1.0 Purpose Every patient undergoing endoscopy should be examined with clean, disinfected equipment. All endoscopic equipment will be cleaned and disinfected / sterilized according to current recommended guidelines. 2.0 Scope All patients. 3.0 References 1. Gastroenterological Society of Australia (G.E.S.A) and Gastroenterological Nurses Society of Australia (G.E.N.S.A): Infection and Endoscopy Guidelines, 3rd Edition, 2006. 2. AS/NZS 4187 2003 Cleaning, disinfecting and sterilising reusable medical and surgical instruments and equipment, and maintenance of associated environments in healthcare facilities, Standards Australia International Ltd, Sydney. 3. NHMRC Australian Guidelines for the Prevention and Control of Infection in Healthcare, 2010 3. Australian Government Department of Health & Aging (2004) Infection control guidelines for the prevention of transmission of infectious diseases in the health care setting, Union Offset Printers, Canberra. http://www.health.gov.au/internet/main/publishing.nsf/content/icgguidelines-index.htm accessed 29th June 2010. 4.0 Definition Endoscope/scope: An instrument (fibreoptic or video) that permits a medical practitioner the ability to view or inspect the inside of various organs/cavities. Fibreoptic: Implies the use of very thin optical glass fibres to transmit light and/or image from the tip to the eye piece of the endoscope. Video: Implies the use of a microchip (charged coupled device or CCD) to convert the light focused upon it into an electronic image, thus being able to display it onto a TV monitor Page 1 of 6
5.0 Procedures General Principles: Due to the nature of their construction (complex assembly of channels, wires, light guide fibres, metal and rubber coatings) are unable to withstand high temperature sterilisation methods, such as steam autoclaving. Gas sterilisation (such as Ethylene oxide) may be employed however not often used due to the impractical aspects/logistics of the process. Thus current standards recommend the use of a chemical high-level disinfectant, such as Peracetic acid or high concentration Hydrogen peroxide. (Please note that the last two can only be used via automated machines) However, irrelevant of the disinfecting agent used, the most important step in achieving a disinfected instrument is the scrupulous mechanical cleaning. Failure to remove blood, saliva or other organic matter before immersing into the chemical disinfecting agent, may not only facilitate inactivation of the disinfectant, thus compromising the disinfecting process, but ultimately increase the risk of cross-contamination between patients. Prevention of a compromised disinfection process: manual cleaning should only be performed by trained personnel, conversant with the structure of the /endoscopic equipment and appropriate cleaning techniques that /endoscopic equipment are thoroughly rinsed prior to immersion in the chemical disinfectant, thus reducing the risk of dilution or precipitation of the chemical agent Other general principles: All must undergo disinfection processing/cycle prior to use or as close to the time of use as possible. Endoscopes stored overnight must not be used straight out of the cupboard unless in case of an emergency (i.e. where the life of the patient is at risk) and a service exeption/incident report signed by the responsible medical practitioner must follow such practice. In order to prevent excessive re-growth of bacteria whilst in storage (i.e. Pseudomonas), must be air dried at the end of the list, flushed with 70% alcohol, followed by further air drying, before hanging up in the scope cupboard Standard Infection Control principles apply, except in the case of High Risk CJD (Creutzfelt- Jacob Disease) cases, when additional precautions are required Page 2 of 6
1. PRIOR TO COMMENCEMENT OF THE LIST: Check, prepare the Disinfecting solution Check that corresponding tracking sheet is complete And that the have undertaken a full terminal reprocessing cycle the night before * If the endoscope has been received from the manufacturer (ie. Post-repair), is on loan from another institution or has not undertaken a correct terminal reprocessing, a full reprocessing cycle is required, thus including the manual brushing and enzymatic cleaning stage prior to the disinfecting soak. Also a new tracking chart should be commenced. Leak test as per manufacturer s instructions Follow the instructions of section 3. Steps to Manual Disinfection of Endoscopes Attach completed Tracking Chart with details of the Current Use processing section, with the scope Attend to remaining set-up tasks necessary for the day: Test, degas and prepare ultrasonic cleaner (if applicable) Ensure sufficient number of sterile re-usable accessories are available for the day/list (including buttons, water bottles, biopsy forceps and brushing sets) Check and prepare dilators or other therapeutic devices, if necessary Prepare medizyne cleaning tubs and trolleys Prepare and restock necessary cleaning areas Lubricate disinfected valves/ o rings Document Quality Activities undertaken above on the Daily Tracking form (QP7517F3) 2. STEPS FOR MANUAL CLEANING OF ENDOSCOPES Immediately following a procedure, with the still attached to the light source, grasp the control head and place the distal end of the scope in enzymatic solution. Page 3 of 6
Aspirate through suction channel, by depressing and releasing the suction button, to promote gross debris dislodgement. Depress and release the air/water button several times to flush water channel. * Use the specific air/water channel cleaning adopter (blue button) in the case of Olympus scopes Remove all buttons and attachments from the scope (including the water bottle taking care not to contaminate tip) and connect the leak tester Perform the leak testing (as per manufacturer s instructions) *Also, in order to clearly visualise any leaks/bubbles during the leak testing process, the cleaning tub should be free of detergent/foaming solutions Once scope has passed the leak test and has been immersed in the enzymatic solution, use a disposable cloth soaked in enzymatic solution to wipe the exterior of the endoscope, paying special attention to the insertion tube, from the control head to the distal end *If the endoscope has failed the leak test, do not proceed with the next steps, but refer to the instructions highlighted in the leak testing section Q75173. Use the toothbrush to clean the exterior surfaces such as around the control wheels, distal tip and all other channel outlets/valve ports Use a small stubby brush to clean inside the wider channel outlets such as the Biopsy port, Suction and Air/Water button ports Use the long endoscopy cleaning brush to brush the entire suction channel, including umbilical cord, control head and insertion tube sections.. *Follow schematic diagram provided by the manufacturer to ensure entire suction channel has been accessed *Check with manufacturer for any other brushable channels (i.e. some models of have brushable air/water channels) and ensure that appropriate size brush is available for use. *Also, ensure that the brush head is cleaned/brushed each time it emerges from the scope. Page 4 of 6
Always do a visual check of the brush to ensure its quality to use. If the quality is substandard (i.e. reduced number of bristles or kinked), do not use, but leave it aside, marked for the nurse in charge s attention. Fit cleaning adapters and thoroughly flush all channels with enzymatic solution (minimum 150 ml of solution/channel) *Consider additional channels such as a CO2 channel or elevator channels, as special special cleaning adapters may be required to access them. Check with the scope manufacturer or review the instruction manual, if unsure. Omission to clean such channels represents a serious risk of cross-infection to patients. *If due to local circumstances there is a delay in the cleaning of the endoscope, ensure that the above steps have been completed, before leaving the endoscope in the soaking solution. Endoscopes must not be allowed to dry prior to cleaning, as dried organic material becomes difficult, if not impossible to remove, thus compromising the disinfection process. Rinse all channels with fresh water (minimum 150 mls of water/channel) in order to remove all traces of detergent from the scope Purge channels with air and dry outer surfaces with a soft disposable cloth. Proceed to cleaning the buttons and caps as per practice guidelines QP75172. 3. Steps to Manual Disinfection Ensure cleaning buttons/attachments are fitted to the scope Fully immerse endoscope and accessories in the prepared disinfectant solution. Record soaking times on the corresponding Flexible Endoscopy Tracking Sheet (QP7517F1) Remove endoscope and accessories from the soaking tub, and transfer to a clean rinsing tub/sink filled with fresh water Flush all channels with a minimum of 150 ml of bacteria free water /channel and then air Thoroughly rinse the exterior of the endoscope under running water Page 5 of 6
Pat dry, assemble/fit necessary buttons/valves (sterilised or disinfected) and/or hang up scope on a clean & stable hook/pole, ready for immediate use. Attach corresponding tracking chart detailing current use processing. If instrument is prepared for terminal disinfection, proceed to next section 4 Steps to end of list processing 4. Steps for the end of list processing/terminal Processing: With the cleaning attachments still fitted onto the scope, flush all channels with 70% Isopropyl Alcohol Purge all channels with air and pat dry outer surfaces.. * If using an air gun/forced air, ensure that the flow regulator/pressure is adjusted to low for the finer channels (i.e Air/Water, CO2, elevator channel). Alternatively use small 2 or 5 ml syringes to purge such channels. Store endoscope in a well ventilated scope storage cupboard which permits full length hanging on appropriate support structures. *Do not store in transport cases, unless ready for immediate transportation. *Do not attach/reassemble endosope with buttons or other accessories whist storing overnight. In case of video scopes, ensure soaking cap is also unattached during storage. Attach corresponding Tracking Chart with the scope, detailing terminal disinfection process Records QP 7517F1 Flexible Endoscopy Tracking Chart / Manual Process Page 6 of 6