cycle affix pass certificate.no.1 in the clients case notes. No.2 affix to endoscopy / theatre suite records. To ensure full tracking and traceability of endoscope and it s accompanying accessories through the process to the patient and procedure. C:\Users\Scott\Documents\Endoscopy\website docs\decon. NHS Lothian Endoscopy Decontamination Competencies - revised Draft version doc 13

14 CRITERIA STEP 5: Draining / Drying 1. On removal from AER hold endoscope upright to facilitate drying. If air drying function not available, pat dry with clean, disposable paper roll. Removal of excess water. 2. If Tray transport is in use place clean scope in tray, clean liner uppermost. If endoscope is not used within 3 hours, it must be reprocessed fully prior to use. 3. If HEPA filter cabinet is in use ensure endoscope is dry prior to storage. Ensure door is closed. If endoscope is not used within 72 hours, reprocess before further use. 4. C:\Users\Scott\Documents\Endoscopy\website docs\decon. NHS Lothian Endoscopy Decontamination Competencies - revised Draft version doc 14

15 CRITERIA STEP 6: Storage 1. Ensure all endoscopes are stored hanging vertically in a designated, dry and well ventilated cupboard or HEPA filter cabinet. Endoscopes prepared for use must be stored in a manner that prevents contamination, Avoid coiling of endoscope. To reduce risk of water stasis within channels and microbial growth. 2. Scope and dedicated accessories must be stored together but unattached. Allow circulation of air through endoscope channels Ensure that traceability criteria are met 3. If HEPA filter cabinet available ensure endoscope is connected to appropriate attachment. To ensure there is a constant flow of HEPA filtered air through all channels of the endoscope and over the outer sheath. C:\Users\Scott\Documents\Endoscopy\website docs\decon. NHS Lothian Endoscopy Decontamination Competencies - revised Draft version doc 15

16 CRITERIA STEP 7: Traceability 1. System should be in place to track all endoscopes and accessories through the decontamination process and to the patient on whom the devices have been used. In the event of an incident (decontamination failure/incidence of infection) the endoscope and accessories can be traced through all processes and linked to Patient Procedure Staff Competence achieved when: The assessor has observed practice and is satisfied that the correct standards are consistently maintained. C:\Users\Scott\Documents\Endoscopy\website docs\decon. NHS Lothian Endoscopy Decontamination Competencies - revised Draft version doc 16

17 Reference documents: BSEN ISO (2006) General Requirements, Terms and definitions and Tests BSEN ISO (2008) Requirements and tests for washer-disinfectors employing chemical disinfection for thermolabile endoscopes HPS (2007) Endoscope Reprocessing: Guidance on the Requirements for Decontamination Equipment, Facilities and Management HMSO, (1997a) Washer Disinfectors Health Technical Memorandum (HTM) 2030 part 1 (London, HMSO) HMSO, (1997b) Washer Disinfectors part 3 Validation and Verification: Health Technical Memorandum (HTM) 2030 (London, HMSO) Medical Devices Agency (MDA), (2002) Decontamination of Endoscopes: MDA DB 2002(05) NHS Scotland, (2001) Sterile Services Provision Review Group: First Report - The Glennie Framework (Scottish Executive Health Department, Edinburgh) BSG (2007) National Endoscopy Programme: Decontamination Standards for Flexible Endoscopy C:\Users\Scott\Documents\Endoscopy\website docs\decon. NHS Lothian Endoscopy Decontamination Competencies - revised Draft version doc 17