37
THE STRUGGLE IS REAL: ENDOSCOPE REPROCESSING AND WHAT IT MEANS TO YOU Copyright © 2016 Key Surgical
THE STRUGGLE IS REAL
ENDOSCOPE
REPROCESSING AND WHAT IT
MEANS TO YOU
Copyright copy 2016 Key Surgical
OBJECTIVES
Understand the different types of scopes and the classification of scopes
Understand the anatomy of rigid and flexible endoscopes
Understand what endoscopes do and how they work
Understand the basic steps in reprocessing endoscopes and the importance of each step
Identify industry guidelines as they relate to the reprocessing of endoscopes
Identify risks involved with improper reprocessing of endoscopes
SPAULDING CLASSIFICATION SYSTEM
ldquoThis classification system is widely accepted
and used by the FDA CDC epidemiologists
microbiologists and professional medical
organizationsrdquo
-Society of Healthcare Epidemiology of America and American Society of
Gastrointestinal Endoscopy 2011
CLASSIFICATION CRITICAL
A device that enters sterile tissue or the vascular system
Such devices should be sterilized defined as the destruction
of all microbial life Types of critical devices include
endoscopic instruments that require sterilization biopsy
forceps sphincterotomes papillotomes or other cutting
instruments
NEW AORN CRITICAL DEVICE
DESIGNATION
New critical designation Bronchoscopes Cystoscopes and
Duodenoscopes increase the risk of infection if they are
contaminated with microorganisms when used
Semi-critical all other flexible endoscopes
CLASSIFICATION SEMI-CRITICAL
A device that comes into contact with intact mucous membranes and
does not penetrate sterile tissue These devices should receive at least
high level disinfection defined as the destruction of all vegetative
microorganisms mycobacteria small or non-lipid viruses medium or
lipid viruses fungal spores and some but not all bacterial spores Types
of semi-critical devices include respiratory therapy and anesthesia
equipment some endoscopes laryngoscope blades esophageal
probes cystoscopes anorectal manometry catheters and diaphragm
fitting rings
CLASSIFICATION NON-CRITICAL
Devices that do not touch the patient or touch only intact skin
Types of noncritical devices include stethoscopes and patient
carts These items may be cleaned by low-level disinfection
SCOPES FALL INTO TWO CATEGORIES
Flexible
Rigid (includes semi-rigid)
ANATOMY OF A RIGID ENDOSCOPE
ANATOMY OF A RIGID ENDOSCOPECONTINUEDhellip
Light GuideConnector This is where light enters and illuminates the distal end
Light cable should never be on when not connected to scope
Shaft Houses majority of the optics system
Never hold shaft from distal end- damage easily done
Houses lumen for passage of instrumentsirrigation
Distal End Houses the lens and lens system
Different lens arrangements provide variousangled lines of sight
ANATOMY OF A FLEXIBLE
ENDOSCOPE
Contains plumbing with all outlets for air and
suction
Instruments can be introduced here allowing for
biopsy tools to be used
Location of the control knobs that operate the
flex motion of the distal tip
Contains a dry lubricant that permits the internal
components to move about freely If water
invades the control body and mixes with this dry
lubricant it creates a gritty substance that
causes damage to the internal structures
ANATOMY OF A SCOPE CONTROL BODY
The point of most wear and tear since itrsquos the point that comes in direct contact with
patients during surgery- entering body cavities with varying degrees of pressure
Contains complex wires glass bundles light fibers and channels
The light source is connected at the light connector and is passed through here via
fiber optic channels
ANATOMY OF A SCOPE INSERTION TUBE
Houses the terminal end of the airwater ports and biopsy port
Contains lens covering the imaging system
Contains lens covering the light system
ANATOMY OF A SCOPE BENDING SECTION amp DISTAL TIP
More than 34 million GI endoscopic procedures are performed
annually
Flexible endoscopes are a complex medical device that is made of
materials that are not compatible with all sterilization methods
Endoscopes are used to
Diagnose prevent and treat diseases
Confirm a diagnosis
Deliver therapy
Perform arthroscopic surgeries
Perform laparoscopic surgeries
Allows access to hard to reach cavities without having to open said
cavities via major surgery
WHAT DO ENDOSCOPES DOHOW DO THEY WORK
BASIC STEPS IN REPROCESSING
ENDOSCOPES
Any given endoscope could require upwards of
30 distinct steps in reprocessing according to
the manufacturerrsquos instructions for use
STEP 1 PERSONAL PROTECTIVE EQUIPMENT (PPE)
Most important step is protecting yourself
Wash hands before donning PPE and after removing PPE
Fluid resistant impervious gown- disposable
Chemicalfluid resistant gloves
Mask and shield impervious to fluid
STEP 2 PRE-CLEANING
Happens at the point-of-use immediately afterscope is removed from patient
Important to pre-clean as potentially infectiousmaterials could start to form biofilms that are extremely difficult to remove
Wash the external surfaces of the endoscope
Flush the channels with enzymatic detergent- both rigid and flexible scopes
Visually inspect the distal tip for damage and cleanliness
Attach protective cap to video connector after removing from the light source and suction
Detach and soak all detachable parts
Discard enzymatic detergent solution after each use
STEP 3 TRANSPORTATION
Transport to decontamination area before any
remaining organic matter has a chance to dry
Contain the scope in an enclosed container with a
biohazard label or fluid resistant bag
If using a bag- transport while supporting the
scope from the bottom of the bag so as not to
damage the scope
Each endoscope should be isolated and
transported with its components in its own closed
system to the next stage of processingrdquo AAMI
ST91 2015
STEP 4 LEAKPRESSURE TESTING
Pressurization is required to determine if leaks exist anywhere on the scope
Perform on newrepairedrefurbished scopes
Determine if perforations in outer covering or lining of internal channels may have occurred during manufacturing shipping transportation or use
Manipulate the control knobs of flexible endoscope in all directions to expose surfaces and reveal any small perforations
Perform leakpressure test per manufacturerrsquos instructions for use
Insufflate the scope first (pressurize) then submerge in water to prevent further damage
Make sure any waterproof caps are in place before submerging the scope
Attach flexible endoscope to the leak test system and submerge the entire scope in water Air bubbles indicate a leak in the covering or in a channel
LEAKPRESSURE TESTING CONTINUEDhellip
Make sure there is no detergent in the water as the foam could prevent you from seeing any air bubbles
If you see a leak keep the scope attached to the air pressure until it is completely removed from the water to keep water from entering the channels which could cause more damage
Common places for a leak bending section seams control knobs water cap
If you are using a leak test apparatus that doesnrsquot require water- complete leak testing before submerging scope in water or detergent A leak is present if you see a drop in pressure or if you donrsquot see inflation of the scope
IMPORTANT Never disconnect pressure while scope is fully immersed-only after it is completely depressurized to prevent damage
STEP 5 MANUAL CLEANING Manual cleaning always happens prior to high level disinfection
or entry into an automated endoscope reprocessor
Manual cleaning is more thorough than pre-cleaning
Wipe all external surfaces with a non-linting soft cloth or spongebull For cystoscopes and ureteroscopes use more of a milking action For
gastroscopes and colonoscopes slide the clothsponge down the length of the tubes
Submerge in enzymatic detergent solution as specified in manufacturerrsquos IFU
Consult the manufacturerrsquos IFU for correct measurements of enzymatic cleaners and water levels
MANUAL CLEANING CONTINUEDhellip
Cleaning brushes can be reusable or disposable be sure all brushes are of the correct size for the endoscope channel or port Inspect all reusable brushes to make sure they are in proper working order
Move any elevator cables up and down several times ndash helps to water pick this area with a syringe
Insert brush into submerged endoscope channel
Brush out all ports ndash under water at all times
Inspect brush and manipulate bristles under water to ensure that ALL bioburden saliva lubrication etc is removed before reintroducing brush into channel
Use your eyes Look for bioburdenresidue
STEP 6 DETERGENT FLUSHSUCTION AND WATER
FLUSHRINSE THE SCOPE
Wash the insertion tube and flush the channels using manufacturer issued cleaning adaptors to make sure all components are adequately flushed with detergent If using an automated flushing device like a Scope Buddyreg ndash refer to the manufacturer IFUs for proper flushing of your channels and ports
Airwater channels- one water stream and biopsy channel another water stream when you flush the scope
Flush the elevator channel with a syringe
Rinse scope with water after the detergentflushsuction- rinse off all detergent from the outside of the scope Flushsuction the channels with water
DETERGENT FLUSHSUCTION AND WATER
FLUSHRINSE THE SCOPE CONTINUEDhellip
If you have a smellydirty scope- it cannot safely be high-
level disinfected Use manufacturer recommended or
approved detergent that cleansdissolves fat cells that hold
onto and produce bad smells
Detergents should be used for only one scope and then
discarded
STEP 7 HIGH-LEVEL
DISINFECTIONSTERILIZATION
Flexible endoscopes can be disinfected manually or with an automated endoscope reprocessor
This step always happens AFTER manual cleaning
Immerse scope completely in solution or automated endoscope reprocessor- be sure to consult IFU for exposure times and temperatures
Check elevator channels before and after HLD
Gluteraldahyde OPA paracetic acid hydrogen peroxide can all be used to high level disinfect
Check with manufacturer IFU to see if scope can be put into a sterilizer
STEP 8 INSPECTION
Inspect flexible endoscopes and accessories of all components to determine damages loss of function gross soils as all of these things can result in patient harm
Inspect a scope Before use
During procedure
After procedure
Immediately after decontamination
Before disinfection or sterilization
Accessories to inspect Water bottle and tubing
Biopsy forceps
Cytology brushes
Cleaning brushes
INSPECTION CONTINUEDhellip
If you see damage remove scope from use and contact
service provider
If yoursquore sending your scope back to the manufacturer or a
third party provider package it in an impenetrable material
that complies with the Department of Transportation
shipping regulations and label as biohazard
STEP 9 STORAGE
Flush scope channel with 70-90 ethyl or isopropyl alcohol followed by
low-pressure forced air to dry internal channels
Store scopes in a closed cabinet with proper air circulation
Store scopes with all valvesaccessories removed
Hang scopes vertically without coiling or kinking
to facilitate any additional drying needed
Always store scopes in a way that protects the
scope and minimizes contamination
Be sure to clean and disinfect the storage
cabinets per manufacturerrsquos IFU
STORAGE CONTINUEDhellip
Storage time ranges between 5-24 days Always be sure to
document high-level disinfection dates and specifics
APIC suggests 7 days
AORN and AAMI recommend that each facility perform a risk
assessment to determine proper storage time
Multi-Society Guideline 2011 contamination during storage
negligible for 7-14 days contamination occurs only on exterior
SGNA supports 7 day storage intervals if scopes were
reprocessed and stored according to professional guidelines
and manufacturer IFU
INDUSTRY GUIDELINES
ENDOSCOPE PROCESSING
ldquoUse cleaning brushes appropriate for the size of the endoscope
channel or portrdquo
-CDC Guideline for Disinfection and Sterilization in Healthcare
Facilities 2008 pg 86
ldquoThorough cleaning is essential before high-level disinfection or
sterilization because inorganic or organic materials that remain on
surfaces of instruments interfere with the effectiveness of these
processesrdquo
-CDC Guideline for Disinfection and Sterilization in
Healthcare Facilities 2008
INDUSTRY GUIDELINES CONTINUEDhellip
ldquoCleaning and decontamination should occur as soon as possible after instruments and equipment are used to prevent the formation of biofilm Cleaning and decontamination must be thoroughly accomplished or disinfection and sterilization may not be effectiverdquo
-AORN Section 29 Recommendations V
ldquoManual cleaninghellipis the most important step in removing microbial burden from an endoscopehellipRetained debris may inactivate or interfere with the capabilityhellipto effectively kill andor inactivate microorganismsrdquo
-SGNA Standards of Infection Control in processing of Flexible Gastrointestinal Endoscopes 2013
ldquoCleaning refers to the removal of all visible and non-visible soil and any other foreign material from the medical device being processed It is the most important step in the disinfectionsterilization process Instruments must be thoroughly cleaned and rinsed for subsequent reprocessing steps to be effectiverdquo
-IAHCSMM Central Service Technical Manual 2007
INDUSTRY GUIDELINES CONTINUEDhellip
ldquoPersonnel involved in endoscope processing should be provided education
training and complete competency verification activities related to their duties upon
initial hire annually at designated intervals or whenever new endoscopic models
new processing equipment or products such as new chemicals are introduced for
processingrdquo
-ANSIAAMI ST91 2015 43
ldquoAt a minimum it is recommended that devices are subjected to high-level
disinfection after each use When possible and practical flexible and semi-rigid
endoscopes should be sterilized due to the greater margin of safety built into
sterilizationrdquo
-ANSIAAMI ST91 2015 43
RISKS INVOLVED WITH IMPROPER
PROCESSING OF ENDOSCOPES
Cross-contamination of harmful diseases like Hepatitis B Hepatitis C MRSA HIV CRE High rates of infection transmission
Biofilm growth on endoscope channels
Damage to the scope general diagnostic scopes cost $25-35000 with repair costs ranging from $500-$10000 per repair Ultrasound scopes cost $40-50000 with average repair costs of $8-11000 per repair
Debris on distal tip (camera) could result in the surgeonrsquos inability to adequately see inside the patient
Patient harm due to damaged and dirty scopes
SOURCESContent Sourcesbull ANSIAAMI ST91 2015 Flexible and semi-rigid endoscope processing in health care facilitiesbull Society of Healthcare Epidemiology of America and American Society of Gastrointestinal Endoscopy 2011 bull CDC Guideline for Disinfection and Sterilization in Healthcare Facilities 2008bull AORN Guidelines for Recommended Practice Section 29 Recommendations Vbull SGNA Standards of Infection Control in processing of Flexible Gastrointestinal Endoscopes 2013bull IAHCSMM Central Service Technical Manual 2007bull AAMI Best Practices in Endoscope Reprocessing Webinar 2015bull AAMI Endoscope Reprocessing Critical Training Steps to Promote Patient Safety 2013bull httphealthnvgovhcqchaicleaning_sterilization_disinfection_healthcare_facilitiespdfbull httpwwwsgnaorgPortals0Standard20of20Infection20Prevention_FINALpdf
Image sourcesbull httpswwweducationaldimensionscomeLearnendoscopeanatomyphpbull httpssitesgooglecomsitevoicedisordernodulesdiagnosis-assessmentassessment-proceduresbull httpsurgicalendocombull http1technationcomroundtable-flexible-endoscopybull httpwwwmedical-hospitalbedscomsale-912541-abs-multi-functional-patient-transportation-cart-hospital-stretcher-trolley-als-st004htmlbull httpwwwusendoscopycomendoscopyendoscope-care-and-accessoriesprocedure-kitsVIA-bedside-precleaning-kitaspxVSVKLJNV1Zgbull httpwwwwashingtonpostcomnationalhealth-sciencein-effort-to-halt-outbreaks-protocol-for-cleaning-medical-scope-is-
updated201503262c0b5d8c-d3e8-11e4-ab77-9646eea6a4c7_storyhtmlbull httpwwwoutpatientsurgerynetsurgical-facility-administrationinfection-controlare-you-cleaning-gi-scopes-properly--10-14bull httpwwwprwebcomreleasesendoscoperepairsprweb11626296htmbull httpwwwmedivatorscomproductsendoscope-reprocessingbrushes-and-flushing-aidsscope-buddy-endoscope-flushing-aidbull httpwwwzutroncomendoscope-leak-testersphpbull httpwwwoptimaxonlinecomremote-visual-inspection-rigid-endoscope83swing-prism-
endoscopePHPSESSID=09ad5b323b4d40e885021856d65aa727bull httpwwwusendoscopycomurologystone-management-and-foreign-body-retrievalmoray-focepsMoray-biopsy-
forcepsaspxVUFVHpPe9Zgbull httpswwwtechno-aidecomstoreproducthydraulic_general_patient_stretcherVUFWXpPe9Zgbull httpswiley-vche-bookshelfdeproductsreading-epubproduct-
id600494titlePractical2BGastrointestinal2BEndoscopyhtmlautr=22Peter+B+Cotton22
CONTACT INFORMATION
Sarah Nolan CCSVP
952-288-2246 Direct
SarahNolanKeySurgicalcom
Key Surgical Inc
800-541-7995
infokeysurgicalcom
Keep Educating Yourself
OBJECTIVES
Understand the different types of scopes and the classification of scopes
Understand the anatomy of rigid and flexible endoscopes
Understand what endoscopes do and how they work
Understand the basic steps in reprocessing endoscopes and the importance of each step
Identify industry guidelines as they relate to the reprocessing of endoscopes
Identify risks involved with improper reprocessing of endoscopes
SPAULDING CLASSIFICATION SYSTEM
ldquoThis classification system is widely accepted
and used by the FDA CDC epidemiologists
microbiologists and professional medical
organizationsrdquo
-Society of Healthcare Epidemiology of America and American Society of
Gastrointestinal Endoscopy 2011
CLASSIFICATION CRITICAL
A device that enters sterile tissue or the vascular system
Such devices should be sterilized defined as the destruction
of all microbial life Types of critical devices include
endoscopic instruments that require sterilization biopsy
forceps sphincterotomes papillotomes or other cutting
instruments
NEW AORN CRITICAL DEVICE
DESIGNATION
New critical designation Bronchoscopes Cystoscopes and
Duodenoscopes increase the risk of infection if they are
contaminated with microorganisms when used
Semi-critical all other flexible endoscopes
CLASSIFICATION SEMI-CRITICAL
A device that comes into contact with intact mucous membranes and
does not penetrate sterile tissue These devices should receive at least
high level disinfection defined as the destruction of all vegetative
microorganisms mycobacteria small or non-lipid viruses medium or
lipid viruses fungal spores and some but not all bacterial spores Types
of semi-critical devices include respiratory therapy and anesthesia
equipment some endoscopes laryngoscope blades esophageal
probes cystoscopes anorectal manometry catheters and diaphragm
fitting rings
CLASSIFICATION NON-CRITICAL
Devices that do not touch the patient or touch only intact skin
Types of noncritical devices include stethoscopes and patient
carts These items may be cleaned by low-level disinfection
SCOPES FALL INTO TWO CATEGORIES
Flexible
Rigid (includes semi-rigid)
ANATOMY OF A RIGID ENDOSCOPE
ANATOMY OF A RIGID ENDOSCOPECONTINUEDhellip
Light GuideConnector This is where light enters and illuminates the distal end
Light cable should never be on when not connected to scope
Shaft Houses majority of the optics system
Never hold shaft from distal end- damage easily done
Houses lumen for passage of instrumentsirrigation
Distal End Houses the lens and lens system
Different lens arrangements provide variousangled lines of sight
ANATOMY OF A FLEXIBLE
ENDOSCOPE
Contains plumbing with all outlets for air and
suction
Instruments can be introduced here allowing for
biopsy tools to be used
Location of the control knobs that operate the
flex motion of the distal tip
Contains a dry lubricant that permits the internal
components to move about freely If water
invades the control body and mixes with this dry
lubricant it creates a gritty substance that
causes damage to the internal structures
ANATOMY OF A SCOPE CONTROL BODY
The point of most wear and tear since itrsquos the point that comes in direct contact with
patients during surgery- entering body cavities with varying degrees of pressure
Contains complex wires glass bundles light fibers and channels
The light source is connected at the light connector and is passed through here via
fiber optic channels
ANATOMY OF A SCOPE INSERTION TUBE
Houses the terminal end of the airwater ports and biopsy port
Contains lens covering the imaging system
Contains lens covering the light system
ANATOMY OF A SCOPE BENDING SECTION amp DISTAL TIP
More than 34 million GI endoscopic procedures are performed
annually
Flexible endoscopes are a complex medical device that is made of
materials that are not compatible with all sterilization methods
Endoscopes are used to
Diagnose prevent and treat diseases
Confirm a diagnosis
Deliver therapy
Perform arthroscopic surgeries
Perform laparoscopic surgeries
Allows access to hard to reach cavities without having to open said
cavities via major surgery
WHAT DO ENDOSCOPES DOHOW DO THEY WORK
BASIC STEPS IN REPROCESSING
ENDOSCOPES
Any given endoscope could require upwards of
30 distinct steps in reprocessing according to
the manufacturerrsquos instructions for use
STEP 1 PERSONAL PROTECTIVE EQUIPMENT (PPE)
Most important step is protecting yourself
Wash hands before donning PPE and after removing PPE
Fluid resistant impervious gown- disposable
Chemicalfluid resistant gloves
Mask and shield impervious to fluid
STEP 2 PRE-CLEANING
Happens at the point-of-use immediately afterscope is removed from patient
Important to pre-clean as potentially infectiousmaterials could start to form biofilms that are extremely difficult to remove
Wash the external surfaces of the endoscope
Flush the channels with enzymatic detergent- both rigid and flexible scopes
Visually inspect the distal tip for damage and cleanliness
Attach protective cap to video connector after removing from the light source and suction
Detach and soak all detachable parts
Discard enzymatic detergent solution after each use
STEP 3 TRANSPORTATION
Transport to decontamination area before any
remaining organic matter has a chance to dry
Contain the scope in an enclosed container with a
biohazard label or fluid resistant bag
If using a bag- transport while supporting the
scope from the bottom of the bag so as not to
damage the scope
Each endoscope should be isolated and
transported with its components in its own closed
system to the next stage of processingrdquo AAMI
ST91 2015
STEP 4 LEAKPRESSURE TESTING
Pressurization is required to determine if leaks exist anywhere on the scope
Perform on newrepairedrefurbished scopes
Determine if perforations in outer covering or lining of internal channels may have occurred during manufacturing shipping transportation or use
Manipulate the control knobs of flexible endoscope in all directions to expose surfaces and reveal any small perforations
Perform leakpressure test per manufacturerrsquos instructions for use
Insufflate the scope first (pressurize) then submerge in water to prevent further damage
Make sure any waterproof caps are in place before submerging the scope
Attach flexible endoscope to the leak test system and submerge the entire scope in water Air bubbles indicate a leak in the covering or in a channel
LEAKPRESSURE TESTING CONTINUEDhellip
Make sure there is no detergent in the water as the foam could prevent you from seeing any air bubbles
If you see a leak keep the scope attached to the air pressure until it is completely removed from the water to keep water from entering the channels which could cause more damage
Common places for a leak bending section seams control knobs water cap
If you are using a leak test apparatus that doesnrsquot require water- complete leak testing before submerging scope in water or detergent A leak is present if you see a drop in pressure or if you donrsquot see inflation of the scope
IMPORTANT Never disconnect pressure while scope is fully immersed-only after it is completely depressurized to prevent damage
STEP 5 MANUAL CLEANING Manual cleaning always happens prior to high level disinfection
or entry into an automated endoscope reprocessor
Manual cleaning is more thorough than pre-cleaning
Wipe all external surfaces with a non-linting soft cloth or spongebull For cystoscopes and ureteroscopes use more of a milking action For
gastroscopes and colonoscopes slide the clothsponge down the length of the tubes
Submerge in enzymatic detergent solution as specified in manufacturerrsquos IFU
Consult the manufacturerrsquos IFU for correct measurements of enzymatic cleaners and water levels
MANUAL CLEANING CONTINUEDhellip
Cleaning brushes can be reusable or disposable be sure all brushes are of the correct size for the endoscope channel or port Inspect all reusable brushes to make sure they are in proper working order
Move any elevator cables up and down several times ndash helps to water pick this area with a syringe
Insert brush into submerged endoscope channel
Brush out all ports ndash under water at all times
Inspect brush and manipulate bristles under water to ensure that ALL bioburden saliva lubrication etc is removed before reintroducing brush into channel
Use your eyes Look for bioburdenresidue
STEP 6 DETERGENT FLUSHSUCTION AND WATER
FLUSHRINSE THE SCOPE
Wash the insertion tube and flush the channels using manufacturer issued cleaning adaptors to make sure all components are adequately flushed with detergent If using an automated flushing device like a Scope Buddyreg ndash refer to the manufacturer IFUs for proper flushing of your channels and ports
Airwater channels- one water stream and biopsy channel another water stream when you flush the scope
Flush the elevator channel with a syringe
Rinse scope with water after the detergentflushsuction- rinse off all detergent from the outside of the scope Flushsuction the channels with water
DETERGENT FLUSHSUCTION AND WATER
FLUSHRINSE THE SCOPE CONTINUEDhellip
If you have a smellydirty scope- it cannot safely be high-
level disinfected Use manufacturer recommended or
approved detergent that cleansdissolves fat cells that hold
onto and produce bad smells
Detergents should be used for only one scope and then
discarded
STEP 7 HIGH-LEVEL
DISINFECTIONSTERILIZATION
Flexible endoscopes can be disinfected manually or with an automated endoscope reprocessor
This step always happens AFTER manual cleaning
Immerse scope completely in solution or automated endoscope reprocessor- be sure to consult IFU for exposure times and temperatures
Check elevator channels before and after HLD
Gluteraldahyde OPA paracetic acid hydrogen peroxide can all be used to high level disinfect
Check with manufacturer IFU to see if scope can be put into a sterilizer
STEP 8 INSPECTION
Inspect flexible endoscopes and accessories of all components to determine damages loss of function gross soils as all of these things can result in patient harm
Inspect a scope Before use
During procedure
After procedure
Immediately after decontamination
Before disinfection or sterilization
Accessories to inspect Water bottle and tubing
Biopsy forceps
Cytology brushes
Cleaning brushes
INSPECTION CONTINUEDhellip
If you see damage remove scope from use and contact
service provider
If yoursquore sending your scope back to the manufacturer or a
third party provider package it in an impenetrable material
that complies with the Department of Transportation
shipping regulations and label as biohazard
STEP 9 STORAGE
Flush scope channel with 70-90 ethyl or isopropyl alcohol followed by
low-pressure forced air to dry internal channels
Store scopes in a closed cabinet with proper air circulation
Store scopes with all valvesaccessories removed
Hang scopes vertically without coiling or kinking
to facilitate any additional drying needed
Always store scopes in a way that protects the
scope and minimizes contamination
Be sure to clean and disinfect the storage
cabinets per manufacturerrsquos IFU
STORAGE CONTINUEDhellip
Storage time ranges between 5-24 days Always be sure to
document high-level disinfection dates and specifics
APIC suggests 7 days
AORN and AAMI recommend that each facility perform a risk
assessment to determine proper storage time
Multi-Society Guideline 2011 contamination during storage
negligible for 7-14 days contamination occurs only on exterior
SGNA supports 7 day storage intervals if scopes were
reprocessed and stored according to professional guidelines
and manufacturer IFU
INDUSTRY GUIDELINES
ENDOSCOPE PROCESSING
ldquoUse cleaning brushes appropriate for the size of the endoscope
channel or portrdquo
-CDC Guideline for Disinfection and Sterilization in Healthcare
Facilities 2008 pg 86
ldquoThorough cleaning is essential before high-level disinfection or
sterilization because inorganic or organic materials that remain on
surfaces of instruments interfere with the effectiveness of these
processesrdquo
-CDC Guideline for Disinfection and Sterilization in
Healthcare Facilities 2008
INDUSTRY GUIDELINES CONTINUEDhellip
ldquoCleaning and decontamination should occur as soon as possible after instruments and equipment are used to prevent the formation of biofilm Cleaning and decontamination must be thoroughly accomplished or disinfection and sterilization may not be effectiverdquo
-AORN Section 29 Recommendations V
ldquoManual cleaninghellipis the most important step in removing microbial burden from an endoscopehellipRetained debris may inactivate or interfere with the capabilityhellipto effectively kill andor inactivate microorganismsrdquo
-SGNA Standards of Infection Control in processing of Flexible Gastrointestinal Endoscopes 2013
ldquoCleaning refers to the removal of all visible and non-visible soil and any other foreign material from the medical device being processed It is the most important step in the disinfectionsterilization process Instruments must be thoroughly cleaned and rinsed for subsequent reprocessing steps to be effectiverdquo
-IAHCSMM Central Service Technical Manual 2007
INDUSTRY GUIDELINES CONTINUEDhellip
ldquoPersonnel involved in endoscope processing should be provided education
training and complete competency verification activities related to their duties upon
initial hire annually at designated intervals or whenever new endoscopic models
new processing equipment or products such as new chemicals are introduced for
processingrdquo
-ANSIAAMI ST91 2015 43
ldquoAt a minimum it is recommended that devices are subjected to high-level
disinfection after each use When possible and practical flexible and semi-rigid
endoscopes should be sterilized due to the greater margin of safety built into
sterilizationrdquo
-ANSIAAMI ST91 2015 43
RISKS INVOLVED WITH IMPROPER
PROCESSING OF ENDOSCOPES
Cross-contamination of harmful diseases like Hepatitis B Hepatitis C MRSA HIV CRE High rates of infection transmission
Biofilm growth on endoscope channels
Damage to the scope general diagnostic scopes cost $25-35000 with repair costs ranging from $500-$10000 per repair Ultrasound scopes cost $40-50000 with average repair costs of $8-11000 per repair
Debris on distal tip (camera) could result in the surgeonrsquos inability to adequately see inside the patient
Patient harm due to damaged and dirty scopes
SOURCESContent Sourcesbull ANSIAAMI ST91 2015 Flexible and semi-rigid endoscope processing in health care facilitiesbull Society of Healthcare Epidemiology of America and American Society of Gastrointestinal Endoscopy 2011 bull CDC Guideline for Disinfection and Sterilization in Healthcare Facilities 2008bull AORN Guidelines for Recommended Practice Section 29 Recommendations Vbull SGNA Standards of Infection Control in processing of Flexible Gastrointestinal Endoscopes 2013bull IAHCSMM Central Service Technical Manual 2007bull AAMI Best Practices in Endoscope Reprocessing Webinar 2015bull AAMI Endoscope Reprocessing Critical Training Steps to Promote Patient Safety 2013bull httphealthnvgovhcqchaicleaning_sterilization_disinfection_healthcare_facilitiespdfbull httpwwwsgnaorgPortals0Standard20of20Infection20Prevention_FINALpdf
Image sourcesbull httpswwweducationaldimensionscomeLearnendoscopeanatomyphpbull httpssitesgooglecomsitevoicedisordernodulesdiagnosis-assessmentassessment-proceduresbull httpsurgicalendocombull http1technationcomroundtable-flexible-endoscopybull httpwwwmedical-hospitalbedscomsale-912541-abs-multi-functional-patient-transportation-cart-hospital-stretcher-trolley-als-st004htmlbull httpwwwusendoscopycomendoscopyendoscope-care-and-accessoriesprocedure-kitsVIA-bedside-precleaning-kitaspxVSVKLJNV1Zgbull httpwwwwashingtonpostcomnationalhealth-sciencein-effort-to-halt-outbreaks-protocol-for-cleaning-medical-scope-is-
updated201503262c0b5d8c-d3e8-11e4-ab77-9646eea6a4c7_storyhtmlbull httpwwwoutpatientsurgerynetsurgical-facility-administrationinfection-controlare-you-cleaning-gi-scopes-properly--10-14bull httpwwwprwebcomreleasesendoscoperepairsprweb11626296htmbull httpwwwmedivatorscomproductsendoscope-reprocessingbrushes-and-flushing-aidsscope-buddy-endoscope-flushing-aidbull httpwwwzutroncomendoscope-leak-testersphpbull httpwwwoptimaxonlinecomremote-visual-inspection-rigid-endoscope83swing-prism-
endoscopePHPSESSID=09ad5b323b4d40e885021856d65aa727bull httpwwwusendoscopycomurologystone-management-and-foreign-body-retrievalmoray-focepsMoray-biopsy-
forcepsaspxVUFVHpPe9Zgbull httpswwwtechno-aidecomstoreproducthydraulic_general_patient_stretcherVUFWXpPe9Zgbull httpswiley-vche-bookshelfdeproductsreading-epubproduct-
id600494titlePractical2BGastrointestinal2BEndoscopyhtmlautr=22Peter+B+Cotton22
CONTACT INFORMATION
Sarah Nolan CCSVP
952-288-2246 Direct
SarahNolanKeySurgicalcom
Key Surgical Inc
800-541-7995
infokeysurgicalcom
Keep Educating Yourself
SPAULDING CLASSIFICATION SYSTEM
ldquoThis classification system is widely accepted
and used by the FDA CDC epidemiologists
microbiologists and professional medical
organizationsrdquo
-Society of Healthcare Epidemiology of America and American Society of
Gastrointestinal Endoscopy 2011
CLASSIFICATION CRITICAL
A device that enters sterile tissue or the vascular system
Such devices should be sterilized defined as the destruction
of all microbial life Types of critical devices include
endoscopic instruments that require sterilization biopsy
forceps sphincterotomes papillotomes or other cutting
instruments
NEW AORN CRITICAL DEVICE
DESIGNATION
New critical designation Bronchoscopes Cystoscopes and
Duodenoscopes increase the risk of infection if they are
contaminated with microorganisms when used
Semi-critical all other flexible endoscopes
CLASSIFICATION SEMI-CRITICAL
A device that comes into contact with intact mucous membranes and
does not penetrate sterile tissue These devices should receive at least
high level disinfection defined as the destruction of all vegetative
microorganisms mycobacteria small or non-lipid viruses medium or
lipid viruses fungal spores and some but not all bacterial spores Types
of semi-critical devices include respiratory therapy and anesthesia
equipment some endoscopes laryngoscope blades esophageal
probes cystoscopes anorectal manometry catheters and diaphragm
fitting rings
CLASSIFICATION NON-CRITICAL
Devices that do not touch the patient or touch only intact skin
Types of noncritical devices include stethoscopes and patient
carts These items may be cleaned by low-level disinfection
SCOPES FALL INTO TWO CATEGORIES
Flexible
Rigid (includes semi-rigid)
ANATOMY OF A RIGID ENDOSCOPE
ANATOMY OF A RIGID ENDOSCOPECONTINUEDhellip
Light GuideConnector This is where light enters and illuminates the distal end
Light cable should never be on when not connected to scope
Shaft Houses majority of the optics system
Never hold shaft from distal end- damage easily done
Houses lumen for passage of instrumentsirrigation
Distal End Houses the lens and lens system
Different lens arrangements provide variousangled lines of sight
ANATOMY OF A FLEXIBLE
ENDOSCOPE
Contains plumbing with all outlets for air and
suction
Instruments can be introduced here allowing for
biopsy tools to be used
Location of the control knobs that operate the
flex motion of the distal tip
Contains a dry lubricant that permits the internal
components to move about freely If water
invades the control body and mixes with this dry
lubricant it creates a gritty substance that
causes damage to the internal structures
ANATOMY OF A SCOPE CONTROL BODY
The point of most wear and tear since itrsquos the point that comes in direct contact with
patients during surgery- entering body cavities with varying degrees of pressure
Contains complex wires glass bundles light fibers and channels
The light source is connected at the light connector and is passed through here via
fiber optic channels
ANATOMY OF A SCOPE INSERTION TUBE
Houses the terminal end of the airwater ports and biopsy port
Contains lens covering the imaging system
Contains lens covering the light system
ANATOMY OF A SCOPE BENDING SECTION amp DISTAL TIP
More than 34 million GI endoscopic procedures are performed
annually
Flexible endoscopes are a complex medical device that is made of
materials that are not compatible with all sterilization methods
Endoscopes are used to
Diagnose prevent and treat diseases
Confirm a diagnosis
Deliver therapy
Perform arthroscopic surgeries
Perform laparoscopic surgeries
Allows access to hard to reach cavities without having to open said
cavities via major surgery
WHAT DO ENDOSCOPES DOHOW DO THEY WORK
BASIC STEPS IN REPROCESSING
ENDOSCOPES
Any given endoscope could require upwards of
30 distinct steps in reprocessing according to
the manufacturerrsquos instructions for use
STEP 1 PERSONAL PROTECTIVE EQUIPMENT (PPE)
Most important step is protecting yourself
Wash hands before donning PPE and after removing PPE
Fluid resistant impervious gown- disposable
Chemicalfluid resistant gloves
Mask and shield impervious to fluid
STEP 2 PRE-CLEANING
Happens at the point-of-use immediately afterscope is removed from patient
Important to pre-clean as potentially infectiousmaterials could start to form biofilms that are extremely difficult to remove
Wash the external surfaces of the endoscope
Flush the channels with enzymatic detergent- both rigid and flexible scopes
Visually inspect the distal tip for damage and cleanliness
Attach protective cap to video connector after removing from the light source and suction
Detach and soak all detachable parts
Discard enzymatic detergent solution after each use
STEP 3 TRANSPORTATION
Transport to decontamination area before any
remaining organic matter has a chance to dry
Contain the scope in an enclosed container with a
biohazard label or fluid resistant bag
If using a bag- transport while supporting the
scope from the bottom of the bag so as not to
damage the scope
Each endoscope should be isolated and
transported with its components in its own closed
system to the next stage of processingrdquo AAMI
ST91 2015
STEP 4 LEAKPRESSURE TESTING
Pressurization is required to determine if leaks exist anywhere on the scope
Perform on newrepairedrefurbished scopes
Determine if perforations in outer covering or lining of internal channels may have occurred during manufacturing shipping transportation or use
Manipulate the control knobs of flexible endoscope in all directions to expose surfaces and reveal any small perforations
Perform leakpressure test per manufacturerrsquos instructions for use
Insufflate the scope first (pressurize) then submerge in water to prevent further damage
Make sure any waterproof caps are in place before submerging the scope
Attach flexible endoscope to the leak test system and submerge the entire scope in water Air bubbles indicate a leak in the covering or in a channel
LEAKPRESSURE TESTING CONTINUEDhellip
Make sure there is no detergent in the water as the foam could prevent you from seeing any air bubbles
If you see a leak keep the scope attached to the air pressure until it is completely removed from the water to keep water from entering the channels which could cause more damage
Common places for a leak bending section seams control knobs water cap
If you are using a leak test apparatus that doesnrsquot require water- complete leak testing before submerging scope in water or detergent A leak is present if you see a drop in pressure or if you donrsquot see inflation of the scope
IMPORTANT Never disconnect pressure while scope is fully immersed-only after it is completely depressurized to prevent damage
STEP 5 MANUAL CLEANING Manual cleaning always happens prior to high level disinfection
or entry into an automated endoscope reprocessor
Manual cleaning is more thorough than pre-cleaning
Wipe all external surfaces with a non-linting soft cloth or spongebull For cystoscopes and ureteroscopes use more of a milking action For
gastroscopes and colonoscopes slide the clothsponge down the length of the tubes
Submerge in enzymatic detergent solution as specified in manufacturerrsquos IFU
Consult the manufacturerrsquos IFU for correct measurements of enzymatic cleaners and water levels
MANUAL CLEANING CONTINUEDhellip
Cleaning brushes can be reusable or disposable be sure all brushes are of the correct size for the endoscope channel or port Inspect all reusable brushes to make sure they are in proper working order
Move any elevator cables up and down several times ndash helps to water pick this area with a syringe
Insert brush into submerged endoscope channel
Brush out all ports ndash under water at all times
Inspect brush and manipulate bristles under water to ensure that ALL bioburden saliva lubrication etc is removed before reintroducing brush into channel
Use your eyes Look for bioburdenresidue
STEP 6 DETERGENT FLUSHSUCTION AND WATER
FLUSHRINSE THE SCOPE
Wash the insertion tube and flush the channels using manufacturer issued cleaning adaptors to make sure all components are adequately flushed with detergent If using an automated flushing device like a Scope Buddyreg ndash refer to the manufacturer IFUs for proper flushing of your channels and ports
Airwater channels- one water stream and biopsy channel another water stream when you flush the scope
Flush the elevator channel with a syringe
Rinse scope with water after the detergentflushsuction- rinse off all detergent from the outside of the scope Flushsuction the channels with water
DETERGENT FLUSHSUCTION AND WATER
FLUSHRINSE THE SCOPE CONTINUEDhellip
If you have a smellydirty scope- it cannot safely be high-
level disinfected Use manufacturer recommended or
approved detergent that cleansdissolves fat cells that hold
onto and produce bad smells
Detergents should be used for only one scope and then
discarded
STEP 7 HIGH-LEVEL
DISINFECTIONSTERILIZATION
Flexible endoscopes can be disinfected manually or with an automated endoscope reprocessor
This step always happens AFTER manual cleaning
Immerse scope completely in solution or automated endoscope reprocessor- be sure to consult IFU for exposure times and temperatures
Check elevator channels before and after HLD
Gluteraldahyde OPA paracetic acid hydrogen peroxide can all be used to high level disinfect
Check with manufacturer IFU to see if scope can be put into a sterilizer
STEP 8 INSPECTION
Inspect flexible endoscopes and accessories of all components to determine damages loss of function gross soils as all of these things can result in patient harm
Inspect a scope Before use
During procedure
After procedure
Immediately after decontamination
Before disinfection or sterilization
Accessories to inspect Water bottle and tubing
Biopsy forceps
Cytology brushes
Cleaning brushes
INSPECTION CONTINUEDhellip
If you see damage remove scope from use and contact
service provider
If yoursquore sending your scope back to the manufacturer or a
third party provider package it in an impenetrable material
that complies with the Department of Transportation
shipping regulations and label as biohazard
STEP 9 STORAGE
Flush scope channel with 70-90 ethyl or isopropyl alcohol followed by
low-pressure forced air to dry internal channels
Store scopes in a closed cabinet with proper air circulation
Store scopes with all valvesaccessories removed
Hang scopes vertically without coiling or kinking
to facilitate any additional drying needed
Always store scopes in a way that protects the
scope and minimizes contamination
Be sure to clean and disinfect the storage
cabinets per manufacturerrsquos IFU
STORAGE CONTINUEDhellip
Storage time ranges between 5-24 days Always be sure to
document high-level disinfection dates and specifics
APIC suggests 7 days
AORN and AAMI recommend that each facility perform a risk
assessment to determine proper storage time
Multi-Society Guideline 2011 contamination during storage
negligible for 7-14 days contamination occurs only on exterior
SGNA supports 7 day storage intervals if scopes were
reprocessed and stored according to professional guidelines
and manufacturer IFU
INDUSTRY GUIDELINES
ENDOSCOPE PROCESSING
ldquoUse cleaning brushes appropriate for the size of the endoscope
channel or portrdquo
-CDC Guideline for Disinfection and Sterilization in Healthcare
Facilities 2008 pg 86
ldquoThorough cleaning is essential before high-level disinfection or
sterilization because inorganic or organic materials that remain on
surfaces of instruments interfere with the effectiveness of these
processesrdquo
-CDC Guideline for Disinfection and Sterilization in
Healthcare Facilities 2008
INDUSTRY GUIDELINES CONTINUEDhellip
ldquoCleaning and decontamination should occur as soon as possible after instruments and equipment are used to prevent the formation of biofilm Cleaning and decontamination must be thoroughly accomplished or disinfection and sterilization may not be effectiverdquo
-AORN Section 29 Recommendations V
ldquoManual cleaninghellipis the most important step in removing microbial burden from an endoscopehellipRetained debris may inactivate or interfere with the capabilityhellipto effectively kill andor inactivate microorganismsrdquo
-SGNA Standards of Infection Control in processing of Flexible Gastrointestinal Endoscopes 2013
ldquoCleaning refers to the removal of all visible and non-visible soil and any other foreign material from the medical device being processed It is the most important step in the disinfectionsterilization process Instruments must be thoroughly cleaned and rinsed for subsequent reprocessing steps to be effectiverdquo
-IAHCSMM Central Service Technical Manual 2007
INDUSTRY GUIDELINES CONTINUEDhellip
ldquoPersonnel involved in endoscope processing should be provided education
training and complete competency verification activities related to their duties upon
initial hire annually at designated intervals or whenever new endoscopic models
new processing equipment or products such as new chemicals are introduced for
processingrdquo
-ANSIAAMI ST91 2015 43
ldquoAt a minimum it is recommended that devices are subjected to high-level
disinfection after each use When possible and practical flexible and semi-rigid
endoscopes should be sterilized due to the greater margin of safety built into
sterilizationrdquo
-ANSIAAMI ST91 2015 43
RISKS INVOLVED WITH IMPROPER
PROCESSING OF ENDOSCOPES
Cross-contamination of harmful diseases like Hepatitis B Hepatitis C MRSA HIV CRE High rates of infection transmission
Biofilm growth on endoscope channels
Damage to the scope general diagnostic scopes cost $25-35000 with repair costs ranging from $500-$10000 per repair Ultrasound scopes cost $40-50000 with average repair costs of $8-11000 per repair
Debris on distal tip (camera) could result in the surgeonrsquos inability to adequately see inside the patient
Patient harm due to damaged and dirty scopes
SOURCESContent Sourcesbull ANSIAAMI ST91 2015 Flexible and semi-rigid endoscope processing in health care facilitiesbull Society of Healthcare Epidemiology of America and American Society of Gastrointestinal Endoscopy 2011 bull CDC Guideline for Disinfection and Sterilization in Healthcare Facilities 2008bull AORN Guidelines for Recommended Practice Section 29 Recommendations Vbull SGNA Standards of Infection Control in processing of Flexible Gastrointestinal Endoscopes 2013bull IAHCSMM Central Service Technical Manual 2007bull AAMI Best Practices in Endoscope Reprocessing Webinar 2015bull AAMI Endoscope Reprocessing Critical Training Steps to Promote Patient Safety 2013bull httphealthnvgovhcqchaicleaning_sterilization_disinfection_healthcare_facilitiespdfbull httpwwwsgnaorgPortals0Standard20of20Infection20Prevention_FINALpdf
Image sourcesbull httpswwweducationaldimensionscomeLearnendoscopeanatomyphpbull httpssitesgooglecomsitevoicedisordernodulesdiagnosis-assessmentassessment-proceduresbull httpsurgicalendocombull http1technationcomroundtable-flexible-endoscopybull httpwwwmedical-hospitalbedscomsale-912541-abs-multi-functional-patient-transportation-cart-hospital-stretcher-trolley-als-st004htmlbull httpwwwusendoscopycomendoscopyendoscope-care-and-accessoriesprocedure-kitsVIA-bedside-precleaning-kitaspxVSVKLJNV1Zgbull httpwwwwashingtonpostcomnationalhealth-sciencein-effort-to-halt-outbreaks-protocol-for-cleaning-medical-scope-is-
updated201503262c0b5d8c-d3e8-11e4-ab77-9646eea6a4c7_storyhtmlbull httpwwwoutpatientsurgerynetsurgical-facility-administrationinfection-controlare-you-cleaning-gi-scopes-properly--10-14bull httpwwwprwebcomreleasesendoscoperepairsprweb11626296htmbull httpwwwmedivatorscomproductsendoscope-reprocessingbrushes-and-flushing-aidsscope-buddy-endoscope-flushing-aidbull httpwwwzutroncomendoscope-leak-testersphpbull httpwwwoptimaxonlinecomremote-visual-inspection-rigid-endoscope83swing-prism-
endoscopePHPSESSID=09ad5b323b4d40e885021856d65aa727bull httpwwwusendoscopycomurologystone-management-and-foreign-body-retrievalmoray-focepsMoray-biopsy-
forcepsaspxVUFVHpPe9Zgbull httpswwwtechno-aidecomstoreproducthydraulic_general_patient_stretcherVUFWXpPe9Zgbull httpswiley-vche-bookshelfdeproductsreading-epubproduct-
id600494titlePractical2BGastrointestinal2BEndoscopyhtmlautr=22Peter+B+Cotton22
CONTACT INFORMATION
Sarah Nolan CCSVP
952-288-2246 Direct
SarahNolanKeySurgicalcom
Key Surgical Inc
800-541-7995
infokeysurgicalcom
Keep Educating Yourself
CLASSIFICATION CRITICAL
A device that enters sterile tissue or the vascular system
Such devices should be sterilized defined as the destruction
of all microbial life Types of critical devices include
endoscopic instruments that require sterilization biopsy
forceps sphincterotomes papillotomes or other cutting
instruments
NEW AORN CRITICAL DEVICE
DESIGNATION
New critical designation Bronchoscopes Cystoscopes and
Duodenoscopes increase the risk of infection if they are
contaminated with microorganisms when used
Semi-critical all other flexible endoscopes
CLASSIFICATION SEMI-CRITICAL
A device that comes into contact with intact mucous membranes and
does not penetrate sterile tissue These devices should receive at least
high level disinfection defined as the destruction of all vegetative
microorganisms mycobacteria small or non-lipid viruses medium or
lipid viruses fungal spores and some but not all bacterial spores Types
of semi-critical devices include respiratory therapy and anesthesia
equipment some endoscopes laryngoscope blades esophageal
probes cystoscopes anorectal manometry catheters and diaphragm
fitting rings
CLASSIFICATION NON-CRITICAL
Devices that do not touch the patient or touch only intact skin
Types of noncritical devices include stethoscopes and patient
carts These items may be cleaned by low-level disinfection
SCOPES FALL INTO TWO CATEGORIES
Flexible
Rigid (includes semi-rigid)
ANATOMY OF A RIGID ENDOSCOPE
ANATOMY OF A RIGID ENDOSCOPECONTINUEDhellip
Light GuideConnector This is where light enters and illuminates the distal end
Light cable should never be on when not connected to scope
Shaft Houses majority of the optics system
Never hold shaft from distal end- damage easily done
Houses lumen for passage of instrumentsirrigation
Distal End Houses the lens and lens system
Different lens arrangements provide variousangled lines of sight
ANATOMY OF A FLEXIBLE
ENDOSCOPE
Contains plumbing with all outlets for air and
suction
Instruments can be introduced here allowing for
biopsy tools to be used
Location of the control knobs that operate the
flex motion of the distal tip
Contains a dry lubricant that permits the internal
components to move about freely If water
invades the control body and mixes with this dry
lubricant it creates a gritty substance that
causes damage to the internal structures
ANATOMY OF A SCOPE CONTROL BODY
The point of most wear and tear since itrsquos the point that comes in direct contact with
patients during surgery- entering body cavities with varying degrees of pressure
Contains complex wires glass bundles light fibers and channels
The light source is connected at the light connector and is passed through here via
fiber optic channels
ANATOMY OF A SCOPE INSERTION TUBE
Houses the terminal end of the airwater ports and biopsy port
Contains lens covering the imaging system
Contains lens covering the light system
ANATOMY OF A SCOPE BENDING SECTION amp DISTAL TIP
More than 34 million GI endoscopic procedures are performed
annually
Flexible endoscopes are a complex medical device that is made of
materials that are not compatible with all sterilization methods
Endoscopes are used to
Diagnose prevent and treat diseases
Confirm a diagnosis
Deliver therapy
Perform arthroscopic surgeries
Perform laparoscopic surgeries
Allows access to hard to reach cavities without having to open said
cavities via major surgery
WHAT DO ENDOSCOPES DOHOW DO THEY WORK
BASIC STEPS IN REPROCESSING
ENDOSCOPES
Any given endoscope could require upwards of
30 distinct steps in reprocessing according to
the manufacturerrsquos instructions for use
STEP 1 PERSONAL PROTECTIVE EQUIPMENT (PPE)
Most important step is protecting yourself
Wash hands before donning PPE and after removing PPE
Fluid resistant impervious gown- disposable
Chemicalfluid resistant gloves
Mask and shield impervious to fluid
STEP 2 PRE-CLEANING
Happens at the point-of-use immediately afterscope is removed from patient
Important to pre-clean as potentially infectiousmaterials could start to form biofilms that are extremely difficult to remove
Wash the external surfaces of the endoscope
Flush the channels with enzymatic detergent- both rigid and flexible scopes
Visually inspect the distal tip for damage and cleanliness
Attach protective cap to video connector after removing from the light source and suction
Detach and soak all detachable parts
Discard enzymatic detergent solution after each use
STEP 3 TRANSPORTATION
Transport to decontamination area before any
remaining organic matter has a chance to dry
Contain the scope in an enclosed container with a
biohazard label or fluid resistant bag
If using a bag- transport while supporting the
scope from the bottom of the bag so as not to
damage the scope
Each endoscope should be isolated and
transported with its components in its own closed
system to the next stage of processingrdquo AAMI
ST91 2015
STEP 4 LEAKPRESSURE TESTING
Pressurization is required to determine if leaks exist anywhere on the scope
Perform on newrepairedrefurbished scopes
Determine if perforations in outer covering or lining of internal channels may have occurred during manufacturing shipping transportation or use
Manipulate the control knobs of flexible endoscope in all directions to expose surfaces and reveal any small perforations
Perform leakpressure test per manufacturerrsquos instructions for use
Insufflate the scope first (pressurize) then submerge in water to prevent further damage
Make sure any waterproof caps are in place before submerging the scope
Attach flexible endoscope to the leak test system and submerge the entire scope in water Air bubbles indicate a leak in the covering or in a channel
LEAKPRESSURE TESTING CONTINUEDhellip
Make sure there is no detergent in the water as the foam could prevent you from seeing any air bubbles
If you see a leak keep the scope attached to the air pressure until it is completely removed from the water to keep water from entering the channels which could cause more damage
Common places for a leak bending section seams control knobs water cap
If you are using a leak test apparatus that doesnrsquot require water- complete leak testing before submerging scope in water or detergent A leak is present if you see a drop in pressure or if you donrsquot see inflation of the scope
IMPORTANT Never disconnect pressure while scope is fully immersed-only after it is completely depressurized to prevent damage
STEP 5 MANUAL CLEANING Manual cleaning always happens prior to high level disinfection
or entry into an automated endoscope reprocessor
Manual cleaning is more thorough than pre-cleaning
Wipe all external surfaces with a non-linting soft cloth or spongebull For cystoscopes and ureteroscopes use more of a milking action For
gastroscopes and colonoscopes slide the clothsponge down the length of the tubes
Submerge in enzymatic detergent solution as specified in manufacturerrsquos IFU
Consult the manufacturerrsquos IFU for correct measurements of enzymatic cleaners and water levels
MANUAL CLEANING CONTINUEDhellip
Cleaning brushes can be reusable or disposable be sure all brushes are of the correct size for the endoscope channel or port Inspect all reusable brushes to make sure they are in proper working order
Move any elevator cables up and down several times ndash helps to water pick this area with a syringe
Insert brush into submerged endoscope channel
Brush out all ports ndash under water at all times
Inspect brush and manipulate bristles under water to ensure that ALL bioburden saliva lubrication etc is removed before reintroducing brush into channel
Use your eyes Look for bioburdenresidue
STEP 6 DETERGENT FLUSHSUCTION AND WATER
FLUSHRINSE THE SCOPE
Wash the insertion tube and flush the channels using manufacturer issued cleaning adaptors to make sure all components are adequately flushed with detergent If using an automated flushing device like a Scope Buddyreg ndash refer to the manufacturer IFUs for proper flushing of your channels and ports
Airwater channels- one water stream and biopsy channel another water stream when you flush the scope
Flush the elevator channel with a syringe
Rinse scope with water after the detergentflushsuction- rinse off all detergent from the outside of the scope Flushsuction the channels with water
DETERGENT FLUSHSUCTION AND WATER
FLUSHRINSE THE SCOPE CONTINUEDhellip
If you have a smellydirty scope- it cannot safely be high-
level disinfected Use manufacturer recommended or
approved detergent that cleansdissolves fat cells that hold
onto and produce bad smells
Detergents should be used for only one scope and then
discarded
STEP 7 HIGH-LEVEL
DISINFECTIONSTERILIZATION
Flexible endoscopes can be disinfected manually or with an automated endoscope reprocessor
This step always happens AFTER manual cleaning
Immerse scope completely in solution or automated endoscope reprocessor- be sure to consult IFU for exposure times and temperatures
Check elevator channels before and after HLD
Gluteraldahyde OPA paracetic acid hydrogen peroxide can all be used to high level disinfect
Check with manufacturer IFU to see if scope can be put into a sterilizer
STEP 8 INSPECTION
Inspect flexible endoscopes and accessories of all components to determine damages loss of function gross soils as all of these things can result in patient harm
Inspect a scope Before use
During procedure
After procedure
Immediately after decontamination
Before disinfection or sterilization
Accessories to inspect Water bottle and tubing
Biopsy forceps
Cytology brushes
Cleaning brushes
INSPECTION CONTINUEDhellip
If you see damage remove scope from use and contact
service provider
If yoursquore sending your scope back to the manufacturer or a
third party provider package it in an impenetrable material
that complies with the Department of Transportation
shipping regulations and label as biohazard
STEP 9 STORAGE
Flush scope channel with 70-90 ethyl or isopropyl alcohol followed by
low-pressure forced air to dry internal channels
Store scopes in a closed cabinet with proper air circulation
Store scopes with all valvesaccessories removed
Hang scopes vertically without coiling or kinking
to facilitate any additional drying needed
Always store scopes in a way that protects the
scope and minimizes contamination
Be sure to clean and disinfect the storage
cabinets per manufacturerrsquos IFU
STORAGE CONTINUEDhellip
Storage time ranges between 5-24 days Always be sure to
document high-level disinfection dates and specifics
APIC suggests 7 days
AORN and AAMI recommend that each facility perform a risk
assessment to determine proper storage time
Multi-Society Guideline 2011 contamination during storage
negligible for 7-14 days contamination occurs only on exterior
SGNA supports 7 day storage intervals if scopes were
reprocessed and stored according to professional guidelines
and manufacturer IFU
INDUSTRY GUIDELINES
ENDOSCOPE PROCESSING
ldquoUse cleaning brushes appropriate for the size of the endoscope
channel or portrdquo
-CDC Guideline for Disinfection and Sterilization in Healthcare
Facilities 2008 pg 86
ldquoThorough cleaning is essential before high-level disinfection or
sterilization because inorganic or organic materials that remain on
surfaces of instruments interfere with the effectiveness of these
processesrdquo
-CDC Guideline for Disinfection and Sterilization in
Healthcare Facilities 2008
INDUSTRY GUIDELINES CONTINUEDhellip
ldquoCleaning and decontamination should occur as soon as possible after instruments and equipment are used to prevent the formation of biofilm Cleaning and decontamination must be thoroughly accomplished or disinfection and sterilization may not be effectiverdquo
-AORN Section 29 Recommendations V
ldquoManual cleaninghellipis the most important step in removing microbial burden from an endoscopehellipRetained debris may inactivate or interfere with the capabilityhellipto effectively kill andor inactivate microorganismsrdquo
-SGNA Standards of Infection Control in processing of Flexible Gastrointestinal Endoscopes 2013
ldquoCleaning refers to the removal of all visible and non-visible soil and any other foreign material from the medical device being processed It is the most important step in the disinfectionsterilization process Instruments must be thoroughly cleaned and rinsed for subsequent reprocessing steps to be effectiverdquo
-IAHCSMM Central Service Technical Manual 2007
INDUSTRY GUIDELINES CONTINUEDhellip
ldquoPersonnel involved in endoscope processing should be provided education
training and complete competency verification activities related to their duties upon
initial hire annually at designated intervals or whenever new endoscopic models
new processing equipment or products such as new chemicals are introduced for
processingrdquo
-ANSIAAMI ST91 2015 43
ldquoAt a minimum it is recommended that devices are subjected to high-level
disinfection after each use When possible and practical flexible and semi-rigid
endoscopes should be sterilized due to the greater margin of safety built into
sterilizationrdquo
-ANSIAAMI ST91 2015 43
RISKS INVOLVED WITH IMPROPER
PROCESSING OF ENDOSCOPES
Cross-contamination of harmful diseases like Hepatitis B Hepatitis C MRSA HIV CRE High rates of infection transmission
Biofilm growth on endoscope channels
Damage to the scope general diagnostic scopes cost $25-35000 with repair costs ranging from $500-$10000 per repair Ultrasound scopes cost $40-50000 with average repair costs of $8-11000 per repair
Debris on distal tip (camera) could result in the surgeonrsquos inability to adequately see inside the patient
Patient harm due to damaged and dirty scopes
SOURCESContent Sourcesbull ANSIAAMI ST91 2015 Flexible and semi-rigid endoscope processing in health care facilitiesbull Society of Healthcare Epidemiology of America and American Society of Gastrointestinal Endoscopy 2011 bull CDC Guideline for Disinfection and Sterilization in Healthcare Facilities 2008bull AORN Guidelines for Recommended Practice Section 29 Recommendations Vbull SGNA Standards of Infection Control in processing of Flexible Gastrointestinal Endoscopes 2013bull IAHCSMM Central Service Technical Manual 2007bull AAMI Best Practices in Endoscope Reprocessing Webinar 2015bull AAMI Endoscope Reprocessing Critical Training Steps to Promote Patient Safety 2013bull httphealthnvgovhcqchaicleaning_sterilization_disinfection_healthcare_facilitiespdfbull httpwwwsgnaorgPortals0Standard20of20Infection20Prevention_FINALpdf
Image sourcesbull httpswwweducationaldimensionscomeLearnendoscopeanatomyphpbull httpssitesgooglecomsitevoicedisordernodulesdiagnosis-assessmentassessment-proceduresbull httpsurgicalendocombull http1technationcomroundtable-flexible-endoscopybull httpwwwmedical-hospitalbedscomsale-912541-abs-multi-functional-patient-transportation-cart-hospital-stretcher-trolley-als-st004htmlbull httpwwwusendoscopycomendoscopyendoscope-care-and-accessoriesprocedure-kitsVIA-bedside-precleaning-kitaspxVSVKLJNV1Zgbull httpwwwwashingtonpostcomnationalhealth-sciencein-effort-to-halt-outbreaks-protocol-for-cleaning-medical-scope-is-
updated201503262c0b5d8c-d3e8-11e4-ab77-9646eea6a4c7_storyhtmlbull httpwwwoutpatientsurgerynetsurgical-facility-administrationinfection-controlare-you-cleaning-gi-scopes-properly--10-14bull httpwwwprwebcomreleasesendoscoperepairsprweb11626296htmbull httpwwwmedivatorscomproductsendoscope-reprocessingbrushes-and-flushing-aidsscope-buddy-endoscope-flushing-aidbull httpwwwzutroncomendoscope-leak-testersphpbull httpwwwoptimaxonlinecomremote-visual-inspection-rigid-endoscope83swing-prism-
endoscopePHPSESSID=09ad5b323b4d40e885021856d65aa727bull httpwwwusendoscopycomurologystone-management-and-foreign-body-retrievalmoray-focepsMoray-biopsy-
forcepsaspxVUFVHpPe9Zgbull httpswwwtechno-aidecomstoreproducthydraulic_general_patient_stretcherVUFWXpPe9Zgbull httpswiley-vche-bookshelfdeproductsreading-epubproduct-
id600494titlePractical2BGastrointestinal2BEndoscopyhtmlautr=22Peter+B+Cotton22
CONTACT INFORMATION
Sarah Nolan CCSVP
952-288-2246 Direct
SarahNolanKeySurgicalcom
Key Surgical Inc
800-541-7995
infokeysurgicalcom
Keep Educating Yourself
NEW AORN CRITICAL DEVICE
DESIGNATION
New critical designation Bronchoscopes Cystoscopes and
Duodenoscopes increase the risk of infection if they are
contaminated with microorganisms when used
Semi-critical all other flexible endoscopes
CLASSIFICATION SEMI-CRITICAL
A device that comes into contact with intact mucous membranes and
does not penetrate sterile tissue These devices should receive at least
high level disinfection defined as the destruction of all vegetative
microorganisms mycobacteria small or non-lipid viruses medium or
lipid viruses fungal spores and some but not all bacterial spores Types
of semi-critical devices include respiratory therapy and anesthesia
equipment some endoscopes laryngoscope blades esophageal
probes cystoscopes anorectal manometry catheters and diaphragm
fitting rings
CLASSIFICATION NON-CRITICAL
Devices that do not touch the patient or touch only intact skin
Types of noncritical devices include stethoscopes and patient
carts These items may be cleaned by low-level disinfection
SCOPES FALL INTO TWO CATEGORIES
Flexible
Rigid (includes semi-rigid)
ANATOMY OF A RIGID ENDOSCOPE
ANATOMY OF A RIGID ENDOSCOPECONTINUEDhellip
Light GuideConnector This is where light enters and illuminates the distal end
Light cable should never be on when not connected to scope
Shaft Houses majority of the optics system
Never hold shaft from distal end- damage easily done
Houses lumen for passage of instrumentsirrigation
Distal End Houses the lens and lens system
Different lens arrangements provide variousangled lines of sight
ANATOMY OF A FLEXIBLE
ENDOSCOPE
Contains plumbing with all outlets for air and
suction
Instruments can be introduced here allowing for
biopsy tools to be used
Location of the control knobs that operate the
flex motion of the distal tip
Contains a dry lubricant that permits the internal
components to move about freely If water
invades the control body and mixes with this dry
lubricant it creates a gritty substance that
causes damage to the internal structures
ANATOMY OF A SCOPE CONTROL BODY
The point of most wear and tear since itrsquos the point that comes in direct contact with
patients during surgery- entering body cavities with varying degrees of pressure
Contains complex wires glass bundles light fibers and channels
The light source is connected at the light connector and is passed through here via
fiber optic channels
ANATOMY OF A SCOPE INSERTION TUBE
Houses the terminal end of the airwater ports and biopsy port
Contains lens covering the imaging system
Contains lens covering the light system
ANATOMY OF A SCOPE BENDING SECTION amp DISTAL TIP
More than 34 million GI endoscopic procedures are performed
annually
Flexible endoscopes are a complex medical device that is made of
materials that are not compatible with all sterilization methods
Endoscopes are used to
Diagnose prevent and treat diseases
Confirm a diagnosis
Deliver therapy
Perform arthroscopic surgeries
Perform laparoscopic surgeries
Allows access to hard to reach cavities without having to open said
cavities via major surgery
WHAT DO ENDOSCOPES DOHOW DO THEY WORK
BASIC STEPS IN REPROCESSING
ENDOSCOPES
Any given endoscope could require upwards of
30 distinct steps in reprocessing according to
the manufacturerrsquos instructions for use
STEP 1 PERSONAL PROTECTIVE EQUIPMENT (PPE)
Most important step is protecting yourself
Wash hands before donning PPE and after removing PPE
Fluid resistant impervious gown- disposable
Chemicalfluid resistant gloves
Mask and shield impervious to fluid
STEP 2 PRE-CLEANING
Happens at the point-of-use immediately afterscope is removed from patient
Important to pre-clean as potentially infectiousmaterials could start to form biofilms that are extremely difficult to remove
Wash the external surfaces of the endoscope
Flush the channels with enzymatic detergent- both rigid and flexible scopes
Visually inspect the distal tip for damage and cleanliness
Attach protective cap to video connector after removing from the light source and suction
Detach and soak all detachable parts
Discard enzymatic detergent solution after each use
STEP 3 TRANSPORTATION
Transport to decontamination area before any
remaining organic matter has a chance to dry
Contain the scope in an enclosed container with a
biohazard label or fluid resistant bag
If using a bag- transport while supporting the
scope from the bottom of the bag so as not to
damage the scope
Each endoscope should be isolated and
transported with its components in its own closed
system to the next stage of processingrdquo AAMI
ST91 2015
STEP 4 LEAKPRESSURE TESTING
Pressurization is required to determine if leaks exist anywhere on the scope
Perform on newrepairedrefurbished scopes
Determine if perforations in outer covering or lining of internal channels may have occurred during manufacturing shipping transportation or use
Manipulate the control knobs of flexible endoscope in all directions to expose surfaces and reveal any small perforations
Perform leakpressure test per manufacturerrsquos instructions for use
Insufflate the scope first (pressurize) then submerge in water to prevent further damage
Make sure any waterproof caps are in place before submerging the scope
Attach flexible endoscope to the leak test system and submerge the entire scope in water Air bubbles indicate a leak in the covering or in a channel
LEAKPRESSURE TESTING CONTINUEDhellip
Make sure there is no detergent in the water as the foam could prevent you from seeing any air bubbles
If you see a leak keep the scope attached to the air pressure until it is completely removed from the water to keep water from entering the channels which could cause more damage
Common places for a leak bending section seams control knobs water cap
If you are using a leak test apparatus that doesnrsquot require water- complete leak testing before submerging scope in water or detergent A leak is present if you see a drop in pressure or if you donrsquot see inflation of the scope
IMPORTANT Never disconnect pressure while scope is fully immersed-only after it is completely depressurized to prevent damage
STEP 5 MANUAL CLEANING Manual cleaning always happens prior to high level disinfection
or entry into an automated endoscope reprocessor
Manual cleaning is more thorough than pre-cleaning
Wipe all external surfaces with a non-linting soft cloth or spongebull For cystoscopes and ureteroscopes use more of a milking action For
gastroscopes and colonoscopes slide the clothsponge down the length of the tubes
Submerge in enzymatic detergent solution as specified in manufacturerrsquos IFU
Consult the manufacturerrsquos IFU for correct measurements of enzymatic cleaners and water levels
MANUAL CLEANING CONTINUEDhellip
Cleaning brushes can be reusable or disposable be sure all brushes are of the correct size for the endoscope channel or port Inspect all reusable brushes to make sure they are in proper working order
Move any elevator cables up and down several times ndash helps to water pick this area with a syringe
Insert brush into submerged endoscope channel
Brush out all ports ndash under water at all times
Inspect brush and manipulate bristles under water to ensure that ALL bioburden saliva lubrication etc is removed before reintroducing brush into channel
Use your eyes Look for bioburdenresidue
STEP 6 DETERGENT FLUSHSUCTION AND WATER
FLUSHRINSE THE SCOPE
Wash the insertion tube and flush the channels using manufacturer issued cleaning adaptors to make sure all components are adequately flushed with detergent If using an automated flushing device like a Scope Buddyreg ndash refer to the manufacturer IFUs for proper flushing of your channels and ports
Airwater channels- one water stream and biopsy channel another water stream when you flush the scope
Flush the elevator channel with a syringe
Rinse scope with water after the detergentflushsuction- rinse off all detergent from the outside of the scope Flushsuction the channels with water
DETERGENT FLUSHSUCTION AND WATER
FLUSHRINSE THE SCOPE CONTINUEDhellip
If you have a smellydirty scope- it cannot safely be high-
level disinfected Use manufacturer recommended or
approved detergent that cleansdissolves fat cells that hold
onto and produce bad smells
Detergents should be used for only one scope and then
discarded
STEP 7 HIGH-LEVEL
DISINFECTIONSTERILIZATION
Flexible endoscopes can be disinfected manually or with an automated endoscope reprocessor
This step always happens AFTER manual cleaning
Immerse scope completely in solution or automated endoscope reprocessor- be sure to consult IFU for exposure times and temperatures
Check elevator channels before and after HLD
Gluteraldahyde OPA paracetic acid hydrogen peroxide can all be used to high level disinfect
Check with manufacturer IFU to see if scope can be put into a sterilizer
STEP 8 INSPECTION
Inspect flexible endoscopes and accessories of all components to determine damages loss of function gross soils as all of these things can result in patient harm
Inspect a scope Before use
During procedure
After procedure
Immediately after decontamination
Before disinfection or sterilization
Accessories to inspect Water bottle and tubing
Biopsy forceps
Cytology brushes
Cleaning brushes
INSPECTION CONTINUEDhellip
If you see damage remove scope from use and contact
service provider
If yoursquore sending your scope back to the manufacturer or a
third party provider package it in an impenetrable material
that complies with the Department of Transportation
shipping regulations and label as biohazard
STEP 9 STORAGE
Flush scope channel with 70-90 ethyl or isopropyl alcohol followed by
low-pressure forced air to dry internal channels
Store scopes in a closed cabinet with proper air circulation
Store scopes with all valvesaccessories removed
Hang scopes vertically without coiling or kinking
to facilitate any additional drying needed
Always store scopes in a way that protects the
scope and minimizes contamination
Be sure to clean and disinfect the storage
cabinets per manufacturerrsquos IFU
STORAGE CONTINUEDhellip
Storage time ranges between 5-24 days Always be sure to
document high-level disinfection dates and specifics
APIC suggests 7 days
AORN and AAMI recommend that each facility perform a risk
assessment to determine proper storage time
Multi-Society Guideline 2011 contamination during storage
negligible for 7-14 days contamination occurs only on exterior
SGNA supports 7 day storage intervals if scopes were
reprocessed and stored according to professional guidelines
and manufacturer IFU
INDUSTRY GUIDELINES
ENDOSCOPE PROCESSING
ldquoUse cleaning brushes appropriate for the size of the endoscope
channel or portrdquo
-CDC Guideline for Disinfection and Sterilization in Healthcare
Facilities 2008 pg 86
ldquoThorough cleaning is essential before high-level disinfection or
sterilization because inorganic or organic materials that remain on
surfaces of instruments interfere with the effectiveness of these
processesrdquo
-CDC Guideline for Disinfection and Sterilization in
Healthcare Facilities 2008
INDUSTRY GUIDELINES CONTINUEDhellip
ldquoCleaning and decontamination should occur as soon as possible after instruments and equipment are used to prevent the formation of biofilm Cleaning and decontamination must be thoroughly accomplished or disinfection and sterilization may not be effectiverdquo
-AORN Section 29 Recommendations V
ldquoManual cleaninghellipis the most important step in removing microbial burden from an endoscopehellipRetained debris may inactivate or interfere with the capabilityhellipto effectively kill andor inactivate microorganismsrdquo
-SGNA Standards of Infection Control in processing of Flexible Gastrointestinal Endoscopes 2013
ldquoCleaning refers to the removal of all visible and non-visible soil and any other foreign material from the medical device being processed It is the most important step in the disinfectionsterilization process Instruments must be thoroughly cleaned and rinsed for subsequent reprocessing steps to be effectiverdquo
-IAHCSMM Central Service Technical Manual 2007
INDUSTRY GUIDELINES CONTINUEDhellip
ldquoPersonnel involved in endoscope processing should be provided education
training and complete competency verification activities related to their duties upon
initial hire annually at designated intervals or whenever new endoscopic models
new processing equipment or products such as new chemicals are introduced for
processingrdquo
-ANSIAAMI ST91 2015 43
ldquoAt a minimum it is recommended that devices are subjected to high-level
disinfection after each use When possible and practical flexible and semi-rigid
endoscopes should be sterilized due to the greater margin of safety built into
sterilizationrdquo
-ANSIAAMI ST91 2015 43
RISKS INVOLVED WITH IMPROPER
PROCESSING OF ENDOSCOPES
Cross-contamination of harmful diseases like Hepatitis B Hepatitis C MRSA HIV CRE High rates of infection transmission
Biofilm growth on endoscope channels
Damage to the scope general diagnostic scopes cost $25-35000 with repair costs ranging from $500-$10000 per repair Ultrasound scopes cost $40-50000 with average repair costs of $8-11000 per repair
Debris on distal tip (camera) could result in the surgeonrsquos inability to adequately see inside the patient
Patient harm due to damaged and dirty scopes
SOURCESContent Sourcesbull ANSIAAMI ST91 2015 Flexible and semi-rigid endoscope processing in health care facilitiesbull Society of Healthcare Epidemiology of America and American Society of Gastrointestinal Endoscopy 2011 bull CDC Guideline for Disinfection and Sterilization in Healthcare Facilities 2008bull AORN Guidelines for Recommended Practice Section 29 Recommendations Vbull SGNA Standards of Infection Control in processing of Flexible Gastrointestinal Endoscopes 2013bull IAHCSMM Central Service Technical Manual 2007bull AAMI Best Practices in Endoscope Reprocessing Webinar 2015bull AAMI Endoscope Reprocessing Critical Training Steps to Promote Patient Safety 2013bull httphealthnvgovhcqchaicleaning_sterilization_disinfection_healthcare_facilitiespdfbull httpwwwsgnaorgPortals0Standard20of20Infection20Prevention_FINALpdf
Image sourcesbull httpswwweducationaldimensionscomeLearnendoscopeanatomyphpbull httpssitesgooglecomsitevoicedisordernodulesdiagnosis-assessmentassessment-proceduresbull httpsurgicalendocombull http1technationcomroundtable-flexible-endoscopybull httpwwwmedical-hospitalbedscomsale-912541-abs-multi-functional-patient-transportation-cart-hospital-stretcher-trolley-als-st004htmlbull httpwwwusendoscopycomendoscopyendoscope-care-and-accessoriesprocedure-kitsVIA-bedside-precleaning-kitaspxVSVKLJNV1Zgbull httpwwwwashingtonpostcomnationalhealth-sciencein-effort-to-halt-outbreaks-protocol-for-cleaning-medical-scope-is-
updated201503262c0b5d8c-d3e8-11e4-ab77-9646eea6a4c7_storyhtmlbull httpwwwoutpatientsurgerynetsurgical-facility-administrationinfection-controlare-you-cleaning-gi-scopes-properly--10-14bull httpwwwprwebcomreleasesendoscoperepairsprweb11626296htmbull httpwwwmedivatorscomproductsendoscope-reprocessingbrushes-and-flushing-aidsscope-buddy-endoscope-flushing-aidbull httpwwwzutroncomendoscope-leak-testersphpbull httpwwwoptimaxonlinecomremote-visual-inspection-rigid-endoscope83swing-prism-
endoscopePHPSESSID=09ad5b323b4d40e885021856d65aa727bull httpwwwusendoscopycomurologystone-management-and-foreign-body-retrievalmoray-focepsMoray-biopsy-
forcepsaspxVUFVHpPe9Zgbull httpswwwtechno-aidecomstoreproducthydraulic_general_patient_stretcherVUFWXpPe9Zgbull httpswiley-vche-bookshelfdeproductsreading-epubproduct-
id600494titlePractical2BGastrointestinal2BEndoscopyhtmlautr=22Peter+B+Cotton22
CONTACT INFORMATION
Sarah Nolan CCSVP
952-288-2246 Direct
SarahNolanKeySurgicalcom
Key Surgical Inc
800-541-7995
infokeysurgicalcom
Keep Educating Yourself
CLASSIFICATION SEMI-CRITICAL
A device that comes into contact with intact mucous membranes and
does not penetrate sterile tissue These devices should receive at least
high level disinfection defined as the destruction of all vegetative
microorganisms mycobacteria small or non-lipid viruses medium or
lipid viruses fungal spores and some but not all bacterial spores Types
of semi-critical devices include respiratory therapy and anesthesia
equipment some endoscopes laryngoscope blades esophageal
probes cystoscopes anorectal manometry catheters and diaphragm
fitting rings
CLASSIFICATION NON-CRITICAL
Devices that do not touch the patient or touch only intact skin
Types of noncritical devices include stethoscopes and patient
carts These items may be cleaned by low-level disinfection
SCOPES FALL INTO TWO CATEGORIES
Flexible
Rigid (includes semi-rigid)
ANATOMY OF A RIGID ENDOSCOPE
ANATOMY OF A RIGID ENDOSCOPECONTINUEDhellip
Light GuideConnector This is where light enters and illuminates the distal end
Light cable should never be on when not connected to scope
Shaft Houses majority of the optics system
Never hold shaft from distal end- damage easily done
Houses lumen for passage of instrumentsirrigation
Distal End Houses the lens and lens system
Different lens arrangements provide variousangled lines of sight
ANATOMY OF A FLEXIBLE
ENDOSCOPE
Contains plumbing with all outlets for air and
suction
Instruments can be introduced here allowing for
biopsy tools to be used
Location of the control knobs that operate the
flex motion of the distal tip
Contains a dry lubricant that permits the internal
components to move about freely If water
invades the control body and mixes with this dry
lubricant it creates a gritty substance that
causes damage to the internal structures
ANATOMY OF A SCOPE CONTROL BODY
The point of most wear and tear since itrsquos the point that comes in direct contact with
patients during surgery- entering body cavities with varying degrees of pressure
Contains complex wires glass bundles light fibers and channels
The light source is connected at the light connector and is passed through here via
fiber optic channels
ANATOMY OF A SCOPE INSERTION TUBE
Houses the terminal end of the airwater ports and biopsy port
Contains lens covering the imaging system
Contains lens covering the light system
ANATOMY OF A SCOPE BENDING SECTION amp DISTAL TIP
More than 34 million GI endoscopic procedures are performed
annually
Flexible endoscopes are a complex medical device that is made of
materials that are not compatible with all sterilization methods
Endoscopes are used to
Diagnose prevent and treat diseases
Confirm a diagnosis
Deliver therapy
Perform arthroscopic surgeries
Perform laparoscopic surgeries
Allows access to hard to reach cavities without having to open said
cavities via major surgery
WHAT DO ENDOSCOPES DOHOW DO THEY WORK
BASIC STEPS IN REPROCESSING
ENDOSCOPES
Any given endoscope could require upwards of
30 distinct steps in reprocessing according to
the manufacturerrsquos instructions for use
STEP 1 PERSONAL PROTECTIVE EQUIPMENT (PPE)
Most important step is protecting yourself
Wash hands before donning PPE and after removing PPE
Fluid resistant impervious gown- disposable
Chemicalfluid resistant gloves
Mask and shield impervious to fluid
STEP 2 PRE-CLEANING
Happens at the point-of-use immediately afterscope is removed from patient
Important to pre-clean as potentially infectiousmaterials could start to form biofilms that are extremely difficult to remove
Wash the external surfaces of the endoscope
Flush the channels with enzymatic detergent- both rigid and flexible scopes
Visually inspect the distal tip for damage and cleanliness
Attach protective cap to video connector after removing from the light source and suction
Detach and soak all detachable parts
Discard enzymatic detergent solution after each use
STEP 3 TRANSPORTATION
Transport to decontamination area before any
remaining organic matter has a chance to dry
Contain the scope in an enclosed container with a
biohazard label or fluid resistant bag
If using a bag- transport while supporting the
scope from the bottom of the bag so as not to
damage the scope
Each endoscope should be isolated and
transported with its components in its own closed
system to the next stage of processingrdquo AAMI
ST91 2015
STEP 4 LEAKPRESSURE TESTING
Pressurization is required to determine if leaks exist anywhere on the scope
Perform on newrepairedrefurbished scopes
Determine if perforations in outer covering or lining of internal channels may have occurred during manufacturing shipping transportation or use
Manipulate the control knobs of flexible endoscope in all directions to expose surfaces and reveal any small perforations
Perform leakpressure test per manufacturerrsquos instructions for use
Insufflate the scope first (pressurize) then submerge in water to prevent further damage
Make sure any waterproof caps are in place before submerging the scope
Attach flexible endoscope to the leak test system and submerge the entire scope in water Air bubbles indicate a leak in the covering or in a channel
LEAKPRESSURE TESTING CONTINUEDhellip
Make sure there is no detergent in the water as the foam could prevent you from seeing any air bubbles
If you see a leak keep the scope attached to the air pressure until it is completely removed from the water to keep water from entering the channels which could cause more damage
Common places for a leak bending section seams control knobs water cap
If you are using a leak test apparatus that doesnrsquot require water- complete leak testing before submerging scope in water or detergent A leak is present if you see a drop in pressure or if you donrsquot see inflation of the scope
IMPORTANT Never disconnect pressure while scope is fully immersed-only after it is completely depressurized to prevent damage
STEP 5 MANUAL CLEANING Manual cleaning always happens prior to high level disinfection
or entry into an automated endoscope reprocessor
Manual cleaning is more thorough than pre-cleaning
Wipe all external surfaces with a non-linting soft cloth or spongebull For cystoscopes and ureteroscopes use more of a milking action For
gastroscopes and colonoscopes slide the clothsponge down the length of the tubes
Submerge in enzymatic detergent solution as specified in manufacturerrsquos IFU
Consult the manufacturerrsquos IFU for correct measurements of enzymatic cleaners and water levels
MANUAL CLEANING CONTINUEDhellip
Cleaning brushes can be reusable or disposable be sure all brushes are of the correct size for the endoscope channel or port Inspect all reusable brushes to make sure they are in proper working order
Move any elevator cables up and down several times ndash helps to water pick this area with a syringe
Insert brush into submerged endoscope channel
Brush out all ports ndash under water at all times
Inspect brush and manipulate bristles under water to ensure that ALL bioburden saliva lubrication etc is removed before reintroducing brush into channel
Use your eyes Look for bioburdenresidue
STEP 6 DETERGENT FLUSHSUCTION AND WATER
FLUSHRINSE THE SCOPE
Wash the insertion tube and flush the channels using manufacturer issued cleaning adaptors to make sure all components are adequately flushed with detergent If using an automated flushing device like a Scope Buddyreg ndash refer to the manufacturer IFUs for proper flushing of your channels and ports
Airwater channels- one water stream and biopsy channel another water stream when you flush the scope
Flush the elevator channel with a syringe
Rinse scope with water after the detergentflushsuction- rinse off all detergent from the outside of the scope Flushsuction the channels with water
DETERGENT FLUSHSUCTION AND WATER
FLUSHRINSE THE SCOPE CONTINUEDhellip
If you have a smellydirty scope- it cannot safely be high-
level disinfected Use manufacturer recommended or
approved detergent that cleansdissolves fat cells that hold
onto and produce bad smells
Detergents should be used for only one scope and then
discarded
STEP 7 HIGH-LEVEL
DISINFECTIONSTERILIZATION
Flexible endoscopes can be disinfected manually or with an automated endoscope reprocessor
This step always happens AFTER manual cleaning
Immerse scope completely in solution or automated endoscope reprocessor- be sure to consult IFU for exposure times and temperatures
Check elevator channels before and after HLD
Gluteraldahyde OPA paracetic acid hydrogen peroxide can all be used to high level disinfect
Check with manufacturer IFU to see if scope can be put into a sterilizer
STEP 8 INSPECTION
Inspect flexible endoscopes and accessories of all components to determine damages loss of function gross soils as all of these things can result in patient harm
Inspect a scope Before use
During procedure
After procedure
Immediately after decontamination
Before disinfection or sterilization
Accessories to inspect Water bottle and tubing
Biopsy forceps
Cytology brushes
Cleaning brushes
INSPECTION CONTINUEDhellip
If you see damage remove scope from use and contact
service provider
If yoursquore sending your scope back to the manufacturer or a
third party provider package it in an impenetrable material
that complies with the Department of Transportation
shipping regulations and label as biohazard
STEP 9 STORAGE
Flush scope channel with 70-90 ethyl or isopropyl alcohol followed by
low-pressure forced air to dry internal channels
Store scopes in a closed cabinet with proper air circulation
Store scopes with all valvesaccessories removed
Hang scopes vertically without coiling or kinking
to facilitate any additional drying needed
Always store scopes in a way that protects the
scope and minimizes contamination
Be sure to clean and disinfect the storage
cabinets per manufacturerrsquos IFU
STORAGE CONTINUEDhellip
Storage time ranges between 5-24 days Always be sure to
document high-level disinfection dates and specifics
APIC suggests 7 days
AORN and AAMI recommend that each facility perform a risk
assessment to determine proper storage time
Multi-Society Guideline 2011 contamination during storage
negligible for 7-14 days contamination occurs only on exterior
SGNA supports 7 day storage intervals if scopes were
reprocessed and stored according to professional guidelines
and manufacturer IFU
INDUSTRY GUIDELINES
ENDOSCOPE PROCESSING
ldquoUse cleaning brushes appropriate for the size of the endoscope
channel or portrdquo
-CDC Guideline for Disinfection and Sterilization in Healthcare
Facilities 2008 pg 86
ldquoThorough cleaning is essential before high-level disinfection or
sterilization because inorganic or organic materials that remain on
surfaces of instruments interfere with the effectiveness of these
processesrdquo
-CDC Guideline for Disinfection and Sterilization in
Healthcare Facilities 2008
INDUSTRY GUIDELINES CONTINUEDhellip
ldquoCleaning and decontamination should occur as soon as possible after instruments and equipment are used to prevent the formation of biofilm Cleaning and decontamination must be thoroughly accomplished or disinfection and sterilization may not be effectiverdquo
-AORN Section 29 Recommendations V
ldquoManual cleaninghellipis the most important step in removing microbial burden from an endoscopehellipRetained debris may inactivate or interfere with the capabilityhellipto effectively kill andor inactivate microorganismsrdquo
-SGNA Standards of Infection Control in processing of Flexible Gastrointestinal Endoscopes 2013
ldquoCleaning refers to the removal of all visible and non-visible soil and any other foreign material from the medical device being processed It is the most important step in the disinfectionsterilization process Instruments must be thoroughly cleaned and rinsed for subsequent reprocessing steps to be effectiverdquo
-IAHCSMM Central Service Technical Manual 2007
INDUSTRY GUIDELINES CONTINUEDhellip
ldquoPersonnel involved in endoscope processing should be provided education
training and complete competency verification activities related to their duties upon
initial hire annually at designated intervals or whenever new endoscopic models
new processing equipment or products such as new chemicals are introduced for
processingrdquo
-ANSIAAMI ST91 2015 43
ldquoAt a minimum it is recommended that devices are subjected to high-level
disinfection after each use When possible and practical flexible and semi-rigid
endoscopes should be sterilized due to the greater margin of safety built into
sterilizationrdquo
-ANSIAAMI ST91 2015 43
RISKS INVOLVED WITH IMPROPER
PROCESSING OF ENDOSCOPES
Cross-contamination of harmful diseases like Hepatitis B Hepatitis C MRSA HIV CRE High rates of infection transmission
Biofilm growth on endoscope channels
Damage to the scope general diagnostic scopes cost $25-35000 with repair costs ranging from $500-$10000 per repair Ultrasound scopes cost $40-50000 with average repair costs of $8-11000 per repair
Debris on distal tip (camera) could result in the surgeonrsquos inability to adequately see inside the patient
Patient harm due to damaged and dirty scopes
SOURCESContent Sourcesbull ANSIAAMI ST91 2015 Flexible and semi-rigid endoscope processing in health care facilitiesbull Society of Healthcare Epidemiology of America and American Society of Gastrointestinal Endoscopy 2011 bull CDC Guideline for Disinfection and Sterilization in Healthcare Facilities 2008bull AORN Guidelines for Recommended Practice Section 29 Recommendations Vbull SGNA Standards of Infection Control in processing of Flexible Gastrointestinal Endoscopes 2013bull IAHCSMM Central Service Technical Manual 2007bull AAMI Best Practices in Endoscope Reprocessing Webinar 2015bull AAMI Endoscope Reprocessing Critical Training Steps to Promote Patient Safety 2013bull httphealthnvgovhcqchaicleaning_sterilization_disinfection_healthcare_facilitiespdfbull httpwwwsgnaorgPortals0Standard20of20Infection20Prevention_FINALpdf
Image sourcesbull httpswwweducationaldimensionscomeLearnendoscopeanatomyphpbull httpssitesgooglecomsitevoicedisordernodulesdiagnosis-assessmentassessment-proceduresbull httpsurgicalendocombull http1technationcomroundtable-flexible-endoscopybull httpwwwmedical-hospitalbedscomsale-912541-abs-multi-functional-patient-transportation-cart-hospital-stretcher-trolley-als-st004htmlbull httpwwwusendoscopycomendoscopyendoscope-care-and-accessoriesprocedure-kitsVIA-bedside-precleaning-kitaspxVSVKLJNV1Zgbull httpwwwwashingtonpostcomnationalhealth-sciencein-effort-to-halt-outbreaks-protocol-for-cleaning-medical-scope-is-
updated201503262c0b5d8c-d3e8-11e4-ab77-9646eea6a4c7_storyhtmlbull httpwwwoutpatientsurgerynetsurgical-facility-administrationinfection-controlare-you-cleaning-gi-scopes-properly--10-14bull httpwwwprwebcomreleasesendoscoperepairsprweb11626296htmbull httpwwwmedivatorscomproductsendoscope-reprocessingbrushes-and-flushing-aidsscope-buddy-endoscope-flushing-aidbull httpwwwzutroncomendoscope-leak-testersphpbull httpwwwoptimaxonlinecomremote-visual-inspection-rigid-endoscope83swing-prism-
endoscopePHPSESSID=09ad5b323b4d40e885021856d65aa727bull httpwwwusendoscopycomurologystone-management-and-foreign-body-retrievalmoray-focepsMoray-biopsy-
forcepsaspxVUFVHpPe9Zgbull httpswwwtechno-aidecomstoreproducthydraulic_general_patient_stretcherVUFWXpPe9Zgbull httpswiley-vche-bookshelfdeproductsreading-epubproduct-
id600494titlePractical2BGastrointestinal2BEndoscopyhtmlautr=22Peter+B+Cotton22
CONTACT INFORMATION
Sarah Nolan CCSVP
952-288-2246 Direct
SarahNolanKeySurgicalcom
Key Surgical Inc
800-541-7995
infokeysurgicalcom
Keep Educating Yourself
CLASSIFICATION NON-CRITICAL
Devices that do not touch the patient or touch only intact skin
Types of noncritical devices include stethoscopes and patient
carts These items may be cleaned by low-level disinfection
SCOPES FALL INTO TWO CATEGORIES
Flexible
Rigid (includes semi-rigid)
ANATOMY OF A RIGID ENDOSCOPE
ANATOMY OF A RIGID ENDOSCOPECONTINUEDhellip
Light GuideConnector This is where light enters and illuminates the distal end
Light cable should never be on when not connected to scope
Shaft Houses majority of the optics system
Never hold shaft from distal end- damage easily done
Houses lumen for passage of instrumentsirrigation
Distal End Houses the lens and lens system
Different lens arrangements provide variousangled lines of sight
ANATOMY OF A FLEXIBLE
ENDOSCOPE
Contains plumbing with all outlets for air and
suction
Instruments can be introduced here allowing for
biopsy tools to be used
Location of the control knobs that operate the
flex motion of the distal tip
Contains a dry lubricant that permits the internal
components to move about freely If water
invades the control body and mixes with this dry
lubricant it creates a gritty substance that
causes damage to the internal structures
ANATOMY OF A SCOPE CONTROL BODY
The point of most wear and tear since itrsquos the point that comes in direct contact with
patients during surgery- entering body cavities with varying degrees of pressure
Contains complex wires glass bundles light fibers and channels
The light source is connected at the light connector and is passed through here via
fiber optic channels
ANATOMY OF A SCOPE INSERTION TUBE
Houses the terminal end of the airwater ports and biopsy port
Contains lens covering the imaging system
Contains lens covering the light system
ANATOMY OF A SCOPE BENDING SECTION amp DISTAL TIP
More than 34 million GI endoscopic procedures are performed
annually
Flexible endoscopes are a complex medical device that is made of
materials that are not compatible with all sterilization methods
Endoscopes are used to
Diagnose prevent and treat diseases
Confirm a diagnosis
Deliver therapy
Perform arthroscopic surgeries
Perform laparoscopic surgeries
Allows access to hard to reach cavities without having to open said
cavities via major surgery
WHAT DO ENDOSCOPES DOHOW DO THEY WORK
BASIC STEPS IN REPROCESSING
ENDOSCOPES
Any given endoscope could require upwards of
30 distinct steps in reprocessing according to
the manufacturerrsquos instructions for use
STEP 1 PERSONAL PROTECTIVE EQUIPMENT (PPE)
Most important step is protecting yourself
Wash hands before donning PPE and after removing PPE
Fluid resistant impervious gown- disposable
Chemicalfluid resistant gloves
Mask and shield impervious to fluid
STEP 2 PRE-CLEANING
Happens at the point-of-use immediately afterscope is removed from patient
Important to pre-clean as potentially infectiousmaterials could start to form biofilms that are extremely difficult to remove
Wash the external surfaces of the endoscope
Flush the channels with enzymatic detergent- both rigid and flexible scopes
Visually inspect the distal tip for damage and cleanliness
Attach protective cap to video connector after removing from the light source and suction
Detach and soak all detachable parts
Discard enzymatic detergent solution after each use
STEP 3 TRANSPORTATION
Transport to decontamination area before any
remaining organic matter has a chance to dry
Contain the scope in an enclosed container with a
biohazard label or fluid resistant bag
If using a bag- transport while supporting the
scope from the bottom of the bag so as not to
damage the scope
Each endoscope should be isolated and
transported with its components in its own closed
system to the next stage of processingrdquo AAMI
ST91 2015
STEP 4 LEAKPRESSURE TESTING
Pressurization is required to determine if leaks exist anywhere on the scope
Perform on newrepairedrefurbished scopes
Determine if perforations in outer covering or lining of internal channels may have occurred during manufacturing shipping transportation or use
Manipulate the control knobs of flexible endoscope in all directions to expose surfaces and reveal any small perforations
Perform leakpressure test per manufacturerrsquos instructions for use
Insufflate the scope first (pressurize) then submerge in water to prevent further damage
Make sure any waterproof caps are in place before submerging the scope
Attach flexible endoscope to the leak test system and submerge the entire scope in water Air bubbles indicate a leak in the covering or in a channel
LEAKPRESSURE TESTING CONTINUEDhellip
Make sure there is no detergent in the water as the foam could prevent you from seeing any air bubbles
If you see a leak keep the scope attached to the air pressure until it is completely removed from the water to keep water from entering the channels which could cause more damage
Common places for a leak bending section seams control knobs water cap
If you are using a leak test apparatus that doesnrsquot require water- complete leak testing before submerging scope in water or detergent A leak is present if you see a drop in pressure or if you donrsquot see inflation of the scope
IMPORTANT Never disconnect pressure while scope is fully immersed-only after it is completely depressurized to prevent damage
STEP 5 MANUAL CLEANING Manual cleaning always happens prior to high level disinfection
or entry into an automated endoscope reprocessor
Manual cleaning is more thorough than pre-cleaning
Wipe all external surfaces with a non-linting soft cloth or spongebull For cystoscopes and ureteroscopes use more of a milking action For
gastroscopes and colonoscopes slide the clothsponge down the length of the tubes
Submerge in enzymatic detergent solution as specified in manufacturerrsquos IFU
Consult the manufacturerrsquos IFU for correct measurements of enzymatic cleaners and water levels
MANUAL CLEANING CONTINUEDhellip
Cleaning brushes can be reusable or disposable be sure all brushes are of the correct size for the endoscope channel or port Inspect all reusable brushes to make sure they are in proper working order
Move any elevator cables up and down several times ndash helps to water pick this area with a syringe
Insert brush into submerged endoscope channel
Brush out all ports ndash under water at all times
Inspect brush and manipulate bristles under water to ensure that ALL bioburden saliva lubrication etc is removed before reintroducing brush into channel
Use your eyes Look for bioburdenresidue
STEP 6 DETERGENT FLUSHSUCTION AND WATER
FLUSHRINSE THE SCOPE
Wash the insertion tube and flush the channels using manufacturer issued cleaning adaptors to make sure all components are adequately flushed with detergent If using an automated flushing device like a Scope Buddyreg ndash refer to the manufacturer IFUs for proper flushing of your channels and ports
Airwater channels- one water stream and biopsy channel another water stream when you flush the scope
Flush the elevator channel with a syringe
Rinse scope with water after the detergentflushsuction- rinse off all detergent from the outside of the scope Flushsuction the channels with water
DETERGENT FLUSHSUCTION AND WATER
FLUSHRINSE THE SCOPE CONTINUEDhellip
If you have a smellydirty scope- it cannot safely be high-
level disinfected Use manufacturer recommended or
approved detergent that cleansdissolves fat cells that hold
onto and produce bad smells
Detergents should be used for only one scope and then
discarded
STEP 7 HIGH-LEVEL
DISINFECTIONSTERILIZATION
Flexible endoscopes can be disinfected manually or with an automated endoscope reprocessor
This step always happens AFTER manual cleaning
Immerse scope completely in solution or automated endoscope reprocessor- be sure to consult IFU for exposure times and temperatures
Check elevator channels before and after HLD
Gluteraldahyde OPA paracetic acid hydrogen peroxide can all be used to high level disinfect
Check with manufacturer IFU to see if scope can be put into a sterilizer
STEP 8 INSPECTION
Inspect flexible endoscopes and accessories of all components to determine damages loss of function gross soils as all of these things can result in patient harm
Inspect a scope Before use
During procedure
After procedure
Immediately after decontamination
Before disinfection or sterilization
Accessories to inspect Water bottle and tubing
Biopsy forceps
Cytology brushes
Cleaning brushes
INSPECTION CONTINUEDhellip
If you see damage remove scope from use and contact
service provider
If yoursquore sending your scope back to the manufacturer or a
third party provider package it in an impenetrable material
that complies with the Department of Transportation
shipping regulations and label as biohazard
STEP 9 STORAGE
Flush scope channel with 70-90 ethyl or isopropyl alcohol followed by
low-pressure forced air to dry internal channels
Store scopes in a closed cabinet with proper air circulation
Store scopes with all valvesaccessories removed
Hang scopes vertically without coiling or kinking
to facilitate any additional drying needed
Always store scopes in a way that protects the
scope and minimizes contamination
Be sure to clean and disinfect the storage
cabinets per manufacturerrsquos IFU
STORAGE CONTINUEDhellip
Storage time ranges between 5-24 days Always be sure to
document high-level disinfection dates and specifics
APIC suggests 7 days
AORN and AAMI recommend that each facility perform a risk
assessment to determine proper storage time
Multi-Society Guideline 2011 contamination during storage
negligible for 7-14 days contamination occurs only on exterior
SGNA supports 7 day storage intervals if scopes were
reprocessed and stored according to professional guidelines
and manufacturer IFU
INDUSTRY GUIDELINES
ENDOSCOPE PROCESSING
ldquoUse cleaning brushes appropriate for the size of the endoscope
channel or portrdquo
-CDC Guideline for Disinfection and Sterilization in Healthcare
Facilities 2008 pg 86
ldquoThorough cleaning is essential before high-level disinfection or
sterilization because inorganic or organic materials that remain on
surfaces of instruments interfere with the effectiveness of these
processesrdquo
-CDC Guideline for Disinfection and Sterilization in
Healthcare Facilities 2008
INDUSTRY GUIDELINES CONTINUEDhellip
ldquoCleaning and decontamination should occur as soon as possible after instruments and equipment are used to prevent the formation of biofilm Cleaning and decontamination must be thoroughly accomplished or disinfection and sterilization may not be effectiverdquo
-AORN Section 29 Recommendations V
ldquoManual cleaninghellipis the most important step in removing microbial burden from an endoscopehellipRetained debris may inactivate or interfere with the capabilityhellipto effectively kill andor inactivate microorganismsrdquo
-SGNA Standards of Infection Control in processing of Flexible Gastrointestinal Endoscopes 2013
ldquoCleaning refers to the removal of all visible and non-visible soil and any other foreign material from the medical device being processed It is the most important step in the disinfectionsterilization process Instruments must be thoroughly cleaned and rinsed for subsequent reprocessing steps to be effectiverdquo
-IAHCSMM Central Service Technical Manual 2007
INDUSTRY GUIDELINES CONTINUEDhellip
ldquoPersonnel involved in endoscope processing should be provided education
training and complete competency verification activities related to their duties upon
initial hire annually at designated intervals or whenever new endoscopic models
new processing equipment or products such as new chemicals are introduced for
processingrdquo
-ANSIAAMI ST91 2015 43
ldquoAt a minimum it is recommended that devices are subjected to high-level
disinfection after each use When possible and practical flexible and semi-rigid
endoscopes should be sterilized due to the greater margin of safety built into
sterilizationrdquo
-ANSIAAMI ST91 2015 43
RISKS INVOLVED WITH IMPROPER
PROCESSING OF ENDOSCOPES
Cross-contamination of harmful diseases like Hepatitis B Hepatitis C MRSA HIV CRE High rates of infection transmission
Biofilm growth on endoscope channels
Damage to the scope general diagnostic scopes cost $25-35000 with repair costs ranging from $500-$10000 per repair Ultrasound scopes cost $40-50000 with average repair costs of $8-11000 per repair
Debris on distal tip (camera) could result in the surgeonrsquos inability to adequately see inside the patient
Patient harm due to damaged and dirty scopes
SOURCESContent Sourcesbull ANSIAAMI ST91 2015 Flexible and semi-rigid endoscope processing in health care facilitiesbull Society of Healthcare Epidemiology of America and American Society of Gastrointestinal Endoscopy 2011 bull CDC Guideline for Disinfection and Sterilization in Healthcare Facilities 2008bull AORN Guidelines for Recommended Practice Section 29 Recommendations Vbull SGNA Standards of Infection Control in processing of Flexible Gastrointestinal Endoscopes 2013bull IAHCSMM Central Service Technical Manual 2007bull AAMI Best Practices in Endoscope Reprocessing Webinar 2015bull AAMI Endoscope Reprocessing Critical Training Steps to Promote Patient Safety 2013bull httphealthnvgovhcqchaicleaning_sterilization_disinfection_healthcare_facilitiespdfbull httpwwwsgnaorgPortals0Standard20of20Infection20Prevention_FINALpdf
Image sourcesbull httpswwweducationaldimensionscomeLearnendoscopeanatomyphpbull httpssitesgooglecomsitevoicedisordernodulesdiagnosis-assessmentassessment-proceduresbull httpsurgicalendocombull http1technationcomroundtable-flexible-endoscopybull httpwwwmedical-hospitalbedscomsale-912541-abs-multi-functional-patient-transportation-cart-hospital-stretcher-trolley-als-st004htmlbull httpwwwusendoscopycomendoscopyendoscope-care-and-accessoriesprocedure-kitsVIA-bedside-precleaning-kitaspxVSVKLJNV1Zgbull httpwwwwashingtonpostcomnationalhealth-sciencein-effort-to-halt-outbreaks-protocol-for-cleaning-medical-scope-is-
updated201503262c0b5d8c-d3e8-11e4-ab77-9646eea6a4c7_storyhtmlbull httpwwwoutpatientsurgerynetsurgical-facility-administrationinfection-controlare-you-cleaning-gi-scopes-properly--10-14bull httpwwwprwebcomreleasesendoscoperepairsprweb11626296htmbull httpwwwmedivatorscomproductsendoscope-reprocessingbrushes-and-flushing-aidsscope-buddy-endoscope-flushing-aidbull httpwwwzutroncomendoscope-leak-testersphpbull httpwwwoptimaxonlinecomremote-visual-inspection-rigid-endoscope83swing-prism-
endoscopePHPSESSID=09ad5b323b4d40e885021856d65aa727bull httpwwwusendoscopycomurologystone-management-and-foreign-body-retrievalmoray-focepsMoray-biopsy-
forcepsaspxVUFVHpPe9Zgbull httpswwwtechno-aidecomstoreproducthydraulic_general_patient_stretcherVUFWXpPe9Zgbull httpswiley-vche-bookshelfdeproductsreading-epubproduct-
id600494titlePractical2BGastrointestinal2BEndoscopyhtmlautr=22Peter+B+Cotton22
CONTACT INFORMATION
Sarah Nolan CCSVP
952-288-2246 Direct
SarahNolanKeySurgicalcom
Key Surgical Inc
800-541-7995
infokeysurgicalcom
Keep Educating Yourself
SCOPES FALL INTO TWO CATEGORIES
Flexible
Rigid (includes semi-rigid)
ANATOMY OF A RIGID ENDOSCOPE
ANATOMY OF A RIGID ENDOSCOPECONTINUEDhellip
Light GuideConnector This is where light enters and illuminates the distal end
Light cable should never be on when not connected to scope
Shaft Houses majority of the optics system
Never hold shaft from distal end- damage easily done
Houses lumen for passage of instrumentsirrigation
Distal End Houses the lens and lens system
Different lens arrangements provide variousangled lines of sight
ANATOMY OF A FLEXIBLE
ENDOSCOPE
Contains plumbing with all outlets for air and
suction
Instruments can be introduced here allowing for
biopsy tools to be used
Location of the control knobs that operate the
flex motion of the distal tip
Contains a dry lubricant that permits the internal
components to move about freely If water
invades the control body and mixes with this dry
lubricant it creates a gritty substance that
causes damage to the internal structures
ANATOMY OF A SCOPE CONTROL BODY
The point of most wear and tear since itrsquos the point that comes in direct contact with
patients during surgery- entering body cavities with varying degrees of pressure
Contains complex wires glass bundles light fibers and channels
The light source is connected at the light connector and is passed through here via
fiber optic channels
ANATOMY OF A SCOPE INSERTION TUBE
Houses the terminal end of the airwater ports and biopsy port
Contains lens covering the imaging system
Contains lens covering the light system
ANATOMY OF A SCOPE BENDING SECTION amp DISTAL TIP
More than 34 million GI endoscopic procedures are performed
annually
Flexible endoscopes are a complex medical device that is made of
materials that are not compatible with all sterilization methods
Endoscopes are used to
Diagnose prevent and treat diseases
Confirm a diagnosis
Deliver therapy
Perform arthroscopic surgeries
Perform laparoscopic surgeries
Allows access to hard to reach cavities without having to open said
cavities via major surgery
WHAT DO ENDOSCOPES DOHOW DO THEY WORK
BASIC STEPS IN REPROCESSING
ENDOSCOPES
Any given endoscope could require upwards of
30 distinct steps in reprocessing according to
the manufacturerrsquos instructions for use
STEP 1 PERSONAL PROTECTIVE EQUIPMENT (PPE)
Most important step is protecting yourself
Wash hands before donning PPE and after removing PPE
Fluid resistant impervious gown- disposable
Chemicalfluid resistant gloves
Mask and shield impervious to fluid
STEP 2 PRE-CLEANING
Happens at the point-of-use immediately afterscope is removed from patient
Important to pre-clean as potentially infectiousmaterials could start to form biofilms that are extremely difficult to remove
Wash the external surfaces of the endoscope
Flush the channels with enzymatic detergent- both rigid and flexible scopes
Visually inspect the distal tip for damage and cleanliness
Attach protective cap to video connector after removing from the light source and suction
Detach and soak all detachable parts
Discard enzymatic detergent solution after each use
STEP 3 TRANSPORTATION
Transport to decontamination area before any
remaining organic matter has a chance to dry
Contain the scope in an enclosed container with a
biohazard label or fluid resistant bag
If using a bag- transport while supporting the
scope from the bottom of the bag so as not to
damage the scope
Each endoscope should be isolated and
transported with its components in its own closed
system to the next stage of processingrdquo AAMI
ST91 2015
STEP 4 LEAKPRESSURE TESTING
Pressurization is required to determine if leaks exist anywhere on the scope
Perform on newrepairedrefurbished scopes
Determine if perforations in outer covering or lining of internal channels may have occurred during manufacturing shipping transportation or use
Manipulate the control knobs of flexible endoscope in all directions to expose surfaces and reveal any small perforations
Perform leakpressure test per manufacturerrsquos instructions for use
Insufflate the scope first (pressurize) then submerge in water to prevent further damage
Make sure any waterproof caps are in place before submerging the scope
Attach flexible endoscope to the leak test system and submerge the entire scope in water Air bubbles indicate a leak in the covering or in a channel
LEAKPRESSURE TESTING CONTINUEDhellip
Make sure there is no detergent in the water as the foam could prevent you from seeing any air bubbles
If you see a leak keep the scope attached to the air pressure until it is completely removed from the water to keep water from entering the channels which could cause more damage
Common places for a leak bending section seams control knobs water cap
If you are using a leak test apparatus that doesnrsquot require water- complete leak testing before submerging scope in water or detergent A leak is present if you see a drop in pressure or if you donrsquot see inflation of the scope
IMPORTANT Never disconnect pressure while scope is fully immersed-only after it is completely depressurized to prevent damage
STEP 5 MANUAL CLEANING Manual cleaning always happens prior to high level disinfection
or entry into an automated endoscope reprocessor
Manual cleaning is more thorough than pre-cleaning
Wipe all external surfaces with a non-linting soft cloth or spongebull For cystoscopes and ureteroscopes use more of a milking action For
gastroscopes and colonoscopes slide the clothsponge down the length of the tubes
Submerge in enzymatic detergent solution as specified in manufacturerrsquos IFU
Consult the manufacturerrsquos IFU for correct measurements of enzymatic cleaners and water levels
MANUAL CLEANING CONTINUEDhellip
Cleaning brushes can be reusable or disposable be sure all brushes are of the correct size for the endoscope channel or port Inspect all reusable brushes to make sure they are in proper working order
Move any elevator cables up and down several times ndash helps to water pick this area with a syringe
Insert brush into submerged endoscope channel
Brush out all ports ndash under water at all times
Inspect brush and manipulate bristles under water to ensure that ALL bioburden saliva lubrication etc is removed before reintroducing brush into channel
Use your eyes Look for bioburdenresidue
STEP 6 DETERGENT FLUSHSUCTION AND WATER
FLUSHRINSE THE SCOPE
Wash the insertion tube and flush the channels using manufacturer issued cleaning adaptors to make sure all components are adequately flushed with detergent If using an automated flushing device like a Scope Buddyreg ndash refer to the manufacturer IFUs for proper flushing of your channels and ports
Airwater channels- one water stream and biopsy channel another water stream when you flush the scope
Flush the elevator channel with a syringe
Rinse scope with water after the detergentflushsuction- rinse off all detergent from the outside of the scope Flushsuction the channels with water
DETERGENT FLUSHSUCTION AND WATER
FLUSHRINSE THE SCOPE CONTINUEDhellip
If you have a smellydirty scope- it cannot safely be high-
level disinfected Use manufacturer recommended or
approved detergent that cleansdissolves fat cells that hold
onto and produce bad smells
Detergents should be used for only one scope and then
discarded
STEP 7 HIGH-LEVEL
DISINFECTIONSTERILIZATION
Flexible endoscopes can be disinfected manually or with an automated endoscope reprocessor
This step always happens AFTER manual cleaning
Immerse scope completely in solution or automated endoscope reprocessor- be sure to consult IFU for exposure times and temperatures
Check elevator channels before and after HLD
Gluteraldahyde OPA paracetic acid hydrogen peroxide can all be used to high level disinfect
Check with manufacturer IFU to see if scope can be put into a sterilizer
STEP 8 INSPECTION
Inspect flexible endoscopes and accessories of all components to determine damages loss of function gross soils as all of these things can result in patient harm
Inspect a scope Before use
During procedure
After procedure
Immediately after decontamination
Before disinfection or sterilization
Accessories to inspect Water bottle and tubing
Biopsy forceps
Cytology brushes
Cleaning brushes
INSPECTION CONTINUEDhellip
If you see damage remove scope from use and contact
service provider
If yoursquore sending your scope back to the manufacturer or a
third party provider package it in an impenetrable material
that complies with the Department of Transportation
shipping regulations and label as biohazard
STEP 9 STORAGE
Flush scope channel with 70-90 ethyl or isopropyl alcohol followed by
low-pressure forced air to dry internal channels
Store scopes in a closed cabinet with proper air circulation
Store scopes with all valvesaccessories removed
Hang scopes vertically without coiling or kinking
to facilitate any additional drying needed
Always store scopes in a way that protects the
scope and minimizes contamination
Be sure to clean and disinfect the storage
cabinets per manufacturerrsquos IFU
STORAGE CONTINUEDhellip
Storage time ranges between 5-24 days Always be sure to
document high-level disinfection dates and specifics
APIC suggests 7 days
AORN and AAMI recommend that each facility perform a risk
assessment to determine proper storage time
Multi-Society Guideline 2011 contamination during storage
negligible for 7-14 days contamination occurs only on exterior
SGNA supports 7 day storage intervals if scopes were
reprocessed and stored according to professional guidelines
and manufacturer IFU
INDUSTRY GUIDELINES
ENDOSCOPE PROCESSING
ldquoUse cleaning brushes appropriate for the size of the endoscope
channel or portrdquo
-CDC Guideline for Disinfection and Sterilization in Healthcare
Facilities 2008 pg 86
ldquoThorough cleaning is essential before high-level disinfection or
sterilization because inorganic or organic materials that remain on
surfaces of instruments interfere with the effectiveness of these
processesrdquo
-CDC Guideline for Disinfection and Sterilization in
Healthcare Facilities 2008
INDUSTRY GUIDELINES CONTINUEDhellip
ldquoCleaning and decontamination should occur as soon as possible after instruments and equipment are used to prevent the formation of biofilm Cleaning and decontamination must be thoroughly accomplished or disinfection and sterilization may not be effectiverdquo
-AORN Section 29 Recommendations V
ldquoManual cleaninghellipis the most important step in removing microbial burden from an endoscopehellipRetained debris may inactivate or interfere with the capabilityhellipto effectively kill andor inactivate microorganismsrdquo
-SGNA Standards of Infection Control in processing of Flexible Gastrointestinal Endoscopes 2013
ldquoCleaning refers to the removal of all visible and non-visible soil and any other foreign material from the medical device being processed It is the most important step in the disinfectionsterilization process Instruments must be thoroughly cleaned and rinsed for subsequent reprocessing steps to be effectiverdquo
-IAHCSMM Central Service Technical Manual 2007
INDUSTRY GUIDELINES CONTINUEDhellip
ldquoPersonnel involved in endoscope processing should be provided education
training and complete competency verification activities related to their duties upon
initial hire annually at designated intervals or whenever new endoscopic models
new processing equipment or products such as new chemicals are introduced for
processingrdquo
-ANSIAAMI ST91 2015 43
ldquoAt a minimum it is recommended that devices are subjected to high-level
disinfection after each use When possible and practical flexible and semi-rigid
endoscopes should be sterilized due to the greater margin of safety built into
sterilizationrdquo
-ANSIAAMI ST91 2015 43
RISKS INVOLVED WITH IMPROPER
PROCESSING OF ENDOSCOPES
Cross-contamination of harmful diseases like Hepatitis B Hepatitis C MRSA HIV CRE High rates of infection transmission
Biofilm growth on endoscope channels
Damage to the scope general diagnostic scopes cost $25-35000 with repair costs ranging from $500-$10000 per repair Ultrasound scopes cost $40-50000 with average repair costs of $8-11000 per repair
Debris on distal tip (camera) could result in the surgeonrsquos inability to adequately see inside the patient
Patient harm due to damaged and dirty scopes
SOURCESContent Sourcesbull ANSIAAMI ST91 2015 Flexible and semi-rigid endoscope processing in health care facilitiesbull Society of Healthcare Epidemiology of America and American Society of Gastrointestinal Endoscopy 2011 bull CDC Guideline for Disinfection and Sterilization in Healthcare Facilities 2008bull AORN Guidelines for Recommended Practice Section 29 Recommendations Vbull SGNA Standards of Infection Control in processing of Flexible Gastrointestinal Endoscopes 2013bull IAHCSMM Central Service Technical Manual 2007bull AAMI Best Practices in Endoscope Reprocessing Webinar 2015bull AAMI Endoscope Reprocessing Critical Training Steps to Promote Patient Safety 2013bull httphealthnvgovhcqchaicleaning_sterilization_disinfection_healthcare_facilitiespdfbull httpwwwsgnaorgPortals0Standard20of20Infection20Prevention_FINALpdf
Image sourcesbull httpswwweducationaldimensionscomeLearnendoscopeanatomyphpbull httpssitesgooglecomsitevoicedisordernodulesdiagnosis-assessmentassessment-proceduresbull httpsurgicalendocombull http1technationcomroundtable-flexible-endoscopybull httpwwwmedical-hospitalbedscomsale-912541-abs-multi-functional-patient-transportation-cart-hospital-stretcher-trolley-als-st004htmlbull httpwwwusendoscopycomendoscopyendoscope-care-and-accessoriesprocedure-kitsVIA-bedside-precleaning-kitaspxVSVKLJNV1Zgbull httpwwwwashingtonpostcomnationalhealth-sciencein-effort-to-halt-outbreaks-protocol-for-cleaning-medical-scope-is-
updated201503262c0b5d8c-d3e8-11e4-ab77-9646eea6a4c7_storyhtmlbull httpwwwoutpatientsurgerynetsurgical-facility-administrationinfection-controlare-you-cleaning-gi-scopes-properly--10-14bull httpwwwprwebcomreleasesendoscoperepairsprweb11626296htmbull httpwwwmedivatorscomproductsendoscope-reprocessingbrushes-and-flushing-aidsscope-buddy-endoscope-flushing-aidbull httpwwwzutroncomendoscope-leak-testersphpbull httpwwwoptimaxonlinecomremote-visual-inspection-rigid-endoscope83swing-prism-
endoscopePHPSESSID=09ad5b323b4d40e885021856d65aa727bull httpwwwusendoscopycomurologystone-management-and-foreign-body-retrievalmoray-focepsMoray-biopsy-
forcepsaspxVUFVHpPe9Zgbull httpswwwtechno-aidecomstoreproducthydraulic_general_patient_stretcherVUFWXpPe9Zgbull httpswiley-vche-bookshelfdeproductsreading-epubproduct-
id600494titlePractical2BGastrointestinal2BEndoscopyhtmlautr=22Peter+B+Cotton22
CONTACT INFORMATION
Sarah Nolan CCSVP
952-288-2246 Direct
SarahNolanKeySurgicalcom
Key Surgical Inc
800-541-7995
infokeysurgicalcom
Keep Educating Yourself
ANATOMY OF A RIGID ENDOSCOPE
ANATOMY OF A RIGID ENDOSCOPECONTINUEDhellip
Light GuideConnector This is where light enters and illuminates the distal end
Light cable should never be on when not connected to scope
Shaft Houses majority of the optics system
Never hold shaft from distal end- damage easily done
Houses lumen for passage of instrumentsirrigation
Distal End Houses the lens and lens system
Different lens arrangements provide variousangled lines of sight
ANATOMY OF A FLEXIBLE
ENDOSCOPE
Contains plumbing with all outlets for air and
suction
Instruments can be introduced here allowing for
biopsy tools to be used
Location of the control knobs that operate the
flex motion of the distal tip
Contains a dry lubricant that permits the internal
components to move about freely If water
invades the control body and mixes with this dry
lubricant it creates a gritty substance that
causes damage to the internal structures
ANATOMY OF A SCOPE CONTROL BODY
The point of most wear and tear since itrsquos the point that comes in direct contact with
patients during surgery- entering body cavities with varying degrees of pressure
Contains complex wires glass bundles light fibers and channels
The light source is connected at the light connector and is passed through here via
fiber optic channels
ANATOMY OF A SCOPE INSERTION TUBE
Houses the terminal end of the airwater ports and biopsy port
Contains lens covering the imaging system
Contains lens covering the light system
ANATOMY OF A SCOPE BENDING SECTION amp DISTAL TIP
More than 34 million GI endoscopic procedures are performed
annually
Flexible endoscopes are a complex medical device that is made of
materials that are not compatible with all sterilization methods
Endoscopes are used to
Diagnose prevent and treat diseases
Confirm a diagnosis
Deliver therapy
Perform arthroscopic surgeries
Perform laparoscopic surgeries
Allows access to hard to reach cavities without having to open said
cavities via major surgery
WHAT DO ENDOSCOPES DOHOW DO THEY WORK
BASIC STEPS IN REPROCESSING
ENDOSCOPES
Any given endoscope could require upwards of
30 distinct steps in reprocessing according to
the manufacturerrsquos instructions for use
STEP 1 PERSONAL PROTECTIVE EQUIPMENT (PPE)
Most important step is protecting yourself
Wash hands before donning PPE and after removing PPE
Fluid resistant impervious gown- disposable
Chemicalfluid resistant gloves
Mask and shield impervious to fluid
STEP 2 PRE-CLEANING
Happens at the point-of-use immediately afterscope is removed from patient
Important to pre-clean as potentially infectiousmaterials could start to form biofilms that are extremely difficult to remove
Wash the external surfaces of the endoscope
Flush the channels with enzymatic detergent- both rigid and flexible scopes
Visually inspect the distal tip for damage and cleanliness
Attach protective cap to video connector after removing from the light source and suction
Detach and soak all detachable parts
Discard enzymatic detergent solution after each use
STEP 3 TRANSPORTATION
Transport to decontamination area before any
remaining organic matter has a chance to dry
Contain the scope in an enclosed container with a
biohazard label or fluid resistant bag
If using a bag- transport while supporting the
scope from the bottom of the bag so as not to
damage the scope
Each endoscope should be isolated and
transported with its components in its own closed
system to the next stage of processingrdquo AAMI
ST91 2015
STEP 4 LEAKPRESSURE TESTING
Pressurization is required to determine if leaks exist anywhere on the scope
Perform on newrepairedrefurbished scopes
Determine if perforations in outer covering or lining of internal channels may have occurred during manufacturing shipping transportation or use
Manipulate the control knobs of flexible endoscope in all directions to expose surfaces and reveal any small perforations
Perform leakpressure test per manufacturerrsquos instructions for use
Insufflate the scope first (pressurize) then submerge in water to prevent further damage
Make sure any waterproof caps are in place before submerging the scope
Attach flexible endoscope to the leak test system and submerge the entire scope in water Air bubbles indicate a leak in the covering or in a channel
LEAKPRESSURE TESTING CONTINUEDhellip
Make sure there is no detergent in the water as the foam could prevent you from seeing any air bubbles
If you see a leak keep the scope attached to the air pressure until it is completely removed from the water to keep water from entering the channels which could cause more damage
Common places for a leak bending section seams control knobs water cap
If you are using a leak test apparatus that doesnrsquot require water- complete leak testing before submerging scope in water or detergent A leak is present if you see a drop in pressure or if you donrsquot see inflation of the scope
IMPORTANT Never disconnect pressure while scope is fully immersed-only after it is completely depressurized to prevent damage
STEP 5 MANUAL CLEANING Manual cleaning always happens prior to high level disinfection
or entry into an automated endoscope reprocessor
Manual cleaning is more thorough than pre-cleaning
Wipe all external surfaces with a non-linting soft cloth or spongebull For cystoscopes and ureteroscopes use more of a milking action For
gastroscopes and colonoscopes slide the clothsponge down the length of the tubes
Submerge in enzymatic detergent solution as specified in manufacturerrsquos IFU
Consult the manufacturerrsquos IFU for correct measurements of enzymatic cleaners and water levels
MANUAL CLEANING CONTINUEDhellip
Cleaning brushes can be reusable or disposable be sure all brushes are of the correct size for the endoscope channel or port Inspect all reusable brushes to make sure they are in proper working order
Move any elevator cables up and down several times ndash helps to water pick this area with a syringe
Insert brush into submerged endoscope channel
Brush out all ports ndash under water at all times
Inspect brush and manipulate bristles under water to ensure that ALL bioburden saliva lubrication etc is removed before reintroducing brush into channel
Use your eyes Look for bioburdenresidue
STEP 6 DETERGENT FLUSHSUCTION AND WATER
FLUSHRINSE THE SCOPE
Wash the insertion tube and flush the channels using manufacturer issued cleaning adaptors to make sure all components are adequately flushed with detergent If using an automated flushing device like a Scope Buddyreg ndash refer to the manufacturer IFUs for proper flushing of your channels and ports
Airwater channels- one water stream and biopsy channel another water stream when you flush the scope
Flush the elevator channel with a syringe
Rinse scope with water after the detergentflushsuction- rinse off all detergent from the outside of the scope Flushsuction the channels with water
DETERGENT FLUSHSUCTION AND WATER
FLUSHRINSE THE SCOPE CONTINUEDhellip
If you have a smellydirty scope- it cannot safely be high-
level disinfected Use manufacturer recommended or
approved detergent that cleansdissolves fat cells that hold
onto and produce bad smells
Detergents should be used for only one scope and then
discarded
STEP 7 HIGH-LEVEL
DISINFECTIONSTERILIZATION
Flexible endoscopes can be disinfected manually or with an automated endoscope reprocessor
This step always happens AFTER manual cleaning
Immerse scope completely in solution or automated endoscope reprocessor- be sure to consult IFU for exposure times and temperatures
Check elevator channels before and after HLD
Gluteraldahyde OPA paracetic acid hydrogen peroxide can all be used to high level disinfect
Check with manufacturer IFU to see if scope can be put into a sterilizer
STEP 8 INSPECTION
Inspect flexible endoscopes and accessories of all components to determine damages loss of function gross soils as all of these things can result in patient harm
Inspect a scope Before use
During procedure
After procedure
Immediately after decontamination
Before disinfection or sterilization
Accessories to inspect Water bottle and tubing
Biopsy forceps
Cytology brushes
Cleaning brushes
INSPECTION CONTINUEDhellip
If you see damage remove scope from use and contact
service provider
If yoursquore sending your scope back to the manufacturer or a
third party provider package it in an impenetrable material
that complies with the Department of Transportation
shipping regulations and label as biohazard
STEP 9 STORAGE
Flush scope channel with 70-90 ethyl or isopropyl alcohol followed by
low-pressure forced air to dry internal channels
Store scopes in a closed cabinet with proper air circulation
Store scopes with all valvesaccessories removed
Hang scopes vertically without coiling or kinking
to facilitate any additional drying needed
Always store scopes in a way that protects the
scope and minimizes contamination
Be sure to clean and disinfect the storage
cabinets per manufacturerrsquos IFU
STORAGE CONTINUEDhellip
Storage time ranges between 5-24 days Always be sure to
document high-level disinfection dates and specifics
APIC suggests 7 days
AORN and AAMI recommend that each facility perform a risk
assessment to determine proper storage time
Multi-Society Guideline 2011 contamination during storage
negligible for 7-14 days contamination occurs only on exterior
SGNA supports 7 day storage intervals if scopes were
reprocessed and stored according to professional guidelines
and manufacturer IFU
INDUSTRY GUIDELINES
ENDOSCOPE PROCESSING
ldquoUse cleaning brushes appropriate for the size of the endoscope
channel or portrdquo
-CDC Guideline for Disinfection and Sterilization in Healthcare
Facilities 2008 pg 86
ldquoThorough cleaning is essential before high-level disinfection or
sterilization because inorganic or organic materials that remain on
surfaces of instruments interfere with the effectiveness of these
processesrdquo
-CDC Guideline for Disinfection and Sterilization in
Healthcare Facilities 2008
INDUSTRY GUIDELINES CONTINUEDhellip
ldquoCleaning and decontamination should occur as soon as possible after instruments and equipment are used to prevent the formation of biofilm Cleaning and decontamination must be thoroughly accomplished or disinfection and sterilization may not be effectiverdquo
-AORN Section 29 Recommendations V
ldquoManual cleaninghellipis the most important step in removing microbial burden from an endoscopehellipRetained debris may inactivate or interfere with the capabilityhellipto effectively kill andor inactivate microorganismsrdquo
-SGNA Standards of Infection Control in processing of Flexible Gastrointestinal Endoscopes 2013
ldquoCleaning refers to the removal of all visible and non-visible soil and any other foreign material from the medical device being processed It is the most important step in the disinfectionsterilization process Instruments must be thoroughly cleaned and rinsed for subsequent reprocessing steps to be effectiverdquo
-IAHCSMM Central Service Technical Manual 2007
INDUSTRY GUIDELINES CONTINUEDhellip
ldquoPersonnel involved in endoscope processing should be provided education
training and complete competency verification activities related to their duties upon
initial hire annually at designated intervals or whenever new endoscopic models
new processing equipment or products such as new chemicals are introduced for
processingrdquo
-ANSIAAMI ST91 2015 43
ldquoAt a minimum it is recommended that devices are subjected to high-level
disinfection after each use When possible and practical flexible and semi-rigid
endoscopes should be sterilized due to the greater margin of safety built into
sterilizationrdquo
-ANSIAAMI ST91 2015 43
RISKS INVOLVED WITH IMPROPER
PROCESSING OF ENDOSCOPES
Cross-contamination of harmful diseases like Hepatitis B Hepatitis C MRSA HIV CRE High rates of infection transmission
Biofilm growth on endoscope channels
Damage to the scope general diagnostic scopes cost $25-35000 with repair costs ranging from $500-$10000 per repair Ultrasound scopes cost $40-50000 with average repair costs of $8-11000 per repair
Debris on distal tip (camera) could result in the surgeonrsquos inability to adequately see inside the patient
Patient harm due to damaged and dirty scopes
SOURCESContent Sourcesbull ANSIAAMI ST91 2015 Flexible and semi-rigid endoscope processing in health care facilitiesbull Society of Healthcare Epidemiology of America and American Society of Gastrointestinal Endoscopy 2011 bull CDC Guideline for Disinfection and Sterilization in Healthcare Facilities 2008bull AORN Guidelines for Recommended Practice Section 29 Recommendations Vbull SGNA Standards of Infection Control in processing of Flexible Gastrointestinal Endoscopes 2013bull IAHCSMM Central Service Technical Manual 2007bull AAMI Best Practices in Endoscope Reprocessing Webinar 2015bull AAMI Endoscope Reprocessing Critical Training Steps to Promote Patient Safety 2013bull httphealthnvgovhcqchaicleaning_sterilization_disinfection_healthcare_facilitiespdfbull httpwwwsgnaorgPortals0Standard20of20Infection20Prevention_FINALpdf
Image sourcesbull httpswwweducationaldimensionscomeLearnendoscopeanatomyphpbull httpssitesgooglecomsitevoicedisordernodulesdiagnosis-assessmentassessment-proceduresbull httpsurgicalendocombull http1technationcomroundtable-flexible-endoscopybull httpwwwmedical-hospitalbedscomsale-912541-abs-multi-functional-patient-transportation-cart-hospital-stretcher-trolley-als-st004htmlbull httpwwwusendoscopycomendoscopyendoscope-care-and-accessoriesprocedure-kitsVIA-bedside-precleaning-kitaspxVSVKLJNV1Zgbull httpwwwwashingtonpostcomnationalhealth-sciencein-effort-to-halt-outbreaks-protocol-for-cleaning-medical-scope-is-
updated201503262c0b5d8c-d3e8-11e4-ab77-9646eea6a4c7_storyhtmlbull httpwwwoutpatientsurgerynetsurgical-facility-administrationinfection-controlare-you-cleaning-gi-scopes-properly--10-14bull httpwwwprwebcomreleasesendoscoperepairsprweb11626296htmbull httpwwwmedivatorscomproductsendoscope-reprocessingbrushes-and-flushing-aidsscope-buddy-endoscope-flushing-aidbull httpwwwzutroncomendoscope-leak-testersphpbull httpwwwoptimaxonlinecomremote-visual-inspection-rigid-endoscope83swing-prism-
endoscopePHPSESSID=09ad5b323b4d40e885021856d65aa727bull httpwwwusendoscopycomurologystone-management-and-foreign-body-retrievalmoray-focepsMoray-biopsy-
forcepsaspxVUFVHpPe9Zgbull httpswwwtechno-aidecomstoreproducthydraulic_general_patient_stretcherVUFWXpPe9Zgbull httpswiley-vche-bookshelfdeproductsreading-epubproduct-
id600494titlePractical2BGastrointestinal2BEndoscopyhtmlautr=22Peter+B+Cotton22
CONTACT INFORMATION
Sarah Nolan CCSVP
952-288-2246 Direct
SarahNolanKeySurgicalcom
Key Surgical Inc
800-541-7995
infokeysurgicalcom
Keep Educating Yourself
ANATOMY OF A RIGID ENDOSCOPECONTINUEDhellip
Light GuideConnector This is where light enters and illuminates the distal end
Light cable should never be on when not connected to scope
Shaft Houses majority of the optics system
Never hold shaft from distal end- damage easily done
Houses lumen for passage of instrumentsirrigation
Distal End Houses the lens and lens system
Different lens arrangements provide variousangled lines of sight
ANATOMY OF A FLEXIBLE
ENDOSCOPE
Contains plumbing with all outlets for air and
suction
Instruments can be introduced here allowing for
biopsy tools to be used
Location of the control knobs that operate the
flex motion of the distal tip
Contains a dry lubricant that permits the internal
components to move about freely If water
invades the control body and mixes with this dry
lubricant it creates a gritty substance that
causes damage to the internal structures
ANATOMY OF A SCOPE CONTROL BODY
The point of most wear and tear since itrsquos the point that comes in direct contact with
patients during surgery- entering body cavities with varying degrees of pressure
Contains complex wires glass bundles light fibers and channels
The light source is connected at the light connector and is passed through here via
fiber optic channels
ANATOMY OF A SCOPE INSERTION TUBE
Houses the terminal end of the airwater ports and biopsy port
Contains lens covering the imaging system
Contains lens covering the light system
ANATOMY OF A SCOPE BENDING SECTION amp DISTAL TIP
More than 34 million GI endoscopic procedures are performed
annually
Flexible endoscopes are a complex medical device that is made of
materials that are not compatible with all sterilization methods
Endoscopes are used to
Diagnose prevent and treat diseases
Confirm a diagnosis
Deliver therapy
Perform arthroscopic surgeries
Perform laparoscopic surgeries
Allows access to hard to reach cavities without having to open said
cavities via major surgery
WHAT DO ENDOSCOPES DOHOW DO THEY WORK
BASIC STEPS IN REPROCESSING
ENDOSCOPES
Any given endoscope could require upwards of
30 distinct steps in reprocessing according to
the manufacturerrsquos instructions for use
STEP 1 PERSONAL PROTECTIVE EQUIPMENT (PPE)
Most important step is protecting yourself
Wash hands before donning PPE and after removing PPE
Fluid resistant impervious gown- disposable
Chemicalfluid resistant gloves
Mask and shield impervious to fluid
STEP 2 PRE-CLEANING
Happens at the point-of-use immediately afterscope is removed from patient
Important to pre-clean as potentially infectiousmaterials could start to form biofilms that are extremely difficult to remove
Wash the external surfaces of the endoscope
Flush the channels with enzymatic detergent- both rigid and flexible scopes
Visually inspect the distal tip for damage and cleanliness
Attach protective cap to video connector after removing from the light source and suction
Detach and soak all detachable parts
Discard enzymatic detergent solution after each use
STEP 3 TRANSPORTATION
Transport to decontamination area before any
remaining organic matter has a chance to dry
Contain the scope in an enclosed container with a
biohazard label or fluid resistant bag
If using a bag- transport while supporting the
scope from the bottom of the bag so as not to
damage the scope
Each endoscope should be isolated and
transported with its components in its own closed
system to the next stage of processingrdquo AAMI
ST91 2015
STEP 4 LEAKPRESSURE TESTING
Pressurization is required to determine if leaks exist anywhere on the scope
Perform on newrepairedrefurbished scopes
Determine if perforations in outer covering or lining of internal channels may have occurred during manufacturing shipping transportation or use
Manipulate the control knobs of flexible endoscope in all directions to expose surfaces and reveal any small perforations
Perform leakpressure test per manufacturerrsquos instructions for use
Insufflate the scope first (pressurize) then submerge in water to prevent further damage
Make sure any waterproof caps are in place before submerging the scope
Attach flexible endoscope to the leak test system and submerge the entire scope in water Air bubbles indicate a leak in the covering or in a channel
LEAKPRESSURE TESTING CONTINUEDhellip
Make sure there is no detergent in the water as the foam could prevent you from seeing any air bubbles
If you see a leak keep the scope attached to the air pressure until it is completely removed from the water to keep water from entering the channels which could cause more damage
Common places for a leak bending section seams control knobs water cap
If you are using a leak test apparatus that doesnrsquot require water- complete leak testing before submerging scope in water or detergent A leak is present if you see a drop in pressure or if you donrsquot see inflation of the scope
IMPORTANT Never disconnect pressure while scope is fully immersed-only after it is completely depressurized to prevent damage
STEP 5 MANUAL CLEANING Manual cleaning always happens prior to high level disinfection
or entry into an automated endoscope reprocessor
Manual cleaning is more thorough than pre-cleaning
Wipe all external surfaces with a non-linting soft cloth or spongebull For cystoscopes and ureteroscopes use more of a milking action For
gastroscopes and colonoscopes slide the clothsponge down the length of the tubes
Submerge in enzymatic detergent solution as specified in manufacturerrsquos IFU
Consult the manufacturerrsquos IFU for correct measurements of enzymatic cleaners and water levels
MANUAL CLEANING CONTINUEDhellip
Cleaning brushes can be reusable or disposable be sure all brushes are of the correct size for the endoscope channel or port Inspect all reusable brushes to make sure they are in proper working order
Move any elevator cables up and down several times ndash helps to water pick this area with a syringe
Insert brush into submerged endoscope channel
Brush out all ports ndash under water at all times
Inspect brush and manipulate bristles under water to ensure that ALL bioburden saliva lubrication etc is removed before reintroducing brush into channel
Use your eyes Look for bioburdenresidue
STEP 6 DETERGENT FLUSHSUCTION AND WATER
FLUSHRINSE THE SCOPE
Wash the insertion tube and flush the channels using manufacturer issued cleaning adaptors to make sure all components are adequately flushed with detergent If using an automated flushing device like a Scope Buddyreg ndash refer to the manufacturer IFUs for proper flushing of your channels and ports
Airwater channels- one water stream and biopsy channel another water stream when you flush the scope
Flush the elevator channel with a syringe
Rinse scope with water after the detergentflushsuction- rinse off all detergent from the outside of the scope Flushsuction the channels with water
DETERGENT FLUSHSUCTION AND WATER
FLUSHRINSE THE SCOPE CONTINUEDhellip
If you have a smellydirty scope- it cannot safely be high-
level disinfected Use manufacturer recommended or
approved detergent that cleansdissolves fat cells that hold
onto and produce bad smells
Detergents should be used for only one scope and then
discarded
STEP 7 HIGH-LEVEL
DISINFECTIONSTERILIZATION
Flexible endoscopes can be disinfected manually or with an automated endoscope reprocessor
This step always happens AFTER manual cleaning
Immerse scope completely in solution or automated endoscope reprocessor- be sure to consult IFU for exposure times and temperatures
Check elevator channels before and after HLD
Gluteraldahyde OPA paracetic acid hydrogen peroxide can all be used to high level disinfect
Check with manufacturer IFU to see if scope can be put into a sterilizer
STEP 8 INSPECTION
Inspect flexible endoscopes and accessories of all components to determine damages loss of function gross soils as all of these things can result in patient harm
Inspect a scope Before use
During procedure
After procedure
Immediately after decontamination
Before disinfection or sterilization
Accessories to inspect Water bottle and tubing
Biopsy forceps
Cytology brushes
Cleaning brushes
INSPECTION CONTINUEDhellip
If you see damage remove scope from use and contact
service provider
If yoursquore sending your scope back to the manufacturer or a
third party provider package it in an impenetrable material
that complies with the Department of Transportation
shipping regulations and label as biohazard
STEP 9 STORAGE
Flush scope channel with 70-90 ethyl or isopropyl alcohol followed by
low-pressure forced air to dry internal channels
Store scopes in a closed cabinet with proper air circulation
Store scopes with all valvesaccessories removed
Hang scopes vertically without coiling or kinking
to facilitate any additional drying needed
Always store scopes in a way that protects the
scope and minimizes contamination
Be sure to clean and disinfect the storage
cabinets per manufacturerrsquos IFU
STORAGE CONTINUEDhellip
Storage time ranges between 5-24 days Always be sure to
document high-level disinfection dates and specifics
APIC suggests 7 days
AORN and AAMI recommend that each facility perform a risk
assessment to determine proper storage time
Multi-Society Guideline 2011 contamination during storage
negligible for 7-14 days contamination occurs only on exterior
SGNA supports 7 day storage intervals if scopes were
reprocessed and stored according to professional guidelines
and manufacturer IFU
INDUSTRY GUIDELINES
ENDOSCOPE PROCESSING
ldquoUse cleaning brushes appropriate for the size of the endoscope
channel or portrdquo
-CDC Guideline for Disinfection and Sterilization in Healthcare
Facilities 2008 pg 86
ldquoThorough cleaning is essential before high-level disinfection or
sterilization because inorganic or organic materials that remain on
surfaces of instruments interfere with the effectiveness of these
processesrdquo
-CDC Guideline for Disinfection and Sterilization in
Healthcare Facilities 2008
INDUSTRY GUIDELINES CONTINUEDhellip
ldquoCleaning and decontamination should occur as soon as possible after instruments and equipment are used to prevent the formation of biofilm Cleaning and decontamination must be thoroughly accomplished or disinfection and sterilization may not be effectiverdquo
-AORN Section 29 Recommendations V
ldquoManual cleaninghellipis the most important step in removing microbial burden from an endoscopehellipRetained debris may inactivate or interfere with the capabilityhellipto effectively kill andor inactivate microorganismsrdquo
-SGNA Standards of Infection Control in processing of Flexible Gastrointestinal Endoscopes 2013
ldquoCleaning refers to the removal of all visible and non-visible soil and any other foreign material from the medical device being processed It is the most important step in the disinfectionsterilization process Instruments must be thoroughly cleaned and rinsed for subsequent reprocessing steps to be effectiverdquo
-IAHCSMM Central Service Technical Manual 2007
INDUSTRY GUIDELINES CONTINUEDhellip
ldquoPersonnel involved in endoscope processing should be provided education
training and complete competency verification activities related to their duties upon
initial hire annually at designated intervals or whenever new endoscopic models
new processing equipment or products such as new chemicals are introduced for
processingrdquo
-ANSIAAMI ST91 2015 43
ldquoAt a minimum it is recommended that devices are subjected to high-level
disinfection after each use When possible and practical flexible and semi-rigid
endoscopes should be sterilized due to the greater margin of safety built into
sterilizationrdquo
-ANSIAAMI ST91 2015 43
RISKS INVOLVED WITH IMPROPER
PROCESSING OF ENDOSCOPES
Cross-contamination of harmful diseases like Hepatitis B Hepatitis C MRSA HIV CRE High rates of infection transmission
Biofilm growth on endoscope channels
Damage to the scope general diagnostic scopes cost $25-35000 with repair costs ranging from $500-$10000 per repair Ultrasound scopes cost $40-50000 with average repair costs of $8-11000 per repair
Debris on distal tip (camera) could result in the surgeonrsquos inability to adequately see inside the patient
Patient harm due to damaged and dirty scopes
SOURCESContent Sourcesbull ANSIAAMI ST91 2015 Flexible and semi-rigid endoscope processing in health care facilitiesbull Society of Healthcare Epidemiology of America and American Society of Gastrointestinal Endoscopy 2011 bull CDC Guideline for Disinfection and Sterilization in Healthcare Facilities 2008bull AORN Guidelines for Recommended Practice Section 29 Recommendations Vbull SGNA Standards of Infection Control in processing of Flexible Gastrointestinal Endoscopes 2013bull IAHCSMM Central Service Technical Manual 2007bull AAMI Best Practices in Endoscope Reprocessing Webinar 2015bull AAMI Endoscope Reprocessing Critical Training Steps to Promote Patient Safety 2013bull httphealthnvgovhcqchaicleaning_sterilization_disinfection_healthcare_facilitiespdfbull httpwwwsgnaorgPortals0Standard20of20Infection20Prevention_FINALpdf
Image sourcesbull httpswwweducationaldimensionscomeLearnendoscopeanatomyphpbull httpssitesgooglecomsitevoicedisordernodulesdiagnosis-assessmentassessment-proceduresbull httpsurgicalendocombull http1technationcomroundtable-flexible-endoscopybull httpwwwmedical-hospitalbedscomsale-912541-abs-multi-functional-patient-transportation-cart-hospital-stretcher-trolley-als-st004htmlbull httpwwwusendoscopycomendoscopyendoscope-care-and-accessoriesprocedure-kitsVIA-bedside-precleaning-kitaspxVSVKLJNV1Zgbull httpwwwwashingtonpostcomnationalhealth-sciencein-effort-to-halt-outbreaks-protocol-for-cleaning-medical-scope-is-
updated201503262c0b5d8c-d3e8-11e4-ab77-9646eea6a4c7_storyhtmlbull httpwwwoutpatientsurgerynetsurgical-facility-administrationinfection-controlare-you-cleaning-gi-scopes-properly--10-14bull httpwwwprwebcomreleasesendoscoperepairsprweb11626296htmbull httpwwwmedivatorscomproductsendoscope-reprocessingbrushes-and-flushing-aidsscope-buddy-endoscope-flushing-aidbull httpwwwzutroncomendoscope-leak-testersphpbull httpwwwoptimaxonlinecomremote-visual-inspection-rigid-endoscope83swing-prism-
endoscopePHPSESSID=09ad5b323b4d40e885021856d65aa727bull httpwwwusendoscopycomurologystone-management-and-foreign-body-retrievalmoray-focepsMoray-biopsy-
forcepsaspxVUFVHpPe9Zgbull httpswwwtechno-aidecomstoreproducthydraulic_general_patient_stretcherVUFWXpPe9Zgbull httpswiley-vche-bookshelfdeproductsreading-epubproduct-
id600494titlePractical2BGastrointestinal2BEndoscopyhtmlautr=22Peter+B+Cotton22
CONTACT INFORMATION
Sarah Nolan CCSVP
952-288-2246 Direct
SarahNolanKeySurgicalcom
Key Surgical Inc
800-541-7995
infokeysurgicalcom
Keep Educating Yourself
ANATOMY OF A FLEXIBLE
ENDOSCOPE
Contains plumbing with all outlets for air and
suction
Instruments can be introduced here allowing for
biopsy tools to be used
Location of the control knobs that operate the
flex motion of the distal tip
Contains a dry lubricant that permits the internal
components to move about freely If water
invades the control body and mixes with this dry
lubricant it creates a gritty substance that
causes damage to the internal structures
ANATOMY OF A SCOPE CONTROL BODY
The point of most wear and tear since itrsquos the point that comes in direct contact with
patients during surgery- entering body cavities with varying degrees of pressure
Contains complex wires glass bundles light fibers and channels
The light source is connected at the light connector and is passed through here via
fiber optic channels
ANATOMY OF A SCOPE INSERTION TUBE
Houses the terminal end of the airwater ports and biopsy port
Contains lens covering the imaging system
Contains lens covering the light system
ANATOMY OF A SCOPE BENDING SECTION amp DISTAL TIP
More than 34 million GI endoscopic procedures are performed
annually
Flexible endoscopes are a complex medical device that is made of
materials that are not compatible with all sterilization methods
Endoscopes are used to
Diagnose prevent and treat diseases
Confirm a diagnosis
Deliver therapy
Perform arthroscopic surgeries
Perform laparoscopic surgeries
Allows access to hard to reach cavities without having to open said
cavities via major surgery
WHAT DO ENDOSCOPES DOHOW DO THEY WORK
BASIC STEPS IN REPROCESSING
ENDOSCOPES
Any given endoscope could require upwards of
30 distinct steps in reprocessing according to
the manufacturerrsquos instructions for use
STEP 1 PERSONAL PROTECTIVE EQUIPMENT (PPE)
Most important step is protecting yourself
Wash hands before donning PPE and after removing PPE
Fluid resistant impervious gown- disposable
Chemicalfluid resistant gloves
Mask and shield impervious to fluid
STEP 2 PRE-CLEANING
Happens at the point-of-use immediately afterscope is removed from patient
Important to pre-clean as potentially infectiousmaterials could start to form biofilms that are extremely difficult to remove
Wash the external surfaces of the endoscope
Flush the channels with enzymatic detergent- both rigid and flexible scopes
Visually inspect the distal tip for damage and cleanliness
Attach protective cap to video connector after removing from the light source and suction
Detach and soak all detachable parts
Discard enzymatic detergent solution after each use
STEP 3 TRANSPORTATION
Transport to decontamination area before any
remaining organic matter has a chance to dry
Contain the scope in an enclosed container with a
biohazard label or fluid resistant bag
If using a bag- transport while supporting the
scope from the bottom of the bag so as not to
damage the scope
Each endoscope should be isolated and
transported with its components in its own closed
system to the next stage of processingrdquo AAMI
ST91 2015
STEP 4 LEAKPRESSURE TESTING
Pressurization is required to determine if leaks exist anywhere on the scope
Perform on newrepairedrefurbished scopes
Determine if perforations in outer covering or lining of internal channels may have occurred during manufacturing shipping transportation or use
Manipulate the control knobs of flexible endoscope in all directions to expose surfaces and reveal any small perforations
Perform leakpressure test per manufacturerrsquos instructions for use
Insufflate the scope first (pressurize) then submerge in water to prevent further damage
Make sure any waterproof caps are in place before submerging the scope
Attach flexible endoscope to the leak test system and submerge the entire scope in water Air bubbles indicate a leak in the covering or in a channel
LEAKPRESSURE TESTING CONTINUEDhellip
Make sure there is no detergent in the water as the foam could prevent you from seeing any air bubbles
If you see a leak keep the scope attached to the air pressure until it is completely removed from the water to keep water from entering the channels which could cause more damage
Common places for a leak bending section seams control knobs water cap
If you are using a leak test apparatus that doesnrsquot require water- complete leak testing before submerging scope in water or detergent A leak is present if you see a drop in pressure or if you donrsquot see inflation of the scope
IMPORTANT Never disconnect pressure while scope is fully immersed-only after it is completely depressurized to prevent damage
STEP 5 MANUAL CLEANING Manual cleaning always happens prior to high level disinfection
or entry into an automated endoscope reprocessor
Manual cleaning is more thorough than pre-cleaning
Wipe all external surfaces with a non-linting soft cloth or spongebull For cystoscopes and ureteroscopes use more of a milking action For
gastroscopes and colonoscopes slide the clothsponge down the length of the tubes
Submerge in enzymatic detergent solution as specified in manufacturerrsquos IFU
Consult the manufacturerrsquos IFU for correct measurements of enzymatic cleaners and water levels
MANUAL CLEANING CONTINUEDhellip
Cleaning brushes can be reusable or disposable be sure all brushes are of the correct size for the endoscope channel or port Inspect all reusable brushes to make sure they are in proper working order
Move any elevator cables up and down several times ndash helps to water pick this area with a syringe
Insert brush into submerged endoscope channel
Brush out all ports ndash under water at all times
Inspect brush and manipulate bristles under water to ensure that ALL bioburden saliva lubrication etc is removed before reintroducing brush into channel
Use your eyes Look for bioburdenresidue
STEP 6 DETERGENT FLUSHSUCTION AND WATER
FLUSHRINSE THE SCOPE
Wash the insertion tube and flush the channels using manufacturer issued cleaning adaptors to make sure all components are adequately flushed with detergent If using an automated flushing device like a Scope Buddyreg ndash refer to the manufacturer IFUs for proper flushing of your channels and ports
Airwater channels- one water stream and biopsy channel another water stream when you flush the scope
Flush the elevator channel with a syringe
Rinse scope with water after the detergentflushsuction- rinse off all detergent from the outside of the scope Flushsuction the channels with water
DETERGENT FLUSHSUCTION AND WATER
FLUSHRINSE THE SCOPE CONTINUEDhellip
If you have a smellydirty scope- it cannot safely be high-
level disinfected Use manufacturer recommended or
approved detergent that cleansdissolves fat cells that hold
onto and produce bad smells
Detergents should be used for only one scope and then
discarded
STEP 7 HIGH-LEVEL
DISINFECTIONSTERILIZATION
Flexible endoscopes can be disinfected manually or with an automated endoscope reprocessor
This step always happens AFTER manual cleaning
Immerse scope completely in solution or automated endoscope reprocessor- be sure to consult IFU for exposure times and temperatures
Check elevator channels before and after HLD
Gluteraldahyde OPA paracetic acid hydrogen peroxide can all be used to high level disinfect
Check with manufacturer IFU to see if scope can be put into a sterilizer
STEP 8 INSPECTION
Inspect flexible endoscopes and accessories of all components to determine damages loss of function gross soils as all of these things can result in patient harm
Inspect a scope Before use
During procedure
After procedure
Immediately after decontamination
Before disinfection or sterilization
Accessories to inspect Water bottle and tubing
Biopsy forceps
Cytology brushes
Cleaning brushes
INSPECTION CONTINUEDhellip
If you see damage remove scope from use and contact
service provider
If yoursquore sending your scope back to the manufacturer or a
third party provider package it in an impenetrable material
that complies with the Department of Transportation
shipping regulations and label as biohazard
STEP 9 STORAGE
Flush scope channel with 70-90 ethyl or isopropyl alcohol followed by
low-pressure forced air to dry internal channels
Store scopes in a closed cabinet with proper air circulation
Store scopes with all valvesaccessories removed
Hang scopes vertically without coiling or kinking
to facilitate any additional drying needed
Always store scopes in a way that protects the
scope and minimizes contamination
Be sure to clean and disinfect the storage
cabinets per manufacturerrsquos IFU
STORAGE CONTINUEDhellip
Storage time ranges between 5-24 days Always be sure to
document high-level disinfection dates and specifics
APIC suggests 7 days
AORN and AAMI recommend that each facility perform a risk
assessment to determine proper storage time
Multi-Society Guideline 2011 contamination during storage
negligible for 7-14 days contamination occurs only on exterior
SGNA supports 7 day storage intervals if scopes were
reprocessed and stored according to professional guidelines
and manufacturer IFU
INDUSTRY GUIDELINES
ENDOSCOPE PROCESSING
ldquoUse cleaning brushes appropriate for the size of the endoscope
channel or portrdquo
-CDC Guideline for Disinfection and Sterilization in Healthcare
Facilities 2008 pg 86
ldquoThorough cleaning is essential before high-level disinfection or
sterilization because inorganic or organic materials that remain on
surfaces of instruments interfere with the effectiveness of these
processesrdquo
-CDC Guideline for Disinfection and Sterilization in
Healthcare Facilities 2008
INDUSTRY GUIDELINES CONTINUEDhellip
ldquoCleaning and decontamination should occur as soon as possible after instruments and equipment are used to prevent the formation of biofilm Cleaning and decontamination must be thoroughly accomplished or disinfection and sterilization may not be effectiverdquo
-AORN Section 29 Recommendations V
ldquoManual cleaninghellipis the most important step in removing microbial burden from an endoscopehellipRetained debris may inactivate or interfere with the capabilityhellipto effectively kill andor inactivate microorganismsrdquo
-SGNA Standards of Infection Control in processing of Flexible Gastrointestinal Endoscopes 2013
ldquoCleaning refers to the removal of all visible and non-visible soil and any other foreign material from the medical device being processed It is the most important step in the disinfectionsterilization process Instruments must be thoroughly cleaned and rinsed for subsequent reprocessing steps to be effectiverdquo
-IAHCSMM Central Service Technical Manual 2007
INDUSTRY GUIDELINES CONTINUEDhellip
ldquoPersonnel involved in endoscope processing should be provided education
training and complete competency verification activities related to their duties upon
initial hire annually at designated intervals or whenever new endoscopic models
new processing equipment or products such as new chemicals are introduced for
processingrdquo
-ANSIAAMI ST91 2015 43
ldquoAt a minimum it is recommended that devices are subjected to high-level
disinfection after each use When possible and practical flexible and semi-rigid
endoscopes should be sterilized due to the greater margin of safety built into
sterilizationrdquo
-ANSIAAMI ST91 2015 43
RISKS INVOLVED WITH IMPROPER
PROCESSING OF ENDOSCOPES
Cross-contamination of harmful diseases like Hepatitis B Hepatitis C MRSA HIV CRE High rates of infection transmission
Biofilm growth on endoscope channels
Damage to the scope general diagnostic scopes cost $25-35000 with repair costs ranging from $500-$10000 per repair Ultrasound scopes cost $40-50000 with average repair costs of $8-11000 per repair
Debris on distal tip (camera) could result in the surgeonrsquos inability to adequately see inside the patient
Patient harm due to damaged and dirty scopes
SOURCESContent Sourcesbull ANSIAAMI ST91 2015 Flexible and semi-rigid endoscope processing in health care facilitiesbull Society of Healthcare Epidemiology of America and American Society of Gastrointestinal Endoscopy 2011 bull CDC Guideline for Disinfection and Sterilization in Healthcare Facilities 2008bull AORN Guidelines for Recommended Practice Section 29 Recommendations Vbull SGNA Standards of Infection Control in processing of Flexible Gastrointestinal Endoscopes 2013bull IAHCSMM Central Service Technical Manual 2007bull AAMI Best Practices in Endoscope Reprocessing Webinar 2015bull AAMI Endoscope Reprocessing Critical Training Steps to Promote Patient Safety 2013bull httphealthnvgovhcqchaicleaning_sterilization_disinfection_healthcare_facilitiespdfbull httpwwwsgnaorgPortals0Standard20of20Infection20Prevention_FINALpdf
Image sourcesbull httpswwweducationaldimensionscomeLearnendoscopeanatomyphpbull httpssitesgooglecomsitevoicedisordernodulesdiagnosis-assessmentassessment-proceduresbull httpsurgicalendocombull http1technationcomroundtable-flexible-endoscopybull httpwwwmedical-hospitalbedscomsale-912541-abs-multi-functional-patient-transportation-cart-hospital-stretcher-trolley-als-st004htmlbull httpwwwusendoscopycomendoscopyendoscope-care-and-accessoriesprocedure-kitsVIA-bedside-precleaning-kitaspxVSVKLJNV1Zgbull httpwwwwashingtonpostcomnationalhealth-sciencein-effort-to-halt-outbreaks-protocol-for-cleaning-medical-scope-is-
updated201503262c0b5d8c-d3e8-11e4-ab77-9646eea6a4c7_storyhtmlbull httpwwwoutpatientsurgerynetsurgical-facility-administrationinfection-controlare-you-cleaning-gi-scopes-properly--10-14bull httpwwwprwebcomreleasesendoscoperepairsprweb11626296htmbull httpwwwmedivatorscomproductsendoscope-reprocessingbrushes-and-flushing-aidsscope-buddy-endoscope-flushing-aidbull httpwwwzutroncomendoscope-leak-testersphpbull httpwwwoptimaxonlinecomremote-visual-inspection-rigid-endoscope83swing-prism-
endoscopePHPSESSID=09ad5b323b4d40e885021856d65aa727bull httpwwwusendoscopycomurologystone-management-and-foreign-body-retrievalmoray-focepsMoray-biopsy-
forcepsaspxVUFVHpPe9Zgbull httpswwwtechno-aidecomstoreproducthydraulic_general_patient_stretcherVUFWXpPe9Zgbull httpswiley-vche-bookshelfdeproductsreading-epubproduct-
id600494titlePractical2BGastrointestinal2BEndoscopyhtmlautr=22Peter+B+Cotton22
CONTACT INFORMATION
Sarah Nolan CCSVP
952-288-2246 Direct
SarahNolanKeySurgicalcom
Key Surgical Inc
800-541-7995
infokeysurgicalcom
Keep Educating Yourself
Contains plumbing with all outlets for air and
suction
Instruments can be introduced here allowing for
biopsy tools to be used
Location of the control knobs that operate the
flex motion of the distal tip
Contains a dry lubricant that permits the internal
components to move about freely If water
invades the control body and mixes with this dry
lubricant it creates a gritty substance that
causes damage to the internal structures
ANATOMY OF A SCOPE CONTROL BODY
The point of most wear and tear since itrsquos the point that comes in direct contact with
patients during surgery- entering body cavities with varying degrees of pressure
Contains complex wires glass bundles light fibers and channels
The light source is connected at the light connector and is passed through here via
fiber optic channels
ANATOMY OF A SCOPE INSERTION TUBE
Houses the terminal end of the airwater ports and biopsy port
Contains lens covering the imaging system
Contains lens covering the light system
ANATOMY OF A SCOPE BENDING SECTION amp DISTAL TIP
More than 34 million GI endoscopic procedures are performed
annually
Flexible endoscopes are a complex medical device that is made of
materials that are not compatible with all sterilization methods
Endoscopes are used to
Diagnose prevent and treat diseases
Confirm a diagnosis
Deliver therapy
Perform arthroscopic surgeries
Perform laparoscopic surgeries
Allows access to hard to reach cavities without having to open said
cavities via major surgery
WHAT DO ENDOSCOPES DOHOW DO THEY WORK
BASIC STEPS IN REPROCESSING
ENDOSCOPES
Any given endoscope could require upwards of
30 distinct steps in reprocessing according to
the manufacturerrsquos instructions for use
STEP 1 PERSONAL PROTECTIVE EQUIPMENT (PPE)
Most important step is protecting yourself
Wash hands before donning PPE and after removing PPE
Fluid resistant impervious gown- disposable
Chemicalfluid resistant gloves
Mask and shield impervious to fluid
STEP 2 PRE-CLEANING
Happens at the point-of-use immediately afterscope is removed from patient
Important to pre-clean as potentially infectiousmaterials could start to form biofilms that are extremely difficult to remove
Wash the external surfaces of the endoscope
Flush the channels with enzymatic detergent- both rigid and flexible scopes
Visually inspect the distal tip for damage and cleanliness
Attach protective cap to video connector after removing from the light source and suction
Detach and soak all detachable parts
Discard enzymatic detergent solution after each use
STEP 3 TRANSPORTATION
Transport to decontamination area before any
remaining organic matter has a chance to dry
Contain the scope in an enclosed container with a
biohazard label or fluid resistant bag
If using a bag- transport while supporting the
scope from the bottom of the bag so as not to
damage the scope
Each endoscope should be isolated and
transported with its components in its own closed
system to the next stage of processingrdquo AAMI
ST91 2015
STEP 4 LEAKPRESSURE TESTING
Pressurization is required to determine if leaks exist anywhere on the scope
Perform on newrepairedrefurbished scopes
Determine if perforations in outer covering or lining of internal channels may have occurred during manufacturing shipping transportation or use
Manipulate the control knobs of flexible endoscope in all directions to expose surfaces and reveal any small perforations
Perform leakpressure test per manufacturerrsquos instructions for use
Insufflate the scope first (pressurize) then submerge in water to prevent further damage
Make sure any waterproof caps are in place before submerging the scope
Attach flexible endoscope to the leak test system and submerge the entire scope in water Air bubbles indicate a leak in the covering or in a channel
LEAKPRESSURE TESTING CONTINUEDhellip
Make sure there is no detergent in the water as the foam could prevent you from seeing any air bubbles
If you see a leak keep the scope attached to the air pressure until it is completely removed from the water to keep water from entering the channels which could cause more damage
Common places for a leak bending section seams control knobs water cap
If you are using a leak test apparatus that doesnrsquot require water- complete leak testing before submerging scope in water or detergent A leak is present if you see a drop in pressure or if you donrsquot see inflation of the scope
IMPORTANT Never disconnect pressure while scope is fully immersed-only after it is completely depressurized to prevent damage
STEP 5 MANUAL CLEANING Manual cleaning always happens prior to high level disinfection
or entry into an automated endoscope reprocessor
Manual cleaning is more thorough than pre-cleaning
Wipe all external surfaces with a non-linting soft cloth or spongebull For cystoscopes and ureteroscopes use more of a milking action For
gastroscopes and colonoscopes slide the clothsponge down the length of the tubes
Submerge in enzymatic detergent solution as specified in manufacturerrsquos IFU
Consult the manufacturerrsquos IFU for correct measurements of enzymatic cleaners and water levels
MANUAL CLEANING CONTINUEDhellip
Cleaning brushes can be reusable or disposable be sure all brushes are of the correct size for the endoscope channel or port Inspect all reusable brushes to make sure they are in proper working order
Move any elevator cables up and down several times ndash helps to water pick this area with a syringe
Insert brush into submerged endoscope channel
Brush out all ports ndash under water at all times
Inspect brush and manipulate bristles under water to ensure that ALL bioburden saliva lubrication etc is removed before reintroducing brush into channel
Use your eyes Look for bioburdenresidue
STEP 6 DETERGENT FLUSHSUCTION AND WATER
FLUSHRINSE THE SCOPE
Wash the insertion tube and flush the channels using manufacturer issued cleaning adaptors to make sure all components are adequately flushed with detergent If using an automated flushing device like a Scope Buddyreg ndash refer to the manufacturer IFUs for proper flushing of your channels and ports
Airwater channels- one water stream and biopsy channel another water stream when you flush the scope
Flush the elevator channel with a syringe
Rinse scope with water after the detergentflushsuction- rinse off all detergent from the outside of the scope Flushsuction the channels with water
DETERGENT FLUSHSUCTION AND WATER
FLUSHRINSE THE SCOPE CONTINUEDhellip
If you have a smellydirty scope- it cannot safely be high-
level disinfected Use manufacturer recommended or
approved detergent that cleansdissolves fat cells that hold
onto and produce bad smells
Detergents should be used for only one scope and then
discarded
STEP 7 HIGH-LEVEL
DISINFECTIONSTERILIZATION
Flexible endoscopes can be disinfected manually or with an automated endoscope reprocessor
This step always happens AFTER manual cleaning
Immerse scope completely in solution or automated endoscope reprocessor- be sure to consult IFU for exposure times and temperatures
Check elevator channels before and after HLD
Gluteraldahyde OPA paracetic acid hydrogen peroxide can all be used to high level disinfect
Check with manufacturer IFU to see if scope can be put into a sterilizer
STEP 8 INSPECTION
Inspect flexible endoscopes and accessories of all components to determine damages loss of function gross soils as all of these things can result in patient harm
Inspect a scope Before use
During procedure
After procedure
Immediately after decontamination
Before disinfection or sterilization
Accessories to inspect Water bottle and tubing
Biopsy forceps
Cytology brushes
Cleaning brushes
INSPECTION CONTINUEDhellip
If you see damage remove scope from use and contact
service provider
If yoursquore sending your scope back to the manufacturer or a
third party provider package it in an impenetrable material
that complies with the Department of Transportation
shipping regulations and label as biohazard
STEP 9 STORAGE
Flush scope channel with 70-90 ethyl or isopropyl alcohol followed by
low-pressure forced air to dry internal channels
Store scopes in a closed cabinet with proper air circulation
Store scopes with all valvesaccessories removed
Hang scopes vertically without coiling or kinking
to facilitate any additional drying needed
Always store scopes in a way that protects the
scope and minimizes contamination
Be sure to clean and disinfect the storage
cabinets per manufacturerrsquos IFU
STORAGE CONTINUEDhellip
Storage time ranges between 5-24 days Always be sure to
document high-level disinfection dates and specifics
APIC suggests 7 days
AORN and AAMI recommend that each facility perform a risk
assessment to determine proper storage time
Multi-Society Guideline 2011 contamination during storage
negligible for 7-14 days contamination occurs only on exterior
SGNA supports 7 day storage intervals if scopes were
reprocessed and stored according to professional guidelines
and manufacturer IFU
INDUSTRY GUIDELINES
ENDOSCOPE PROCESSING
ldquoUse cleaning brushes appropriate for the size of the endoscope
channel or portrdquo
-CDC Guideline for Disinfection and Sterilization in Healthcare
Facilities 2008 pg 86
ldquoThorough cleaning is essential before high-level disinfection or
sterilization because inorganic or organic materials that remain on
surfaces of instruments interfere with the effectiveness of these
processesrdquo
-CDC Guideline for Disinfection and Sterilization in
Healthcare Facilities 2008
INDUSTRY GUIDELINES CONTINUEDhellip
ldquoCleaning and decontamination should occur as soon as possible after instruments and equipment are used to prevent the formation of biofilm Cleaning and decontamination must be thoroughly accomplished or disinfection and sterilization may not be effectiverdquo
-AORN Section 29 Recommendations V
ldquoManual cleaninghellipis the most important step in removing microbial burden from an endoscopehellipRetained debris may inactivate or interfere with the capabilityhellipto effectively kill andor inactivate microorganismsrdquo
-SGNA Standards of Infection Control in processing of Flexible Gastrointestinal Endoscopes 2013
ldquoCleaning refers to the removal of all visible and non-visible soil and any other foreign material from the medical device being processed It is the most important step in the disinfectionsterilization process Instruments must be thoroughly cleaned and rinsed for subsequent reprocessing steps to be effectiverdquo
-IAHCSMM Central Service Technical Manual 2007
INDUSTRY GUIDELINES CONTINUEDhellip
ldquoPersonnel involved in endoscope processing should be provided education
training and complete competency verification activities related to their duties upon
initial hire annually at designated intervals or whenever new endoscopic models
new processing equipment or products such as new chemicals are introduced for
processingrdquo
-ANSIAAMI ST91 2015 43
ldquoAt a minimum it is recommended that devices are subjected to high-level
disinfection after each use When possible and practical flexible and semi-rigid
endoscopes should be sterilized due to the greater margin of safety built into
sterilizationrdquo
-ANSIAAMI ST91 2015 43
RISKS INVOLVED WITH IMPROPER
PROCESSING OF ENDOSCOPES
Cross-contamination of harmful diseases like Hepatitis B Hepatitis C MRSA HIV CRE High rates of infection transmission
Biofilm growth on endoscope channels
Damage to the scope general diagnostic scopes cost $25-35000 with repair costs ranging from $500-$10000 per repair Ultrasound scopes cost $40-50000 with average repair costs of $8-11000 per repair
Debris on distal tip (camera) could result in the surgeonrsquos inability to adequately see inside the patient
Patient harm due to damaged and dirty scopes
SOURCESContent Sourcesbull ANSIAAMI ST91 2015 Flexible and semi-rigid endoscope processing in health care facilitiesbull Society of Healthcare Epidemiology of America and American Society of Gastrointestinal Endoscopy 2011 bull CDC Guideline for Disinfection and Sterilization in Healthcare Facilities 2008bull AORN Guidelines for Recommended Practice Section 29 Recommendations Vbull SGNA Standards of Infection Control in processing of Flexible Gastrointestinal Endoscopes 2013bull IAHCSMM Central Service Technical Manual 2007bull AAMI Best Practices in Endoscope Reprocessing Webinar 2015bull AAMI Endoscope Reprocessing Critical Training Steps to Promote Patient Safety 2013bull httphealthnvgovhcqchaicleaning_sterilization_disinfection_healthcare_facilitiespdfbull httpwwwsgnaorgPortals0Standard20of20Infection20Prevention_FINALpdf
Image sourcesbull httpswwweducationaldimensionscomeLearnendoscopeanatomyphpbull httpssitesgooglecomsitevoicedisordernodulesdiagnosis-assessmentassessment-proceduresbull httpsurgicalendocombull http1technationcomroundtable-flexible-endoscopybull httpwwwmedical-hospitalbedscomsale-912541-abs-multi-functional-patient-transportation-cart-hospital-stretcher-trolley-als-st004htmlbull httpwwwusendoscopycomendoscopyendoscope-care-and-accessoriesprocedure-kitsVIA-bedside-precleaning-kitaspxVSVKLJNV1Zgbull httpwwwwashingtonpostcomnationalhealth-sciencein-effort-to-halt-outbreaks-protocol-for-cleaning-medical-scope-is-
updated201503262c0b5d8c-d3e8-11e4-ab77-9646eea6a4c7_storyhtmlbull httpwwwoutpatientsurgerynetsurgical-facility-administrationinfection-controlare-you-cleaning-gi-scopes-properly--10-14bull httpwwwprwebcomreleasesendoscoperepairsprweb11626296htmbull httpwwwmedivatorscomproductsendoscope-reprocessingbrushes-and-flushing-aidsscope-buddy-endoscope-flushing-aidbull httpwwwzutroncomendoscope-leak-testersphpbull httpwwwoptimaxonlinecomremote-visual-inspection-rigid-endoscope83swing-prism-
endoscopePHPSESSID=09ad5b323b4d40e885021856d65aa727bull httpwwwusendoscopycomurologystone-management-and-foreign-body-retrievalmoray-focepsMoray-biopsy-
forcepsaspxVUFVHpPe9Zgbull httpswwwtechno-aidecomstoreproducthydraulic_general_patient_stretcherVUFWXpPe9Zgbull httpswiley-vche-bookshelfdeproductsreading-epubproduct-
id600494titlePractical2BGastrointestinal2BEndoscopyhtmlautr=22Peter+B+Cotton22
CONTACT INFORMATION
Sarah Nolan CCSVP
952-288-2246 Direct
SarahNolanKeySurgicalcom
Key Surgical Inc
800-541-7995
infokeysurgicalcom
Keep Educating Yourself
The point of most wear and tear since itrsquos the point that comes in direct contact with
patients during surgery- entering body cavities with varying degrees of pressure
Contains complex wires glass bundles light fibers and channels
The light source is connected at the light connector and is passed through here via
fiber optic channels
ANATOMY OF A SCOPE INSERTION TUBE
Houses the terminal end of the airwater ports and biopsy port
Contains lens covering the imaging system
Contains lens covering the light system
ANATOMY OF A SCOPE BENDING SECTION amp DISTAL TIP
More than 34 million GI endoscopic procedures are performed
annually
Flexible endoscopes are a complex medical device that is made of
materials that are not compatible with all sterilization methods
Endoscopes are used to
Diagnose prevent and treat diseases
Confirm a diagnosis
Deliver therapy
Perform arthroscopic surgeries
Perform laparoscopic surgeries
Allows access to hard to reach cavities without having to open said
cavities via major surgery
WHAT DO ENDOSCOPES DOHOW DO THEY WORK
BASIC STEPS IN REPROCESSING
ENDOSCOPES
Any given endoscope could require upwards of
30 distinct steps in reprocessing according to
the manufacturerrsquos instructions for use
STEP 1 PERSONAL PROTECTIVE EQUIPMENT (PPE)
Most important step is protecting yourself
Wash hands before donning PPE and after removing PPE
Fluid resistant impervious gown- disposable
Chemicalfluid resistant gloves
Mask and shield impervious to fluid
STEP 2 PRE-CLEANING
Happens at the point-of-use immediately afterscope is removed from patient
Important to pre-clean as potentially infectiousmaterials could start to form biofilms that are extremely difficult to remove
Wash the external surfaces of the endoscope
Flush the channels with enzymatic detergent- both rigid and flexible scopes
Visually inspect the distal tip for damage and cleanliness
Attach protective cap to video connector after removing from the light source and suction
Detach and soak all detachable parts
Discard enzymatic detergent solution after each use
STEP 3 TRANSPORTATION
Transport to decontamination area before any
remaining organic matter has a chance to dry
Contain the scope in an enclosed container with a
biohazard label or fluid resistant bag
If using a bag- transport while supporting the
scope from the bottom of the bag so as not to
damage the scope
Each endoscope should be isolated and
transported with its components in its own closed
system to the next stage of processingrdquo AAMI
ST91 2015
STEP 4 LEAKPRESSURE TESTING
Pressurization is required to determine if leaks exist anywhere on the scope
Perform on newrepairedrefurbished scopes
Determine if perforations in outer covering or lining of internal channels may have occurred during manufacturing shipping transportation or use
Manipulate the control knobs of flexible endoscope in all directions to expose surfaces and reveal any small perforations
Perform leakpressure test per manufacturerrsquos instructions for use
Insufflate the scope first (pressurize) then submerge in water to prevent further damage
Make sure any waterproof caps are in place before submerging the scope
Attach flexible endoscope to the leak test system and submerge the entire scope in water Air bubbles indicate a leak in the covering or in a channel
LEAKPRESSURE TESTING CONTINUEDhellip
Make sure there is no detergent in the water as the foam could prevent you from seeing any air bubbles
If you see a leak keep the scope attached to the air pressure until it is completely removed from the water to keep water from entering the channels which could cause more damage
Common places for a leak bending section seams control knobs water cap
If you are using a leak test apparatus that doesnrsquot require water- complete leak testing before submerging scope in water or detergent A leak is present if you see a drop in pressure or if you donrsquot see inflation of the scope
IMPORTANT Never disconnect pressure while scope is fully immersed-only after it is completely depressurized to prevent damage
STEP 5 MANUAL CLEANING Manual cleaning always happens prior to high level disinfection
or entry into an automated endoscope reprocessor
Manual cleaning is more thorough than pre-cleaning
Wipe all external surfaces with a non-linting soft cloth or spongebull For cystoscopes and ureteroscopes use more of a milking action For
gastroscopes and colonoscopes slide the clothsponge down the length of the tubes
Submerge in enzymatic detergent solution as specified in manufacturerrsquos IFU
Consult the manufacturerrsquos IFU for correct measurements of enzymatic cleaners and water levels
MANUAL CLEANING CONTINUEDhellip
Cleaning brushes can be reusable or disposable be sure all brushes are of the correct size for the endoscope channel or port Inspect all reusable brushes to make sure they are in proper working order
Move any elevator cables up and down several times ndash helps to water pick this area with a syringe
Insert brush into submerged endoscope channel
Brush out all ports ndash under water at all times
Inspect brush and manipulate bristles under water to ensure that ALL bioburden saliva lubrication etc is removed before reintroducing brush into channel
Use your eyes Look for bioburdenresidue
STEP 6 DETERGENT FLUSHSUCTION AND WATER
FLUSHRINSE THE SCOPE
Wash the insertion tube and flush the channels using manufacturer issued cleaning adaptors to make sure all components are adequately flushed with detergent If using an automated flushing device like a Scope Buddyreg ndash refer to the manufacturer IFUs for proper flushing of your channels and ports
Airwater channels- one water stream and biopsy channel another water stream when you flush the scope
Flush the elevator channel with a syringe
Rinse scope with water after the detergentflushsuction- rinse off all detergent from the outside of the scope Flushsuction the channels with water
DETERGENT FLUSHSUCTION AND WATER
FLUSHRINSE THE SCOPE CONTINUEDhellip
If you have a smellydirty scope- it cannot safely be high-
level disinfected Use manufacturer recommended or
approved detergent that cleansdissolves fat cells that hold
onto and produce bad smells
Detergents should be used for only one scope and then
discarded
STEP 7 HIGH-LEVEL
DISINFECTIONSTERILIZATION
Flexible endoscopes can be disinfected manually or with an automated endoscope reprocessor
This step always happens AFTER manual cleaning
Immerse scope completely in solution or automated endoscope reprocessor- be sure to consult IFU for exposure times and temperatures
Check elevator channels before and after HLD
Gluteraldahyde OPA paracetic acid hydrogen peroxide can all be used to high level disinfect
Check with manufacturer IFU to see if scope can be put into a sterilizer
STEP 8 INSPECTION
Inspect flexible endoscopes and accessories of all components to determine damages loss of function gross soils as all of these things can result in patient harm
Inspect a scope Before use
During procedure
After procedure
Immediately after decontamination
Before disinfection or sterilization
Accessories to inspect Water bottle and tubing
Biopsy forceps
Cytology brushes
Cleaning brushes
INSPECTION CONTINUEDhellip
If you see damage remove scope from use and contact
service provider
If yoursquore sending your scope back to the manufacturer or a
third party provider package it in an impenetrable material
that complies with the Department of Transportation
shipping regulations and label as biohazard
STEP 9 STORAGE
Flush scope channel with 70-90 ethyl or isopropyl alcohol followed by
low-pressure forced air to dry internal channels
Store scopes in a closed cabinet with proper air circulation
Store scopes with all valvesaccessories removed
Hang scopes vertically without coiling or kinking
to facilitate any additional drying needed
Always store scopes in a way that protects the
scope and minimizes contamination
Be sure to clean and disinfect the storage
cabinets per manufacturerrsquos IFU
STORAGE CONTINUEDhellip
Storage time ranges between 5-24 days Always be sure to
document high-level disinfection dates and specifics
APIC suggests 7 days
AORN and AAMI recommend that each facility perform a risk
assessment to determine proper storage time
Multi-Society Guideline 2011 contamination during storage
negligible for 7-14 days contamination occurs only on exterior
SGNA supports 7 day storage intervals if scopes were
reprocessed and stored according to professional guidelines
and manufacturer IFU
INDUSTRY GUIDELINES
ENDOSCOPE PROCESSING
ldquoUse cleaning brushes appropriate for the size of the endoscope
channel or portrdquo
-CDC Guideline for Disinfection and Sterilization in Healthcare
Facilities 2008 pg 86
ldquoThorough cleaning is essential before high-level disinfection or
sterilization because inorganic or organic materials that remain on
surfaces of instruments interfere with the effectiveness of these
processesrdquo
-CDC Guideline for Disinfection and Sterilization in
Healthcare Facilities 2008
INDUSTRY GUIDELINES CONTINUEDhellip
ldquoCleaning and decontamination should occur as soon as possible after instruments and equipment are used to prevent the formation of biofilm Cleaning and decontamination must be thoroughly accomplished or disinfection and sterilization may not be effectiverdquo
-AORN Section 29 Recommendations V
ldquoManual cleaninghellipis the most important step in removing microbial burden from an endoscopehellipRetained debris may inactivate or interfere with the capabilityhellipto effectively kill andor inactivate microorganismsrdquo
-SGNA Standards of Infection Control in processing of Flexible Gastrointestinal Endoscopes 2013
ldquoCleaning refers to the removal of all visible and non-visible soil and any other foreign material from the medical device being processed It is the most important step in the disinfectionsterilization process Instruments must be thoroughly cleaned and rinsed for subsequent reprocessing steps to be effectiverdquo
-IAHCSMM Central Service Technical Manual 2007
INDUSTRY GUIDELINES CONTINUEDhellip
ldquoPersonnel involved in endoscope processing should be provided education
training and complete competency verification activities related to their duties upon
initial hire annually at designated intervals or whenever new endoscopic models
new processing equipment or products such as new chemicals are introduced for
processingrdquo
-ANSIAAMI ST91 2015 43
ldquoAt a minimum it is recommended that devices are subjected to high-level
disinfection after each use When possible and practical flexible and semi-rigid
endoscopes should be sterilized due to the greater margin of safety built into
sterilizationrdquo
-ANSIAAMI ST91 2015 43
RISKS INVOLVED WITH IMPROPER
PROCESSING OF ENDOSCOPES
Cross-contamination of harmful diseases like Hepatitis B Hepatitis C MRSA HIV CRE High rates of infection transmission
Biofilm growth on endoscope channels
Damage to the scope general diagnostic scopes cost $25-35000 with repair costs ranging from $500-$10000 per repair Ultrasound scopes cost $40-50000 with average repair costs of $8-11000 per repair
Debris on distal tip (camera) could result in the surgeonrsquos inability to adequately see inside the patient
Patient harm due to damaged and dirty scopes
SOURCESContent Sourcesbull ANSIAAMI ST91 2015 Flexible and semi-rigid endoscope processing in health care facilitiesbull Society of Healthcare Epidemiology of America and American Society of Gastrointestinal Endoscopy 2011 bull CDC Guideline for Disinfection and Sterilization in Healthcare Facilities 2008bull AORN Guidelines for Recommended Practice Section 29 Recommendations Vbull SGNA Standards of Infection Control in processing of Flexible Gastrointestinal Endoscopes 2013bull IAHCSMM Central Service Technical Manual 2007bull AAMI Best Practices in Endoscope Reprocessing Webinar 2015bull AAMI Endoscope Reprocessing Critical Training Steps to Promote Patient Safety 2013bull httphealthnvgovhcqchaicleaning_sterilization_disinfection_healthcare_facilitiespdfbull httpwwwsgnaorgPortals0Standard20of20Infection20Prevention_FINALpdf
Image sourcesbull httpswwweducationaldimensionscomeLearnendoscopeanatomyphpbull httpssitesgooglecomsitevoicedisordernodulesdiagnosis-assessmentassessment-proceduresbull httpsurgicalendocombull http1technationcomroundtable-flexible-endoscopybull httpwwwmedical-hospitalbedscomsale-912541-abs-multi-functional-patient-transportation-cart-hospital-stretcher-trolley-als-st004htmlbull httpwwwusendoscopycomendoscopyendoscope-care-and-accessoriesprocedure-kitsVIA-bedside-precleaning-kitaspxVSVKLJNV1Zgbull httpwwwwashingtonpostcomnationalhealth-sciencein-effort-to-halt-outbreaks-protocol-for-cleaning-medical-scope-is-
updated201503262c0b5d8c-d3e8-11e4-ab77-9646eea6a4c7_storyhtmlbull httpwwwoutpatientsurgerynetsurgical-facility-administrationinfection-controlare-you-cleaning-gi-scopes-properly--10-14bull httpwwwprwebcomreleasesendoscoperepairsprweb11626296htmbull httpwwwmedivatorscomproductsendoscope-reprocessingbrushes-and-flushing-aidsscope-buddy-endoscope-flushing-aidbull httpwwwzutroncomendoscope-leak-testersphpbull httpwwwoptimaxonlinecomremote-visual-inspection-rigid-endoscope83swing-prism-
endoscopePHPSESSID=09ad5b323b4d40e885021856d65aa727bull httpwwwusendoscopycomurologystone-management-and-foreign-body-retrievalmoray-focepsMoray-biopsy-
forcepsaspxVUFVHpPe9Zgbull httpswwwtechno-aidecomstoreproducthydraulic_general_patient_stretcherVUFWXpPe9Zgbull httpswiley-vche-bookshelfdeproductsreading-epubproduct-
id600494titlePractical2BGastrointestinal2BEndoscopyhtmlautr=22Peter+B+Cotton22
CONTACT INFORMATION
Sarah Nolan CCSVP
952-288-2246 Direct
SarahNolanKeySurgicalcom
Key Surgical Inc
800-541-7995
infokeysurgicalcom
Keep Educating Yourself
Houses the terminal end of the airwater ports and biopsy port
Contains lens covering the imaging system
Contains lens covering the light system
ANATOMY OF A SCOPE BENDING SECTION amp DISTAL TIP
More than 34 million GI endoscopic procedures are performed
annually
Flexible endoscopes are a complex medical device that is made of
materials that are not compatible with all sterilization methods
Endoscopes are used to
Diagnose prevent and treat diseases
Confirm a diagnosis
Deliver therapy
Perform arthroscopic surgeries
Perform laparoscopic surgeries
Allows access to hard to reach cavities without having to open said
cavities via major surgery
WHAT DO ENDOSCOPES DOHOW DO THEY WORK
BASIC STEPS IN REPROCESSING
ENDOSCOPES
Any given endoscope could require upwards of
30 distinct steps in reprocessing according to
the manufacturerrsquos instructions for use
STEP 1 PERSONAL PROTECTIVE EQUIPMENT (PPE)
Most important step is protecting yourself
Wash hands before donning PPE and after removing PPE
Fluid resistant impervious gown- disposable
Chemicalfluid resistant gloves
Mask and shield impervious to fluid
STEP 2 PRE-CLEANING
Happens at the point-of-use immediately afterscope is removed from patient
Important to pre-clean as potentially infectiousmaterials could start to form biofilms that are extremely difficult to remove
Wash the external surfaces of the endoscope
Flush the channels with enzymatic detergent- both rigid and flexible scopes
Visually inspect the distal tip for damage and cleanliness
Attach protective cap to video connector after removing from the light source and suction
Detach and soak all detachable parts
Discard enzymatic detergent solution after each use
STEP 3 TRANSPORTATION
Transport to decontamination area before any
remaining organic matter has a chance to dry
Contain the scope in an enclosed container with a
biohazard label or fluid resistant bag
If using a bag- transport while supporting the
scope from the bottom of the bag so as not to
damage the scope
Each endoscope should be isolated and
transported with its components in its own closed
system to the next stage of processingrdquo AAMI
ST91 2015
STEP 4 LEAKPRESSURE TESTING
Pressurization is required to determine if leaks exist anywhere on the scope
Perform on newrepairedrefurbished scopes
Determine if perforations in outer covering or lining of internal channels may have occurred during manufacturing shipping transportation or use
Manipulate the control knobs of flexible endoscope in all directions to expose surfaces and reveal any small perforations
Perform leakpressure test per manufacturerrsquos instructions for use
Insufflate the scope first (pressurize) then submerge in water to prevent further damage
Make sure any waterproof caps are in place before submerging the scope
Attach flexible endoscope to the leak test system and submerge the entire scope in water Air bubbles indicate a leak in the covering or in a channel
LEAKPRESSURE TESTING CONTINUEDhellip
Make sure there is no detergent in the water as the foam could prevent you from seeing any air bubbles
If you see a leak keep the scope attached to the air pressure until it is completely removed from the water to keep water from entering the channels which could cause more damage
Common places for a leak bending section seams control knobs water cap
If you are using a leak test apparatus that doesnrsquot require water- complete leak testing before submerging scope in water or detergent A leak is present if you see a drop in pressure or if you donrsquot see inflation of the scope
IMPORTANT Never disconnect pressure while scope is fully immersed-only after it is completely depressurized to prevent damage
STEP 5 MANUAL CLEANING Manual cleaning always happens prior to high level disinfection
or entry into an automated endoscope reprocessor
Manual cleaning is more thorough than pre-cleaning
Wipe all external surfaces with a non-linting soft cloth or spongebull For cystoscopes and ureteroscopes use more of a milking action For
gastroscopes and colonoscopes slide the clothsponge down the length of the tubes
Submerge in enzymatic detergent solution as specified in manufacturerrsquos IFU
Consult the manufacturerrsquos IFU for correct measurements of enzymatic cleaners and water levels
MANUAL CLEANING CONTINUEDhellip
Cleaning brushes can be reusable or disposable be sure all brushes are of the correct size for the endoscope channel or port Inspect all reusable brushes to make sure they are in proper working order
Move any elevator cables up and down several times ndash helps to water pick this area with a syringe
Insert brush into submerged endoscope channel
Brush out all ports ndash under water at all times
Inspect brush and manipulate bristles under water to ensure that ALL bioburden saliva lubrication etc is removed before reintroducing brush into channel
Use your eyes Look for bioburdenresidue
STEP 6 DETERGENT FLUSHSUCTION AND WATER
FLUSHRINSE THE SCOPE
Wash the insertion tube and flush the channels using manufacturer issued cleaning adaptors to make sure all components are adequately flushed with detergent If using an automated flushing device like a Scope Buddyreg ndash refer to the manufacturer IFUs for proper flushing of your channels and ports
Airwater channels- one water stream and biopsy channel another water stream when you flush the scope
Flush the elevator channel with a syringe
Rinse scope with water after the detergentflushsuction- rinse off all detergent from the outside of the scope Flushsuction the channels with water
DETERGENT FLUSHSUCTION AND WATER
FLUSHRINSE THE SCOPE CONTINUEDhellip
If you have a smellydirty scope- it cannot safely be high-
level disinfected Use manufacturer recommended or
approved detergent that cleansdissolves fat cells that hold
onto and produce bad smells
Detergents should be used for only one scope and then
discarded
STEP 7 HIGH-LEVEL
DISINFECTIONSTERILIZATION
Flexible endoscopes can be disinfected manually or with an automated endoscope reprocessor
This step always happens AFTER manual cleaning
Immerse scope completely in solution or automated endoscope reprocessor- be sure to consult IFU for exposure times and temperatures
Check elevator channels before and after HLD
Gluteraldahyde OPA paracetic acid hydrogen peroxide can all be used to high level disinfect
Check with manufacturer IFU to see if scope can be put into a sterilizer
STEP 8 INSPECTION
Inspect flexible endoscopes and accessories of all components to determine damages loss of function gross soils as all of these things can result in patient harm
Inspect a scope Before use
During procedure
After procedure
Immediately after decontamination
Before disinfection or sterilization
Accessories to inspect Water bottle and tubing
Biopsy forceps
Cytology brushes
Cleaning brushes
INSPECTION CONTINUEDhellip
If you see damage remove scope from use and contact
service provider
If yoursquore sending your scope back to the manufacturer or a
third party provider package it in an impenetrable material
that complies with the Department of Transportation
shipping regulations and label as biohazard
STEP 9 STORAGE
Flush scope channel with 70-90 ethyl or isopropyl alcohol followed by
low-pressure forced air to dry internal channels
Store scopes in a closed cabinet with proper air circulation
Store scopes with all valvesaccessories removed
Hang scopes vertically without coiling or kinking
to facilitate any additional drying needed
Always store scopes in a way that protects the
scope and minimizes contamination
Be sure to clean and disinfect the storage
cabinets per manufacturerrsquos IFU
STORAGE CONTINUEDhellip
Storage time ranges between 5-24 days Always be sure to
document high-level disinfection dates and specifics
APIC suggests 7 days
AORN and AAMI recommend that each facility perform a risk
assessment to determine proper storage time
Multi-Society Guideline 2011 contamination during storage
negligible for 7-14 days contamination occurs only on exterior
SGNA supports 7 day storage intervals if scopes were
reprocessed and stored according to professional guidelines
and manufacturer IFU
INDUSTRY GUIDELINES
ENDOSCOPE PROCESSING
ldquoUse cleaning brushes appropriate for the size of the endoscope
channel or portrdquo
-CDC Guideline for Disinfection and Sterilization in Healthcare
Facilities 2008 pg 86
ldquoThorough cleaning is essential before high-level disinfection or
sterilization because inorganic or organic materials that remain on
surfaces of instruments interfere with the effectiveness of these
processesrdquo
-CDC Guideline for Disinfection and Sterilization in
Healthcare Facilities 2008
INDUSTRY GUIDELINES CONTINUEDhellip
ldquoCleaning and decontamination should occur as soon as possible after instruments and equipment are used to prevent the formation of biofilm Cleaning and decontamination must be thoroughly accomplished or disinfection and sterilization may not be effectiverdquo
-AORN Section 29 Recommendations V
ldquoManual cleaninghellipis the most important step in removing microbial burden from an endoscopehellipRetained debris may inactivate or interfere with the capabilityhellipto effectively kill andor inactivate microorganismsrdquo
-SGNA Standards of Infection Control in processing of Flexible Gastrointestinal Endoscopes 2013
ldquoCleaning refers to the removal of all visible and non-visible soil and any other foreign material from the medical device being processed It is the most important step in the disinfectionsterilization process Instruments must be thoroughly cleaned and rinsed for subsequent reprocessing steps to be effectiverdquo
-IAHCSMM Central Service Technical Manual 2007
INDUSTRY GUIDELINES CONTINUEDhellip
ldquoPersonnel involved in endoscope processing should be provided education
training and complete competency verification activities related to their duties upon
initial hire annually at designated intervals or whenever new endoscopic models
new processing equipment or products such as new chemicals are introduced for
processingrdquo
-ANSIAAMI ST91 2015 43
ldquoAt a minimum it is recommended that devices are subjected to high-level
disinfection after each use When possible and practical flexible and semi-rigid
endoscopes should be sterilized due to the greater margin of safety built into
sterilizationrdquo
-ANSIAAMI ST91 2015 43
RISKS INVOLVED WITH IMPROPER
PROCESSING OF ENDOSCOPES
Cross-contamination of harmful diseases like Hepatitis B Hepatitis C MRSA HIV CRE High rates of infection transmission
Biofilm growth on endoscope channels
Damage to the scope general diagnostic scopes cost $25-35000 with repair costs ranging from $500-$10000 per repair Ultrasound scopes cost $40-50000 with average repair costs of $8-11000 per repair
Debris on distal tip (camera) could result in the surgeonrsquos inability to adequately see inside the patient
Patient harm due to damaged and dirty scopes
SOURCESContent Sourcesbull ANSIAAMI ST91 2015 Flexible and semi-rigid endoscope processing in health care facilitiesbull Society of Healthcare Epidemiology of America and American Society of Gastrointestinal Endoscopy 2011 bull CDC Guideline for Disinfection and Sterilization in Healthcare Facilities 2008bull AORN Guidelines for Recommended Practice Section 29 Recommendations Vbull SGNA Standards of Infection Control in processing of Flexible Gastrointestinal Endoscopes 2013bull IAHCSMM Central Service Technical Manual 2007bull AAMI Best Practices in Endoscope Reprocessing Webinar 2015bull AAMI Endoscope Reprocessing Critical Training Steps to Promote Patient Safety 2013bull httphealthnvgovhcqchaicleaning_sterilization_disinfection_healthcare_facilitiespdfbull httpwwwsgnaorgPortals0Standard20of20Infection20Prevention_FINALpdf
Image sourcesbull httpswwweducationaldimensionscomeLearnendoscopeanatomyphpbull httpssitesgooglecomsitevoicedisordernodulesdiagnosis-assessmentassessment-proceduresbull httpsurgicalendocombull http1technationcomroundtable-flexible-endoscopybull httpwwwmedical-hospitalbedscomsale-912541-abs-multi-functional-patient-transportation-cart-hospital-stretcher-trolley-als-st004htmlbull httpwwwusendoscopycomendoscopyendoscope-care-and-accessoriesprocedure-kitsVIA-bedside-precleaning-kitaspxVSVKLJNV1Zgbull httpwwwwashingtonpostcomnationalhealth-sciencein-effort-to-halt-outbreaks-protocol-for-cleaning-medical-scope-is-
updated201503262c0b5d8c-d3e8-11e4-ab77-9646eea6a4c7_storyhtmlbull httpwwwoutpatientsurgerynetsurgical-facility-administrationinfection-controlare-you-cleaning-gi-scopes-properly--10-14bull httpwwwprwebcomreleasesendoscoperepairsprweb11626296htmbull httpwwwmedivatorscomproductsendoscope-reprocessingbrushes-and-flushing-aidsscope-buddy-endoscope-flushing-aidbull httpwwwzutroncomendoscope-leak-testersphpbull httpwwwoptimaxonlinecomremote-visual-inspection-rigid-endoscope83swing-prism-
endoscopePHPSESSID=09ad5b323b4d40e885021856d65aa727bull httpwwwusendoscopycomurologystone-management-and-foreign-body-retrievalmoray-focepsMoray-biopsy-
forcepsaspxVUFVHpPe9Zgbull httpswwwtechno-aidecomstoreproducthydraulic_general_patient_stretcherVUFWXpPe9Zgbull httpswiley-vche-bookshelfdeproductsreading-epubproduct-
id600494titlePractical2BGastrointestinal2BEndoscopyhtmlautr=22Peter+B+Cotton22
CONTACT INFORMATION
Sarah Nolan CCSVP
952-288-2246 Direct
SarahNolanKeySurgicalcom
Key Surgical Inc
800-541-7995
infokeysurgicalcom
Keep Educating Yourself
More than 34 million GI endoscopic procedures are performed
annually
Flexible endoscopes are a complex medical device that is made of
materials that are not compatible with all sterilization methods
Endoscopes are used to
Diagnose prevent and treat diseases
Confirm a diagnosis
Deliver therapy
Perform arthroscopic surgeries
Perform laparoscopic surgeries
Allows access to hard to reach cavities without having to open said
cavities via major surgery
WHAT DO ENDOSCOPES DOHOW DO THEY WORK
BASIC STEPS IN REPROCESSING
ENDOSCOPES
Any given endoscope could require upwards of
30 distinct steps in reprocessing according to
the manufacturerrsquos instructions for use
STEP 1 PERSONAL PROTECTIVE EQUIPMENT (PPE)
Most important step is protecting yourself
Wash hands before donning PPE and after removing PPE
Fluid resistant impervious gown- disposable
Chemicalfluid resistant gloves
Mask and shield impervious to fluid
STEP 2 PRE-CLEANING
Happens at the point-of-use immediately afterscope is removed from patient
Important to pre-clean as potentially infectiousmaterials could start to form biofilms that are extremely difficult to remove
Wash the external surfaces of the endoscope
Flush the channels with enzymatic detergent- both rigid and flexible scopes
Visually inspect the distal tip for damage and cleanliness
Attach protective cap to video connector after removing from the light source and suction
Detach and soak all detachable parts
Discard enzymatic detergent solution after each use
STEP 3 TRANSPORTATION
Transport to decontamination area before any
remaining organic matter has a chance to dry
Contain the scope in an enclosed container with a
biohazard label or fluid resistant bag
If using a bag- transport while supporting the
scope from the bottom of the bag so as not to
damage the scope
Each endoscope should be isolated and
transported with its components in its own closed
system to the next stage of processingrdquo AAMI
ST91 2015
STEP 4 LEAKPRESSURE TESTING
Pressurization is required to determine if leaks exist anywhere on the scope
Perform on newrepairedrefurbished scopes
Determine if perforations in outer covering or lining of internal channels may have occurred during manufacturing shipping transportation or use
Manipulate the control knobs of flexible endoscope in all directions to expose surfaces and reveal any small perforations
Perform leakpressure test per manufacturerrsquos instructions for use
Insufflate the scope first (pressurize) then submerge in water to prevent further damage
Make sure any waterproof caps are in place before submerging the scope
Attach flexible endoscope to the leak test system and submerge the entire scope in water Air bubbles indicate a leak in the covering or in a channel
LEAKPRESSURE TESTING CONTINUEDhellip
Make sure there is no detergent in the water as the foam could prevent you from seeing any air bubbles
If you see a leak keep the scope attached to the air pressure until it is completely removed from the water to keep water from entering the channels which could cause more damage
Common places for a leak bending section seams control knobs water cap
If you are using a leak test apparatus that doesnrsquot require water- complete leak testing before submerging scope in water or detergent A leak is present if you see a drop in pressure or if you donrsquot see inflation of the scope
IMPORTANT Never disconnect pressure while scope is fully immersed-only after it is completely depressurized to prevent damage
STEP 5 MANUAL CLEANING Manual cleaning always happens prior to high level disinfection
or entry into an automated endoscope reprocessor
Manual cleaning is more thorough than pre-cleaning
Wipe all external surfaces with a non-linting soft cloth or spongebull For cystoscopes and ureteroscopes use more of a milking action For
gastroscopes and colonoscopes slide the clothsponge down the length of the tubes
Submerge in enzymatic detergent solution as specified in manufacturerrsquos IFU
Consult the manufacturerrsquos IFU for correct measurements of enzymatic cleaners and water levels
MANUAL CLEANING CONTINUEDhellip
Cleaning brushes can be reusable or disposable be sure all brushes are of the correct size for the endoscope channel or port Inspect all reusable brushes to make sure they are in proper working order
Move any elevator cables up and down several times ndash helps to water pick this area with a syringe
Insert brush into submerged endoscope channel
Brush out all ports ndash under water at all times
Inspect brush and manipulate bristles under water to ensure that ALL bioburden saliva lubrication etc is removed before reintroducing brush into channel
Use your eyes Look for bioburdenresidue
STEP 6 DETERGENT FLUSHSUCTION AND WATER
FLUSHRINSE THE SCOPE
Wash the insertion tube and flush the channels using manufacturer issued cleaning adaptors to make sure all components are adequately flushed with detergent If using an automated flushing device like a Scope Buddyreg ndash refer to the manufacturer IFUs for proper flushing of your channels and ports
Airwater channels- one water stream and biopsy channel another water stream when you flush the scope
Flush the elevator channel with a syringe
Rinse scope with water after the detergentflushsuction- rinse off all detergent from the outside of the scope Flushsuction the channels with water
DETERGENT FLUSHSUCTION AND WATER
FLUSHRINSE THE SCOPE CONTINUEDhellip
If you have a smellydirty scope- it cannot safely be high-
level disinfected Use manufacturer recommended or
approved detergent that cleansdissolves fat cells that hold
onto and produce bad smells
Detergents should be used for only one scope and then
discarded
STEP 7 HIGH-LEVEL
DISINFECTIONSTERILIZATION
Flexible endoscopes can be disinfected manually or with an automated endoscope reprocessor
This step always happens AFTER manual cleaning
Immerse scope completely in solution or automated endoscope reprocessor- be sure to consult IFU for exposure times and temperatures
Check elevator channels before and after HLD
Gluteraldahyde OPA paracetic acid hydrogen peroxide can all be used to high level disinfect
Check with manufacturer IFU to see if scope can be put into a sterilizer
STEP 8 INSPECTION
Inspect flexible endoscopes and accessories of all components to determine damages loss of function gross soils as all of these things can result in patient harm
Inspect a scope Before use
During procedure
After procedure
Immediately after decontamination
Before disinfection or sterilization
Accessories to inspect Water bottle and tubing
Biopsy forceps
Cytology brushes
Cleaning brushes
INSPECTION CONTINUEDhellip
If you see damage remove scope from use and contact
service provider
If yoursquore sending your scope back to the manufacturer or a
third party provider package it in an impenetrable material
that complies with the Department of Transportation
shipping regulations and label as biohazard
STEP 9 STORAGE
Flush scope channel with 70-90 ethyl or isopropyl alcohol followed by
low-pressure forced air to dry internal channels
Store scopes in a closed cabinet with proper air circulation
Store scopes with all valvesaccessories removed
Hang scopes vertically without coiling or kinking
to facilitate any additional drying needed
Always store scopes in a way that protects the
scope and minimizes contamination
Be sure to clean and disinfect the storage
cabinets per manufacturerrsquos IFU
STORAGE CONTINUEDhellip
Storage time ranges between 5-24 days Always be sure to
document high-level disinfection dates and specifics
APIC suggests 7 days
AORN and AAMI recommend that each facility perform a risk
assessment to determine proper storage time
Multi-Society Guideline 2011 contamination during storage
negligible for 7-14 days contamination occurs only on exterior
SGNA supports 7 day storage intervals if scopes were
reprocessed and stored according to professional guidelines
and manufacturer IFU
INDUSTRY GUIDELINES
ENDOSCOPE PROCESSING
ldquoUse cleaning brushes appropriate for the size of the endoscope
channel or portrdquo
-CDC Guideline for Disinfection and Sterilization in Healthcare
Facilities 2008 pg 86
ldquoThorough cleaning is essential before high-level disinfection or
sterilization because inorganic or organic materials that remain on
surfaces of instruments interfere with the effectiveness of these
processesrdquo
-CDC Guideline for Disinfection and Sterilization in
Healthcare Facilities 2008
INDUSTRY GUIDELINES CONTINUEDhellip
ldquoCleaning and decontamination should occur as soon as possible after instruments and equipment are used to prevent the formation of biofilm Cleaning and decontamination must be thoroughly accomplished or disinfection and sterilization may not be effectiverdquo
-AORN Section 29 Recommendations V
ldquoManual cleaninghellipis the most important step in removing microbial burden from an endoscopehellipRetained debris may inactivate or interfere with the capabilityhellipto effectively kill andor inactivate microorganismsrdquo
-SGNA Standards of Infection Control in processing of Flexible Gastrointestinal Endoscopes 2013
ldquoCleaning refers to the removal of all visible and non-visible soil and any other foreign material from the medical device being processed It is the most important step in the disinfectionsterilization process Instruments must be thoroughly cleaned and rinsed for subsequent reprocessing steps to be effectiverdquo
-IAHCSMM Central Service Technical Manual 2007
INDUSTRY GUIDELINES CONTINUEDhellip
ldquoPersonnel involved in endoscope processing should be provided education
training and complete competency verification activities related to their duties upon
initial hire annually at designated intervals or whenever new endoscopic models
new processing equipment or products such as new chemicals are introduced for
processingrdquo
-ANSIAAMI ST91 2015 43
ldquoAt a minimum it is recommended that devices are subjected to high-level
disinfection after each use When possible and practical flexible and semi-rigid
endoscopes should be sterilized due to the greater margin of safety built into
sterilizationrdquo
-ANSIAAMI ST91 2015 43
RISKS INVOLVED WITH IMPROPER
PROCESSING OF ENDOSCOPES
Cross-contamination of harmful diseases like Hepatitis B Hepatitis C MRSA HIV CRE High rates of infection transmission
Biofilm growth on endoscope channels
Damage to the scope general diagnostic scopes cost $25-35000 with repair costs ranging from $500-$10000 per repair Ultrasound scopes cost $40-50000 with average repair costs of $8-11000 per repair
Debris on distal tip (camera) could result in the surgeonrsquos inability to adequately see inside the patient
Patient harm due to damaged and dirty scopes
SOURCESContent Sourcesbull ANSIAAMI ST91 2015 Flexible and semi-rigid endoscope processing in health care facilitiesbull Society of Healthcare Epidemiology of America and American Society of Gastrointestinal Endoscopy 2011 bull CDC Guideline for Disinfection and Sterilization in Healthcare Facilities 2008bull AORN Guidelines for Recommended Practice Section 29 Recommendations Vbull SGNA Standards of Infection Control in processing of Flexible Gastrointestinal Endoscopes 2013bull IAHCSMM Central Service Technical Manual 2007bull AAMI Best Practices in Endoscope Reprocessing Webinar 2015bull AAMI Endoscope Reprocessing Critical Training Steps to Promote Patient Safety 2013bull httphealthnvgovhcqchaicleaning_sterilization_disinfection_healthcare_facilitiespdfbull httpwwwsgnaorgPortals0Standard20of20Infection20Prevention_FINALpdf
Image sourcesbull httpswwweducationaldimensionscomeLearnendoscopeanatomyphpbull httpssitesgooglecomsitevoicedisordernodulesdiagnosis-assessmentassessment-proceduresbull httpsurgicalendocombull http1technationcomroundtable-flexible-endoscopybull httpwwwmedical-hospitalbedscomsale-912541-abs-multi-functional-patient-transportation-cart-hospital-stretcher-trolley-als-st004htmlbull httpwwwusendoscopycomendoscopyendoscope-care-and-accessoriesprocedure-kitsVIA-bedside-precleaning-kitaspxVSVKLJNV1Zgbull httpwwwwashingtonpostcomnationalhealth-sciencein-effort-to-halt-outbreaks-protocol-for-cleaning-medical-scope-is-
updated201503262c0b5d8c-d3e8-11e4-ab77-9646eea6a4c7_storyhtmlbull httpwwwoutpatientsurgerynetsurgical-facility-administrationinfection-controlare-you-cleaning-gi-scopes-properly--10-14bull httpwwwprwebcomreleasesendoscoperepairsprweb11626296htmbull httpwwwmedivatorscomproductsendoscope-reprocessingbrushes-and-flushing-aidsscope-buddy-endoscope-flushing-aidbull httpwwwzutroncomendoscope-leak-testersphpbull httpwwwoptimaxonlinecomremote-visual-inspection-rigid-endoscope83swing-prism-
endoscopePHPSESSID=09ad5b323b4d40e885021856d65aa727bull httpwwwusendoscopycomurologystone-management-and-foreign-body-retrievalmoray-focepsMoray-biopsy-
forcepsaspxVUFVHpPe9Zgbull httpswwwtechno-aidecomstoreproducthydraulic_general_patient_stretcherVUFWXpPe9Zgbull httpswiley-vche-bookshelfdeproductsreading-epubproduct-
id600494titlePractical2BGastrointestinal2BEndoscopyhtmlautr=22Peter+B+Cotton22
CONTACT INFORMATION
Sarah Nolan CCSVP
952-288-2246 Direct
SarahNolanKeySurgicalcom
Key Surgical Inc
800-541-7995
infokeysurgicalcom
Keep Educating Yourself
BASIC STEPS IN REPROCESSING
ENDOSCOPES
Any given endoscope could require upwards of
30 distinct steps in reprocessing according to
the manufacturerrsquos instructions for use
STEP 1 PERSONAL PROTECTIVE EQUIPMENT (PPE)
Most important step is protecting yourself
Wash hands before donning PPE and after removing PPE
Fluid resistant impervious gown- disposable
Chemicalfluid resistant gloves
Mask and shield impervious to fluid
STEP 2 PRE-CLEANING
Happens at the point-of-use immediately afterscope is removed from patient
Important to pre-clean as potentially infectiousmaterials could start to form biofilms that are extremely difficult to remove
Wash the external surfaces of the endoscope
Flush the channels with enzymatic detergent- both rigid and flexible scopes
Visually inspect the distal tip for damage and cleanliness
Attach protective cap to video connector after removing from the light source and suction
Detach and soak all detachable parts
Discard enzymatic detergent solution after each use
STEP 3 TRANSPORTATION
Transport to decontamination area before any
remaining organic matter has a chance to dry
Contain the scope in an enclosed container with a
biohazard label or fluid resistant bag
If using a bag- transport while supporting the
scope from the bottom of the bag so as not to
damage the scope
Each endoscope should be isolated and
transported with its components in its own closed
system to the next stage of processingrdquo AAMI
ST91 2015
STEP 4 LEAKPRESSURE TESTING
Pressurization is required to determine if leaks exist anywhere on the scope
Perform on newrepairedrefurbished scopes
Determine if perforations in outer covering or lining of internal channels may have occurred during manufacturing shipping transportation or use
Manipulate the control knobs of flexible endoscope in all directions to expose surfaces and reveal any small perforations
Perform leakpressure test per manufacturerrsquos instructions for use
Insufflate the scope first (pressurize) then submerge in water to prevent further damage
Make sure any waterproof caps are in place before submerging the scope
Attach flexible endoscope to the leak test system and submerge the entire scope in water Air bubbles indicate a leak in the covering or in a channel
LEAKPRESSURE TESTING CONTINUEDhellip
Make sure there is no detergent in the water as the foam could prevent you from seeing any air bubbles
If you see a leak keep the scope attached to the air pressure until it is completely removed from the water to keep water from entering the channels which could cause more damage
Common places for a leak bending section seams control knobs water cap
If you are using a leak test apparatus that doesnrsquot require water- complete leak testing before submerging scope in water or detergent A leak is present if you see a drop in pressure or if you donrsquot see inflation of the scope
IMPORTANT Never disconnect pressure while scope is fully immersed-only after it is completely depressurized to prevent damage
STEP 5 MANUAL CLEANING Manual cleaning always happens prior to high level disinfection
or entry into an automated endoscope reprocessor
Manual cleaning is more thorough than pre-cleaning
Wipe all external surfaces with a non-linting soft cloth or spongebull For cystoscopes and ureteroscopes use more of a milking action For
gastroscopes and colonoscopes slide the clothsponge down the length of the tubes
Submerge in enzymatic detergent solution as specified in manufacturerrsquos IFU
Consult the manufacturerrsquos IFU for correct measurements of enzymatic cleaners and water levels
MANUAL CLEANING CONTINUEDhellip
Cleaning brushes can be reusable or disposable be sure all brushes are of the correct size for the endoscope channel or port Inspect all reusable brushes to make sure they are in proper working order
Move any elevator cables up and down several times ndash helps to water pick this area with a syringe
Insert brush into submerged endoscope channel
Brush out all ports ndash under water at all times
Inspect brush and manipulate bristles under water to ensure that ALL bioburden saliva lubrication etc is removed before reintroducing brush into channel
Use your eyes Look for bioburdenresidue
STEP 6 DETERGENT FLUSHSUCTION AND WATER
FLUSHRINSE THE SCOPE
Wash the insertion tube and flush the channels using manufacturer issued cleaning adaptors to make sure all components are adequately flushed with detergent If using an automated flushing device like a Scope Buddyreg ndash refer to the manufacturer IFUs for proper flushing of your channels and ports
Airwater channels- one water stream and biopsy channel another water stream when you flush the scope
Flush the elevator channel with a syringe
Rinse scope with water after the detergentflushsuction- rinse off all detergent from the outside of the scope Flushsuction the channels with water
DETERGENT FLUSHSUCTION AND WATER
FLUSHRINSE THE SCOPE CONTINUEDhellip
If you have a smellydirty scope- it cannot safely be high-
level disinfected Use manufacturer recommended or
approved detergent that cleansdissolves fat cells that hold
onto and produce bad smells
Detergents should be used for only one scope and then
discarded
STEP 7 HIGH-LEVEL
DISINFECTIONSTERILIZATION
Flexible endoscopes can be disinfected manually or with an automated endoscope reprocessor
This step always happens AFTER manual cleaning
Immerse scope completely in solution or automated endoscope reprocessor- be sure to consult IFU for exposure times and temperatures
Check elevator channels before and after HLD
Gluteraldahyde OPA paracetic acid hydrogen peroxide can all be used to high level disinfect
Check with manufacturer IFU to see if scope can be put into a sterilizer
STEP 8 INSPECTION
Inspect flexible endoscopes and accessories of all components to determine damages loss of function gross soils as all of these things can result in patient harm
Inspect a scope Before use
During procedure
After procedure
Immediately after decontamination
Before disinfection or sterilization
Accessories to inspect Water bottle and tubing
Biopsy forceps
Cytology brushes
Cleaning brushes
INSPECTION CONTINUEDhellip
If you see damage remove scope from use and contact
service provider
If yoursquore sending your scope back to the manufacturer or a
third party provider package it in an impenetrable material
that complies with the Department of Transportation
shipping regulations and label as biohazard
STEP 9 STORAGE
Flush scope channel with 70-90 ethyl or isopropyl alcohol followed by
low-pressure forced air to dry internal channels
Store scopes in a closed cabinet with proper air circulation
Store scopes with all valvesaccessories removed
Hang scopes vertically without coiling or kinking
to facilitate any additional drying needed
Always store scopes in a way that protects the
scope and minimizes contamination
Be sure to clean and disinfect the storage
cabinets per manufacturerrsquos IFU
STORAGE CONTINUEDhellip
Storage time ranges between 5-24 days Always be sure to
document high-level disinfection dates and specifics
APIC suggests 7 days
AORN and AAMI recommend that each facility perform a risk
assessment to determine proper storage time
Multi-Society Guideline 2011 contamination during storage
negligible for 7-14 days contamination occurs only on exterior
SGNA supports 7 day storage intervals if scopes were
reprocessed and stored according to professional guidelines
and manufacturer IFU
INDUSTRY GUIDELINES
ENDOSCOPE PROCESSING
ldquoUse cleaning brushes appropriate for the size of the endoscope
channel or portrdquo
-CDC Guideline for Disinfection and Sterilization in Healthcare
Facilities 2008 pg 86
ldquoThorough cleaning is essential before high-level disinfection or
sterilization because inorganic or organic materials that remain on
surfaces of instruments interfere with the effectiveness of these
processesrdquo
-CDC Guideline for Disinfection and Sterilization in
Healthcare Facilities 2008
INDUSTRY GUIDELINES CONTINUEDhellip
ldquoCleaning and decontamination should occur as soon as possible after instruments and equipment are used to prevent the formation of biofilm Cleaning and decontamination must be thoroughly accomplished or disinfection and sterilization may not be effectiverdquo
-AORN Section 29 Recommendations V
ldquoManual cleaninghellipis the most important step in removing microbial burden from an endoscopehellipRetained debris may inactivate or interfere with the capabilityhellipto effectively kill andor inactivate microorganismsrdquo
-SGNA Standards of Infection Control in processing of Flexible Gastrointestinal Endoscopes 2013
ldquoCleaning refers to the removal of all visible and non-visible soil and any other foreign material from the medical device being processed It is the most important step in the disinfectionsterilization process Instruments must be thoroughly cleaned and rinsed for subsequent reprocessing steps to be effectiverdquo
-IAHCSMM Central Service Technical Manual 2007
INDUSTRY GUIDELINES CONTINUEDhellip
ldquoPersonnel involved in endoscope processing should be provided education
training and complete competency verification activities related to their duties upon
initial hire annually at designated intervals or whenever new endoscopic models
new processing equipment or products such as new chemicals are introduced for
processingrdquo
-ANSIAAMI ST91 2015 43
ldquoAt a minimum it is recommended that devices are subjected to high-level
disinfection after each use When possible and practical flexible and semi-rigid
endoscopes should be sterilized due to the greater margin of safety built into
sterilizationrdquo
-ANSIAAMI ST91 2015 43
RISKS INVOLVED WITH IMPROPER
PROCESSING OF ENDOSCOPES
Cross-contamination of harmful diseases like Hepatitis B Hepatitis C MRSA HIV CRE High rates of infection transmission
Biofilm growth on endoscope channels
Damage to the scope general diagnostic scopes cost $25-35000 with repair costs ranging from $500-$10000 per repair Ultrasound scopes cost $40-50000 with average repair costs of $8-11000 per repair
Debris on distal tip (camera) could result in the surgeonrsquos inability to adequately see inside the patient
Patient harm due to damaged and dirty scopes
SOURCESContent Sourcesbull ANSIAAMI ST91 2015 Flexible and semi-rigid endoscope processing in health care facilitiesbull Society of Healthcare Epidemiology of America and American Society of Gastrointestinal Endoscopy 2011 bull CDC Guideline for Disinfection and Sterilization in Healthcare Facilities 2008bull AORN Guidelines for Recommended Practice Section 29 Recommendations Vbull SGNA Standards of Infection Control in processing of Flexible Gastrointestinal Endoscopes 2013bull IAHCSMM Central Service Technical Manual 2007bull AAMI Best Practices in Endoscope Reprocessing Webinar 2015bull AAMI Endoscope Reprocessing Critical Training Steps to Promote Patient Safety 2013bull httphealthnvgovhcqchaicleaning_sterilization_disinfection_healthcare_facilitiespdfbull httpwwwsgnaorgPortals0Standard20of20Infection20Prevention_FINALpdf
Image sourcesbull httpswwweducationaldimensionscomeLearnendoscopeanatomyphpbull httpssitesgooglecomsitevoicedisordernodulesdiagnosis-assessmentassessment-proceduresbull httpsurgicalendocombull http1technationcomroundtable-flexible-endoscopybull httpwwwmedical-hospitalbedscomsale-912541-abs-multi-functional-patient-transportation-cart-hospital-stretcher-trolley-als-st004htmlbull httpwwwusendoscopycomendoscopyendoscope-care-and-accessoriesprocedure-kitsVIA-bedside-precleaning-kitaspxVSVKLJNV1Zgbull httpwwwwashingtonpostcomnationalhealth-sciencein-effort-to-halt-outbreaks-protocol-for-cleaning-medical-scope-is-
updated201503262c0b5d8c-d3e8-11e4-ab77-9646eea6a4c7_storyhtmlbull httpwwwoutpatientsurgerynetsurgical-facility-administrationinfection-controlare-you-cleaning-gi-scopes-properly--10-14bull httpwwwprwebcomreleasesendoscoperepairsprweb11626296htmbull httpwwwmedivatorscomproductsendoscope-reprocessingbrushes-and-flushing-aidsscope-buddy-endoscope-flushing-aidbull httpwwwzutroncomendoscope-leak-testersphpbull httpwwwoptimaxonlinecomremote-visual-inspection-rigid-endoscope83swing-prism-
endoscopePHPSESSID=09ad5b323b4d40e885021856d65aa727bull httpwwwusendoscopycomurologystone-management-and-foreign-body-retrievalmoray-focepsMoray-biopsy-
forcepsaspxVUFVHpPe9Zgbull httpswwwtechno-aidecomstoreproducthydraulic_general_patient_stretcherVUFWXpPe9Zgbull httpswiley-vche-bookshelfdeproductsreading-epubproduct-
id600494titlePractical2BGastrointestinal2BEndoscopyhtmlautr=22Peter+B+Cotton22
CONTACT INFORMATION
Sarah Nolan CCSVP
952-288-2246 Direct
SarahNolanKeySurgicalcom
Key Surgical Inc
800-541-7995
infokeysurgicalcom
Keep Educating Yourself
STEP 1 PERSONAL PROTECTIVE EQUIPMENT (PPE)
Most important step is protecting yourself
Wash hands before donning PPE and after removing PPE
Fluid resistant impervious gown- disposable
Chemicalfluid resistant gloves
Mask and shield impervious to fluid
STEP 2 PRE-CLEANING
Happens at the point-of-use immediately afterscope is removed from patient
Important to pre-clean as potentially infectiousmaterials could start to form biofilms that are extremely difficult to remove
Wash the external surfaces of the endoscope
Flush the channels with enzymatic detergent- both rigid and flexible scopes
Visually inspect the distal tip for damage and cleanliness
Attach protective cap to video connector after removing from the light source and suction
Detach and soak all detachable parts
Discard enzymatic detergent solution after each use
STEP 3 TRANSPORTATION
Transport to decontamination area before any
remaining organic matter has a chance to dry
Contain the scope in an enclosed container with a
biohazard label or fluid resistant bag
If using a bag- transport while supporting the
scope from the bottom of the bag so as not to
damage the scope
Each endoscope should be isolated and
transported with its components in its own closed
system to the next stage of processingrdquo AAMI
ST91 2015
STEP 4 LEAKPRESSURE TESTING
Pressurization is required to determine if leaks exist anywhere on the scope
Perform on newrepairedrefurbished scopes
Determine if perforations in outer covering or lining of internal channels may have occurred during manufacturing shipping transportation or use
Manipulate the control knobs of flexible endoscope in all directions to expose surfaces and reveal any small perforations
Perform leakpressure test per manufacturerrsquos instructions for use
Insufflate the scope first (pressurize) then submerge in water to prevent further damage
Make sure any waterproof caps are in place before submerging the scope
Attach flexible endoscope to the leak test system and submerge the entire scope in water Air bubbles indicate a leak in the covering or in a channel
LEAKPRESSURE TESTING CONTINUEDhellip
Make sure there is no detergent in the water as the foam could prevent you from seeing any air bubbles
If you see a leak keep the scope attached to the air pressure until it is completely removed from the water to keep water from entering the channels which could cause more damage
Common places for a leak bending section seams control knobs water cap
If you are using a leak test apparatus that doesnrsquot require water- complete leak testing before submerging scope in water or detergent A leak is present if you see a drop in pressure or if you donrsquot see inflation of the scope
IMPORTANT Never disconnect pressure while scope is fully immersed-only after it is completely depressurized to prevent damage
STEP 5 MANUAL CLEANING Manual cleaning always happens prior to high level disinfection
or entry into an automated endoscope reprocessor
Manual cleaning is more thorough than pre-cleaning
Wipe all external surfaces with a non-linting soft cloth or spongebull For cystoscopes and ureteroscopes use more of a milking action For
gastroscopes and colonoscopes slide the clothsponge down the length of the tubes
Submerge in enzymatic detergent solution as specified in manufacturerrsquos IFU
Consult the manufacturerrsquos IFU for correct measurements of enzymatic cleaners and water levels
MANUAL CLEANING CONTINUEDhellip
Cleaning brushes can be reusable or disposable be sure all brushes are of the correct size for the endoscope channel or port Inspect all reusable brushes to make sure they are in proper working order
Move any elevator cables up and down several times ndash helps to water pick this area with a syringe
Insert brush into submerged endoscope channel
Brush out all ports ndash under water at all times
Inspect brush and manipulate bristles under water to ensure that ALL bioburden saliva lubrication etc is removed before reintroducing brush into channel
Use your eyes Look for bioburdenresidue
STEP 6 DETERGENT FLUSHSUCTION AND WATER
FLUSHRINSE THE SCOPE
Wash the insertion tube and flush the channels using manufacturer issued cleaning adaptors to make sure all components are adequately flushed with detergent If using an automated flushing device like a Scope Buddyreg ndash refer to the manufacturer IFUs for proper flushing of your channels and ports
Airwater channels- one water stream and biopsy channel another water stream when you flush the scope
Flush the elevator channel with a syringe
Rinse scope with water after the detergentflushsuction- rinse off all detergent from the outside of the scope Flushsuction the channels with water
DETERGENT FLUSHSUCTION AND WATER
FLUSHRINSE THE SCOPE CONTINUEDhellip
If you have a smellydirty scope- it cannot safely be high-
level disinfected Use manufacturer recommended or
approved detergent that cleansdissolves fat cells that hold
onto and produce bad smells
Detergents should be used for only one scope and then
discarded
STEP 7 HIGH-LEVEL
DISINFECTIONSTERILIZATION
Flexible endoscopes can be disinfected manually or with an automated endoscope reprocessor
This step always happens AFTER manual cleaning
Immerse scope completely in solution or automated endoscope reprocessor- be sure to consult IFU for exposure times and temperatures
Check elevator channels before and after HLD
Gluteraldahyde OPA paracetic acid hydrogen peroxide can all be used to high level disinfect
Check with manufacturer IFU to see if scope can be put into a sterilizer
STEP 8 INSPECTION
Inspect flexible endoscopes and accessories of all components to determine damages loss of function gross soils as all of these things can result in patient harm
Inspect a scope Before use
During procedure
After procedure
Immediately after decontamination
Before disinfection or sterilization
Accessories to inspect Water bottle and tubing
Biopsy forceps
Cytology brushes
Cleaning brushes
INSPECTION CONTINUEDhellip
If you see damage remove scope from use and contact
service provider
If yoursquore sending your scope back to the manufacturer or a
third party provider package it in an impenetrable material
that complies with the Department of Transportation
shipping regulations and label as biohazard
STEP 9 STORAGE
Flush scope channel with 70-90 ethyl or isopropyl alcohol followed by
low-pressure forced air to dry internal channels
Store scopes in a closed cabinet with proper air circulation
Store scopes with all valvesaccessories removed
Hang scopes vertically without coiling or kinking
to facilitate any additional drying needed
Always store scopes in a way that protects the
scope and minimizes contamination
Be sure to clean and disinfect the storage
cabinets per manufacturerrsquos IFU
STORAGE CONTINUEDhellip
Storage time ranges between 5-24 days Always be sure to
document high-level disinfection dates and specifics
APIC suggests 7 days
AORN and AAMI recommend that each facility perform a risk
assessment to determine proper storage time
Multi-Society Guideline 2011 contamination during storage
negligible for 7-14 days contamination occurs only on exterior
SGNA supports 7 day storage intervals if scopes were
reprocessed and stored according to professional guidelines
and manufacturer IFU
INDUSTRY GUIDELINES
ENDOSCOPE PROCESSING
ldquoUse cleaning brushes appropriate for the size of the endoscope
channel or portrdquo
-CDC Guideline for Disinfection and Sterilization in Healthcare
Facilities 2008 pg 86
ldquoThorough cleaning is essential before high-level disinfection or
sterilization because inorganic or organic materials that remain on
surfaces of instruments interfere with the effectiveness of these
processesrdquo
-CDC Guideline for Disinfection and Sterilization in
Healthcare Facilities 2008
INDUSTRY GUIDELINES CONTINUEDhellip
ldquoCleaning and decontamination should occur as soon as possible after instruments and equipment are used to prevent the formation of biofilm Cleaning and decontamination must be thoroughly accomplished or disinfection and sterilization may not be effectiverdquo
-AORN Section 29 Recommendations V
ldquoManual cleaninghellipis the most important step in removing microbial burden from an endoscopehellipRetained debris may inactivate or interfere with the capabilityhellipto effectively kill andor inactivate microorganismsrdquo
-SGNA Standards of Infection Control in processing of Flexible Gastrointestinal Endoscopes 2013
ldquoCleaning refers to the removal of all visible and non-visible soil and any other foreign material from the medical device being processed It is the most important step in the disinfectionsterilization process Instruments must be thoroughly cleaned and rinsed for subsequent reprocessing steps to be effectiverdquo
-IAHCSMM Central Service Technical Manual 2007
INDUSTRY GUIDELINES CONTINUEDhellip
ldquoPersonnel involved in endoscope processing should be provided education
training and complete competency verification activities related to their duties upon
initial hire annually at designated intervals or whenever new endoscopic models
new processing equipment or products such as new chemicals are introduced for
processingrdquo
-ANSIAAMI ST91 2015 43
ldquoAt a minimum it is recommended that devices are subjected to high-level
disinfection after each use When possible and practical flexible and semi-rigid
endoscopes should be sterilized due to the greater margin of safety built into
sterilizationrdquo
-ANSIAAMI ST91 2015 43
RISKS INVOLVED WITH IMPROPER
PROCESSING OF ENDOSCOPES
Cross-contamination of harmful diseases like Hepatitis B Hepatitis C MRSA HIV CRE High rates of infection transmission
Biofilm growth on endoscope channels
Damage to the scope general diagnostic scopes cost $25-35000 with repair costs ranging from $500-$10000 per repair Ultrasound scopes cost $40-50000 with average repair costs of $8-11000 per repair
Debris on distal tip (camera) could result in the surgeonrsquos inability to adequately see inside the patient
Patient harm due to damaged and dirty scopes
SOURCESContent Sourcesbull ANSIAAMI ST91 2015 Flexible and semi-rigid endoscope processing in health care facilitiesbull Society of Healthcare Epidemiology of America and American Society of Gastrointestinal Endoscopy 2011 bull CDC Guideline for Disinfection and Sterilization in Healthcare Facilities 2008bull AORN Guidelines for Recommended Practice Section 29 Recommendations Vbull SGNA Standards of Infection Control in processing of Flexible Gastrointestinal Endoscopes 2013bull IAHCSMM Central Service Technical Manual 2007bull AAMI Best Practices in Endoscope Reprocessing Webinar 2015bull AAMI Endoscope Reprocessing Critical Training Steps to Promote Patient Safety 2013bull httphealthnvgovhcqchaicleaning_sterilization_disinfection_healthcare_facilitiespdfbull httpwwwsgnaorgPortals0Standard20of20Infection20Prevention_FINALpdf
Image sourcesbull httpswwweducationaldimensionscomeLearnendoscopeanatomyphpbull httpssitesgooglecomsitevoicedisordernodulesdiagnosis-assessmentassessment-proceduresbull httpsurgicalendocombull http1technationcomroundtable-flexible-endoscopybull httpwwwmedical-hospitalbedscomsale-912541-abs-multi-functional-patient-transportation-cart-hospital-stretcher-trolley-als-st004htmlbull httpwwwusendoscopycomendoscopyendoscope-care-and-accessoriesprocedure-kitsVIA-bedside-precleaning-kitaspxVSVKLJNV1Zgbull httpwwwwashingtonpostcomnationalhealth-sciencein-effort-to-halt-outbreaks-protocol-for-cleaning-medical-scope-is-
updated201503262c0b5d8c-d3e8-11e4-ab77-9646eea6a4c7_storyhtmlbull httpwwwoutpatientsurgerynetsurgical-facility-administrationinfection-controlare-you-cleaning-gi-scopes-properly--10-14bull httpwwwprwebcomreleasesendoscoperepairsprweb11626296htmbull httpwwwmedivatorscomproductsendoscope-reprocessingbrushes-and-flushing-aidsscope-buddy-endoscope-flushing-aidbull httpwwwzutroncomendoscope-leak-testersphpbull httpwwwoptimaxonlinecomremote-visual-inspection-rigid-endoscope83swing-prism-
endoscopePHPSESSID=09ad5b323b4d40e885021856d65aa727bull httpwwwusendoscopycomurologystone-management-and-foreign-body-retrievalmoray-focepsMoray-biopsy-
forcepsaspxVUFVHpPe9Zgbull httpswwwtechno-aidecomstoreproducthydraulic_general_patient_stretcherVUFWXpPe9Zgbull httpswiley-vche-bookshelfdeproductsreading-epubproduct-
id600494titlePractical2BGastrointestinal2BEndoscopyhtmlautr=22Peter+B+Cotton22
CONTACT INFORMATION
Sarah Nolan CCSVP
952-288-2246 Direct
SarahNolanKeySurgicalcom
Key Surgical Inc
800-541-7995
infokeysurgicalcom
Keep Educating Yourself
STEP 2 PRE-CLEANING
Happens at the point-of-use immediately afterscope is removed from patient
Important to pre-clean as potentially infectiousmaterials could start to form biofilms that are extremely difficult to remove
Wash the external surfaces of the endoscope
Flush the channels with enzymatic detergent- both rigid and flexible scopes
Visually inspect the distal tip for damage and cleanliness
Attach protective cap to video connector after removing from the light source and suction
Detach and soak all detachable parts
Discard enzymatic detergent solution after each use
STEP 3 TRANSPORTATION
Transport to decontamination area before any
remaining organic matter has a chance to dry
Contain the scope in an enclosed container with a
biohazard label or fluid resistant bag
If using a bag- transport while supporting the
scope from the bottom of the bag so as not to
damage the scope
Each endoscope should be isolated and
transported with its components in its own closed
system to the next stage of processingrdquo AAMI
ST91 2015
STEP 4 LEAKPRESSURE TESTING
Pressurization is required to determine if leaks exist anywhere on the scope
Perform on newrepairedrefurbished scopes
Determine if perforations in outer covering or lining of internal channels may have occurred during manufacturing shipping transportation or use
Manipulate the control knobs of flexible endoscope in all directions to expose surfaces and reveal any small perforations
Perform leakpressure test per manufacturerrsquos instructions for use
Insufflate the scope first (pressurize) then submerge in water to prevent further damage
Make sure any waterproof caps are in place before submerging the scope
Attach flexible endoscope to the leak test system and submerge the entire scope in water Air bubbles indicate a leak in the covering or in a channel
LEAKPRESSURE TESTING CONTINUEDhellip
Make sure there is no detergent in the water as the foam could prevent you from seeing any air bubbles
If you see a leak keep the scope attached to the air pressure until it is completely removed from the water to keep water from entering the channels which could cause more damage
Common places for a leak bending section seams control knobs water cap
If you are using a leak test apparatus that doesnrsquot require water- complete leak testing before submerging scope in water or detergent A leak is present if you see a drop in pressure or if you donrsquot see inflation of the scope
IMPORTANT Never disconnect pressure while scope is fully immersed-only after it is completely depressurized to prevent damage
STEP 5 MANUAL CLEANING Manual cleaning always happens prior to high level disinfection
or entry into an automated endoscope reprocessor
Manual cleaning is more thorough than pre-cleaning
Wipe all external surfaces with a non-linting soft cloth or spongebull For cystoscopes and ureteroscopes use more of a milking action For
gastroscopes and colonoscopes slide the clothsponge down the length of the tubes
Submerge in enzymatic detergent solution as specified in manufacturerrsquos IFU
Consult the manufacturerrsquos IFU for correct measurements of enzymatic cleaners and water levels
MANUAL CLEANING CONTINUEDhellip
Cleaning brushes can be reusable or disposable be sure all brushes are of the correct size for the endoscope channel or port Inspect all reusable brushes to make sure they are in proper working order
Move any elevator cables up and down several times ndash helps to water pick this area with a syringe
Insert brush into submerged endoscope channel
Brush out all ports ndash under water at all times
Inspect brush and manipulate bristles under water to ensure that ALL bioburden saliva lubrication etc is removed before reintroducing brush into channel
Use your eyes Look for bioburdenresidue
STEP 6 DETERGENT FLUSHSUCTION AND WATER
FLUSHRINSE THE SCOPE
Wash the insertion tube and flush the channels using manufacturer issued cleaning adaptors to make sure all components are adequately flushed with detergent If using an automated flushing device like a Scope Buddyreg ndash refer to the manufacturer IFUs for proper flushing of your channels and ports
Airwater channels- one water stream and biopsy channel another water stream when you flush the scope
Flush the elevator channel with a syringe
Rinse scope with water after the detergentflushsuction- rinse off all detergent from the outside of the scope Flushsuction the channels with water
DETERGENT FLUSHSUCTION AND WATER
FLUSHRINSE THE SCOPE CONTINUEDhellip
If you have a smellydirty scope- it cannot safely be high-
level disinfected Use manufacturer recommended or
approved detergent that cleansdissolves fat cells that hold
onto and produce bad smells
Detergents should be used for only one scope and then
discarded
STEP 7 HIGH-LEVEL
DISINFECTIONSTERILIZATION
Flexible endoscopes can be disinfected manually or with an automated endoscope reprocessor
This step always happens AFTER manual cleaning
Immerse scope completely in solution or automated endoscope reprocessor- be sure to consult IFU for exposure times and temperatures
Check elevator channels before and after HLD
Gluteraldahyde OPA paracetic acid hydrogen peroxide can all be used to high level disinfect
Check with manufacturer IFU to see if scope can be put into a sterilizer
STEP 8 INSPECTION
Inspect flexible endoscopes and accessories of all components to determine damages loss of function gross soils as all of these things can result in patient harm
Inspect a scope Before use
During procedure
After procedure
Immediately after decontamination
Before disinfection or sterilization
Accessories to inspect Water bottle and tubing
Biopsy forceps
Cytology brushes
Cleaning brushes
INSPECTION CONTINUEDhellip
If you see damage remove scope from use and contact
service provider
If yoursquore sending your scope back to the manufacturer or a
third party provider package it in an impenetrable material
that complies with the Department of Transportation
shipping regulations and label as biohazard
STEP 9 STORAGE
Flush scope channel with 70-90 ethyl or isopropyl alcohol followed by
low-pressure forced air to dry internal channels
Store scopes in a closed cabinet with proper air circulation
Store scopes with all valvesaccessories removed
Hang scopes vertically without coiling or kinking
to facilitate any additional drying needed
Always store scopes in a way that protects the
scope and minimizes contamination
Be sure to clean and disinfect the storage
cabinets per manufacturerrsquos IFU
STORAGE CONTINUEDhellip
Storage time ranges between 5-24 days Always be sure to
document high-level disinfection dates and specifics
APIC suggests 7 days
AORN and AAMI recommend that each facility perform a risk
assessment to determine proper storage time
Multi-Society Guideline 2011 contamination during storage
negligible for 7-14 days contamination occurs only on exterior
SGNA supports 7 day storage intervals if scopes were
reprocessed and stored according to professional guidelines
and manufacturer IFU
INDUSTRY GUIDELINES
ENDOSCOPE PROCESSING
ldquoUse cleaning brushes appropriate for the size of the endoscope
channel or portrdquo
-CDC Guideline for Disinfection and Sterilization in Healthcare
Facilities 2008 pg 86
ldquoThorough cleaning is essential before high-level disinfection or
sterilization because inorganic or organic materials that remain on
surfaces of instruments interfere with the effectiveness of these
processesrdquo
-CDC Guideline for Disinfection and Sterilization in
Healthcare Facilities 2008
INDUSTRY GUIDELINES CONTINUEDhellip
ldquoCleaning and decontamination should occur as soon as possible after instruments and equipment are used to prevent the formation of biofilm Cleaning and decontamination must be thoroughly accomplished or disinfection and sterilization may not be effectiverdquo
-AORN Section 29 Recommendations V
ldquoManual cleaninghellipis the most important step in removing microbial burden from an endoscopehellipRetained debris may inactivate or interfere with the capabilityhellipto effectively kill andor inactivate microorganismsrdquo
-SGNA Standards of Infection Control in processing of Flexible Gastrointestinal Endoscopes 2013
ldquoCleaning refers to the removal of all visible and non-visible soil and any other foreign material from the medical device being processed It is the most important step in the disinfectionsterilization process Instruments must be thoroughly cleaned and rinsed for subsequent reprocessing steps to be effectiverdquo
-IAHCSMM Central Service Technical Manual 2007
INDUSTRY GUIDELINES CONTINUEDhellip
ldquoPersonnel involved in endoscope processing should be provided education
training and complete competency verification activities related to their duties upon
initial hire annually at designated intervals or whenever new endoscopic models
new processing equipment or products such as new chemicals are introduced for
processingrdquo
-ANSIAAMI ST91 2015 43
ldquoAt a minimum it is recommended that devices are subjected to high-level
disinfection after each use When possible and practical flexible and semi-rigid
endoscopes should be sterilized due to the greater margin of safety built into
sterilizationrdquo
-ANSIAAMI ST91 2015 43
RISKS INVOLVED WITH IMPROPER
PROCESSING OF ENDOSCOPES
Cross-contamination of harmful diseases like Hepatitis B Hepatitis C MRSA HIV CRE High rates of infection transmission
Biofilm growth on endoscope channels
Damage to the scope general diagnostic scopes cost $25-35000 with repair costs ranging from $500-$10000 per repair Ultrasound scopes cost $40-50000 with average repair costs of $8-11000 per repair
Debris on distal tip (camera) could result in the surgeonrsquos inability to adequately see inside the patient
Patient harm due to damaged and dirty scopes
SOURCESContent Sourcesbull ANSIAAMI ST91 2015 Flexible and semi-rigid endoscope processing in health care facilitiesbull Society of Healthcare Epidemiology of America and American Society of Gastrointestinal Endoscopy 2011 bull CDC Guideline for Disinfection and Sterilization in Healthcare Facilities 2008bull AORN Guidelines for Recommended Practice Section 29 Recommendations Vbull SGNA Standards of Infection Control in processing of Flexible Gastrointestinal Endoscopes 2013bull IAHCSMM Central Service Technical Manual 2007bull AAMI Best Practices in Endoscope Reprocessing Webinar 2015bull AAMI Endoscope Reprocessing Critical Training Steps to Promote Patient Safety 2013bull httphealthnvgovhcqchaicleaning_sterilization_disinfection_healthcare_facilitiespdfbull httpwwwsgnaorgPortals0Standard20of20Infection20Prevention_FINALpdf
Image sourcesbull httpswwweducationaldimensionscomeLearnendoscopeanatomyphpbull httpssitesgooglecomsitevoicedisordernodulesdiagnosis-assessmentassessment-proceduresbull httpsurgicalendocombull http1technationcomroundtable-flexible-endoscopybull httpwwwmedical-hospitalbedscomsale-912541-abs-multi-functional-patient-transportation-cart-hospital-stretcher-trolley-als-st004htmlbull httpwwwusendoscopycomendoscopyendoscope-care-and-accessoriesprocedure-kitsVIA-bedside-precleaning-kitaspxVSVKLJNV1Zgbull httpwwwwashingtonpostcomnationalhealth-sciencein-effort-to-halt-outbreaks-protocol-for-cleaning-medical-scope-is-
updated201503262c0b5d8c-d3e8-11e4-ab77-9646eea6a4c7_storyhtmlbull httpwwwoutpatientsurgerynetsurgical-facility-administrationinfection-controlare-you-cleaning-gi-scopes-properly--10-14bull httpwwwprwebcomreleasesendoscoperepairsprweb11626296htmbull httpwwwmedivatorscomproductsendoscope-reprocessingbrushes-and-flushing-aidsscope-buddy-endoscope-flushing-aidbull httpwwwzutroncomendoscope-leak-testersphpbull httpwwwoptimaxonlinecomremote-visual-inspection-rigid-endoscope83swing-prism-
endoscopePHPSESSID=09ad5b323b4d40e885021856d65aa727bull httpwwwusendoscopycomurologystone-management-and-foreign-body-retrievalmoray-focepsMoray-biopsy-
forcepsaspxVUFVHpPe9Zgbull httpswwwtechno-aidecomstoreproducthydraulic_general_patient_stretcherVUFWXpPe9Zgbull httpswiley-vche-bookshelfdeproductsreading-epubproduct-
id600494titlePractical2BGastrointestinal2BEndoscopyhtmlautr=22Peter+B+Cotton22
CONTACT INFORMATION
Sarah Nolan CCSVP
952-288-2246 Direct
SarahNolanKeySurgicalcom
Key Surgical Inc
800-541-7995
infokeysurgicalcom
Keep Educating Yourself
STEP 3 TRANSPORTATION
Transport to decontamination area before any
remaining organic matter has a chance to dry
Contain the scope in an enclosed container with a
biohazard label or fluid resistant bag
If using a bag- transport while supporting the
scope from the bottom of the bag so as not to
damage the scope
Each endoscope should be isolated and
transported with its components in its own closed
system to the next stage of processingrdquo AAMI
ST91 2015
STEP 4 LEAKPRESSURE TESTING
Pressurization is required to determine if leaks exist anywhere on the scope
Perform on newrepairedrefurbished scopes
Determine if perforations in outer covering or lining of internal channels may have occurred during manufacturing shipping transportation or use
Manipulate the control knobs of flexible endoscope in all directions to expose surfaces and reveal any small perforations
Perform leakpressure test per manufacturerrsquos instructions for use
Insufflate the scope first (pressurize) then submerge in water to prevent further damage
Make sure any waterproof caps are in place before submerging the scope
Attach flexible endoscope to the leak test system and submerge the entire scope in water Air bubbles indicate a leak in the covering or in a channel
LEAKPRESSURE TESTING CONTINUEDhellip
Make sure there is no detergent in the water as the foam could prevent you from seeing any air bubbles
If you see a leak keep the scope attached to the air pressure until it is completely removed from the water to keep water from entering the channels which could cause more damage
Common places for a leak bending section seams control knobs water cap
If you are using a leak test apparatus that doesnrsquot require water- complete leak testing before submerging scope in water or detergent A leak is present if you see a drop in pressure or if you donrsquot see inflation of the scope
IMPORTANT Never disconnect pressure while scope is fully immersed-only after it is completely depressurized to prevent damage
STEP 5 MANUAL CLEANING Manual cleaning always happens prior to high level disinfection
or entry into an automated endoscope reprocessor
Manual cleaning is more thorough than pre-cleaning
Wipe all external surfaces with a non-linting soft cloth or spongebull For cystoscopes and ureteroscopes use more of a milking action For
gastroscopes and colonoscopes slide the clothsponge down the length of the tubes
Submerge in enzymatic detergent solution as specified in manufacturerrsquos IFU
Consult the manufacturerrsquos IFU for correct measurements of enzymatic cleaners and water levels
MANUAL CLEANING CONTINUEDhellip
Cleaning brushes can be reusable or disposable be sure all brushes are of the correct size for the endoscope channel or port Inspect all reusable brushes to make sure they are in proper working order
Move any elevator cables up and down several times ndash helps to water pick this area with a syringe
Insert brush into submerged endoscope channel
Brush out all ports ndash under water at all times
Inspect brush and manipulate bristles under water to ensure that ALL bioburden saliva lubrication etc is removed before reintroducing brush into channel
Use your eyes Look for bioburdenresidue
STEP 6 DETERGENT FLUSHSUCTION AND WATER
FLUSHRINSE THE SCOPE
Wash the insertion tube and flush the channels using manufacturer issued cleaning adaptors to make sure all components are adequately flushed with detergent If using an automated flushing device like a Scope Buddyreg ndash refer to the manufacturer IFUs for proper flushing of your channels and ports
Airwater channels- one water stream and biopsy channel another water stream when you flush the scope
Flush the elevator channel with a syringe
Rinse scope with water after the detergentflushsuction- rinse off all detergent from the outside of the scope Flushsuction the channels with water
DETERGENT FLUSHSUCTION AND WATER
FLUSHRINSE THE SCOPE CONTINUEDhellip
If you have a smellydirty scope- it cannot safely be high-
level disinfected Use manufacturer recommended or
approved detergent that cleansdissolves fat cells that hold
onto and produce bad smells
Detergents should be used for only one scope and then
discarded
STEP 7 HIGH-LEVEL
DISINFECTIONSTERILIZATION
Flexible endoscopes can be disinfected manually or with an automated endoscope reprocessor
This step always happens AFTER manual cleaning
Immerse scope completely in solution or automated endoscope reprocessor- be sure to consult IFU for exposure times and temperatures
Check elevator channels before and after HLD
Gluteraldahyde OPA paracetic acid hydrogen peroxide can all be used to high level disinfect
Check with manufacturer IFU to see if scope can be put into a sterilizer
STEP 8 INSPECTION
Inspect flexible endoscopes and accessories of all components to determine damages loss of function gross soils as all of these things can result in patient harm
Inspect a scope Before use
During procedure
After procedure
Immediately after decontamination
Before disinfection or sterilization
Accessories to inspect Water bottle and tubing
Biopsy forceps
Cytology brushes
Cleaning brushes
INSPECTION CONTINUEDhellip
If you see damage remove scope from use and contact
service provider
If yoursquore sending your scope back to the manufacturer or a
third party provider package it in an impenetrable material
that complies with the Department of Transportation
shipping regulations and label as biohazard
STEP 9 STORAGE
Flush scope channel with 70-90 ethyl or isopropyl alcohol followed by
low-pressure forced air to dry internal channels
Store scopes in a closed cabinet with proper air circulation
Store scopes with all valvesaccessories removed
Hang scopes vertically without coiling or kinking
to facilitate any additional drying needed
Always store scopes in a way that protects the
scope and minimizes contamination
Be sure to clean and disinfect the storage
cabinets per manufacturerrsquos IFU
STORAGE CONTINUEDhellip
Storage time ranges between 5-24 days Always be sure to
document high-level disinfection dates and specifics
APIC suggests 7 days
AORN and AAMI recommend that each facility perform a risk
assessment to determine proper storage time
Multi-Society Guideline 2011 contamination during storage
negligible for 7-14 days contamination occurs only on exterior
SGNA supports 7 day storage intervals if scopes were
reprocessed and stored according to professional guidelines
and manufacturer IFU
INDUSTRY GUIDELINES
ENDOSCOPE PROCESSING
ldquoUse cleaning brushes appropriate for the size of the endoscope
channel or portrdquo
-CDC Guideline for Disinfection and Sterilization in Healthcare
Facilities 2008 pg 86
ldquoThorough cleaning is essential before high-level disinfection or
sterilization because inorganic or organic materials that remain on
surfaces of instruments interfere with the effectiveness of these
processesrdquo
-CDC Guideline for Disinfection and Sterilization in
Healthcare Facilities 2008
INDUSTRY GUIDELINES CONTINUEDhellip
ldquoCleaning and decontamination should occur as soon as possible after instruments and equipment are used to prevent the formation of biofilm Cleaning and decontamination must be thoroughly accomplished or disinfection and sterilization may not be effectiverdquo
-AORN Section 29 Recommendations V
ldquoManual cleaninghellipis the most important step in removing microbial burden from an endoscopehellipRetained debris may inactivate or interfere with the capabilityhellipto effectively kill andor inactivate microorganismsrdquo
-SGNA Standards of Infection Control in processing of Flexible Gastrointestinal Endoscopes 2013
ldquoCleaning refers to the removal of all visible and non-visible soil and any other foreign material from the medical device being processed It is the most important step in the disinfectionsterilization process Instruments must be thoroughly cleaned and rinsed for subsequent reprocessing steps to be effectiverdquo
-IAHCSMM Central Service Technical Manual 2007
INDUSTRY GUIDELINES CONTINUEDhellip
ldquoPersonnel involved in endoscope processing should be provided education
training and complete competency verification activities related to their duties upon
initial hire annually at designated intervals or whenever new endoscopic models
new processing equipment or products such as new chemicals are introduced for
processingrdquo
-ANSIAAMI ST91 2015 43
ldquoAt a minimum it is recommended that devices are subjected to high-level
disinfection after each use When possible and practical flexible and semi-rigid
endoscopes should be sterilized due to the greater margin of safety built into
sterilizationrdquo
-ANSIAAMI ST91 2015 43
RISKS INVOLVED WITH IMPROPER
PROCESSING OF ENDOSCOPES
Cross-contamination of harmful diseases like Hepatitis B Hepatitis C MRSA HIV CRE High rates of infection transmission
Biofilm growth on endoscope channels
Damage to the scope general diagnostic scopes cost $25-35000 with repair costs ranging from $500-$10000 per repair Ultrasound scopes cost $40-50000 with average repair costs of $8-11000 per repair
Debris on distal tip (camera) could result in the surgeonrsquos inability to adequately see inside the patient
Patient harm due to damaged and dirty scopes
SOURCESContent Sourcesbull ANSIAAMI ST91 2015 Flexible and semi-rigid endoscope processing in health care facilitiesbull Society of Healthcare Epidemiology of America and American Society of Gastrointestinal Endoscopy 2011 bull CDC Guideline for Disinfection and Sterilization in Healthcare Facilities 2008bull AORN Guidelines for Recommended Practice Section 29 Recommendations Vbull SGNA Standards of Infection Control in processing of Flexible Gastrointestinal Endoscopes 2013bull IAHCSMM Central Service Technical Manual 2007bull AAMI Best Practices in Endoscope Reprocessing Webinar 2015bull AAMI Endoscope Reprocessing Critical Training Steps to Promote Patient Safety 2013bull httphealthnvgovhcqchaicleaning_sterilization_disinfection_healthcare_facilitiespdfbull httpwwwsgnaorgPortals0Standard20of20Infection20Prevention_FINALpdf
Image sourcesbull httpswwweducationaldimensionscomeLearnendoscopeanatomyphpbull httpssitesgooglecomsitevoicedisordernodulesdiagnosis-assessmentassessment-proceduresbull httpsurgicalendocombull http1technationcomroundtable-flexible-endoscopybull httpwwwmedical-hospitalbedscomsale-912541-abs-multi-functional-patient-transportation-cart-hospital-stretcher-trolley-als-st004htmlbull httpwwwusendoscopycomendoscopyendoscope-care-and-accessoriesprocedure-kitsVIA-bedside-precleaning-kitaspxVSVKLJNV1Zgbull httpwwwwashingtonpostcomnationalhealth-sciencein-effort-to-halt-outbreaks-protocol-for-cleaning-medical-scope-is-
updated201503262c0b5d8c-d3e8-11e4-ab77-9646eea6a4c7_storyhtmlbull httpwwwoutpatientsurgerynetsurgical-facility-administrationinfection-controlare-you-cleaning-gi-scopes-properly--10-14bull httpwwwprwebcomreleasesendoscoperepairsprweb11626296htmbull httpwwwmedivatorscomproductsendoscope-reprocessingbrushes-and-flushing-aidsscope-buddy-endoscope-flushing-aidbull httpwwwzutroncomendoscope-leak-testersphpbull httpwwwoptimaxonlinecomremote-visual-inspection-rigid-endoscope83swing-prism-
endoscopePHPSESSID=09ad5b323b4d40e885021856d65aa727bull httpwwwusendoscopycomurologystone-management-and-foreign-body-retrievalmoray-focepsMoray-biopsy-
forcepsaspxVUFVHpPe9Zgbull httpswwwtechno-aidecomstoreproducthydraulic_general_patient_stretcherVUFWXpPe9Zgbull httpswiley-vche-bookshelfdeproductsreading-epubproduct-
id600494titlePractical2BGastrointestinal2BEndoscopyhtmlautr=22Peter+B+Cotton22
CONTACT INFORMATION
Sarah Nolan CCSVP
952-288-2246 Direct
SarahNolanKeySurgicalcom
Key Surgical Inc
800-541-7995
infokeysurgicalcom
Keep Educating Yourself
STEP 4 LEAKPRESSURE TESTING
Pressurization is required to determine if leaks exist anywhere on the scope
Perform on newrepairedrefurbished scopes
Determine if perforations in outer covering or lining of internal channels may have occurred during manufacturing shipping transportation or use
Manipulate the control knobs of flexible endoscope in all directions to expose surfaces and reveal any small perforations
Perform leakpressure test per manufacturerrsquos instructions for use
Insufflate the scope first (pressurize) then submerge in water to prevent further damage
Make sure any waterproof caps are in place before submerging the scope
Attach flexible endoscope to the leak test system and submerge the entire scope in water Air bubbles indicate a leak in the covering or in a channel
LEAKPRESSURE TESTING CONTINUEDhellip
Make sure there is no detergent in the water as the foam could prevent you from seeing any air bubbles
If you see a leak keep the scope attached to the air pressure until it is completely removed from the water to keep water from entering the channels which could cause more damage
Common places for a leak bending section seams control knobs water cap
If you are using a leak test apparatus that doesnrsquot require water- complete leak testing before submerging scope in water or detergent A leak is present if you see a drop in pressure or if you donrsquot see inflation of the scope
IMPORTANT Never disconnect pressure while scope is fully immersed-only after it is completely depressurized to prevent damage
STEP 5 MANUAL CLEANING Manual cleaning always happens prior to high level disinfection
or entry into an automated endoscope reprocessor
Manual cleaning is more thorough than pre-cleaning
Wipe all external surfaces with a non-linting soft cloth or spongebull For cystoscopes and ureteroscopes use more of a milking action For
gastroscopes and colonoscopes slide the clothsponge down the length of the tubes
Submerge in enzymatic detergent solution as specified in manufacturerrsquos IFU
Consult the manufacturerrsquos IFU for correct measurements of enzymatic cleaners and water levels
MANUAL CLEANING CONTINUEDhellip
Cleaning brushes can be reusable or disposable be sure all brushes are of the correct size for the endoscope channel or port Inspect all reusable brushes to make sure they are in proper working order
Move any elevator cables up and down several times ndash helps to water pick this area with a syringe
Insert brush into submerged endoscope channel
Brush out all ports ndash under water at all times
Inspect brush and manipulate bristles under water to ensure that ALL bioburden saliva lubrication etc is removed before reintroducing brush into channel
Use your eyes Look for bioburdenresidue
STEP 6 DETERGENT FLUSHSUCTION AND WATER
FLUSHRINSE THE SCOPE
Wash the insertion tube and flush the channels using manufacturer issued cleaning adaptors to make sure all components are adequately flushed with detergent If using an automated flushing device like a Scope Buddyreg ndash refer to the manufacturer IFUs for proper flushing of your channels and ports
Airwater channels- one water stream and biopsy channel another water stream when you flush the scope
Flush the elevator channel with a syringe
Rinse scope with water after the detergentflushsuction- rinse off all detergent from the outside of the scope Flushsuction the channels with water
DETERGENT FLUSHSUCTION AND WATER
FLUSHRINSE THE SCOPE CONTINUEDhellip
If you have a smellydirty scope- it cannot safely be high-
level disinfected Use manufacturer recommended or
approved detergent that cleansdissolves fat cells that hold
onto and produce bad smells
Detergents should be used for only one scope and then
discarded
STEP 7 HIGH-LEVEL
DISINFECTIONSTERILIZATION
Flexible endoscopes can be disinfected manually or with an automated endoscope reprocessor
This step always happens AFTER manual cleaning
Immerse scope completely in solution or automated endoscope reprocessor- be sure to consult IFU for exposure times and temperatures
Check elevator channels before and after HLD
Gluteraldahyde OPA paracetic acid hydrogen peroxide can all be used to high level disinfect
Check with manufacturer IFU to see if scope can be put into a sterilizer
STEP 8 INSPECTION
Inspect flexible endoscopes and accessories of all components to determine damages loss of function gross soils as all of these things can result in patient harm
Inspect a scope Before use
During procedure
After procedure
Immediately after decontamination
Before disinfection or sterilization
Accessories to inspect Water bottle and tubing
Biopsy forceps
Cytology brushes
Cleaning brushes
INSPECTION CONTINUEDhellip
If you see damage remove scope from use and contact
service provider
If yoursquore sending your scope back to the manufacturer or a
third party provider package it in an impenetrable material
that complies with the Department of Transportation
shipping regulations and label as biohazard
STEP 9 STORAGE
Flush scope channel with 70-90 ethyl or isopropyl alcohol followed by
low-pressure forced air to dry internal channels
Store scopes in a closed cabinet with proper air circulation
Store scopes with all valvesaccessories removed
Hang scopes vertically without coiling or kinking
to facilitate any additional drying needed
Always store scopes in a way that protects the
scope and minimizes contamination
Be sure to clean and disinfect the storage
cabinets per manufacturerrsquos IFU
STORAGE CONTINUEDhellip
Storage time ranges between 5-24 days Always be sure to
document high-level disinfection dates and specifics
APIC suggests 7 days
AORN and AAMI recommend that each facility perform a risk
assessment to determine proper storage time
Multi-Society Guideline 2011 contamination during storage
negligible for 7-14 days contamination occurs only on exterior
SGNA supports 7 day storage intervals if scopes were
reprocessed and stored according to professional guidelines
and manufacturer IFU
INDUSTRY GUIDELINES
ENDOSCOPE PROCESSING
ldquoUse cleaning brushes appropriate for the size of the endoscope
channel or portrdquo
-CDC Guideline for Disinfection and Sterilization in Healthcare
Facilities 2008 pg 86
ldquoThorough cleaning is essential before high-level disinfection or
sterilization because inorganic or organic materials that remain on
surfaces of instruments interfere with the effectiveness of these
processesrdquo
-CDC Guideline for Disinfection and Sterilization in
Healthcare Facilities 2008
INDUSTRY GUIDELINES CONTINUEDhellip
ldquoCleaning and decontamination should occur as soon as possible after instruments and equipment are used to prevent the formation of biofilm Cleaning and decontamination must be thoroughly accomplished or disinfection and sterilization may not be effectiverdquo
-AORN Section 29 Recommendations V
ldquoManual cleaninghellipis the most important step in removing microbial burden from an endoscopehellipRetained debris may inactivate or interfere with the capabilityhellipto effectively kill andor inactivate microorganismsrdquo
-SGNA Standards of Infection Control in processing of Flexible Gastrointestinal Endoscopes 2013
ldquoCleaning refers to the removal of all visible and non-visible soil and any other foreign material from the medical device being processed It is the most important step in the disinfectionsterilization process Instruments must be thoroughly cleaned and rinsed for subsequent reprocessing steps to be effectiverdquo
-IAHCSMM Central Service Technical Manual 2007
INDUSTRY GUIDELINES CONTINUEDhellip
ldquoPersonnel involved in endoscope processing should be provided education
training and complete competency verification activities related to their duties upon
initial hire annually at designated intervals or whenever new endoscopic models
new processing equipment or products such as new chemicals are introduced for
processingrdquo
-ANSIAAMI ST91 2015 43
ldquoAt a minimum it is recommended that devices are subjected to high-level
disinfection after each use When possible and practical flexible and semi-rigid
endoscopes should be sterilized due to the greater margin of safety built into
sterilizationrdquo
-ANSIAAMI ST91 2015 43
RISKS INVOLVED WITH IMPROPER
PROCESSING OF ENDOSCOPES
Cross-contamination of harmful diseases like Hepatitis B Hepatitis C MRSA HIV CRE High rates of infection transmission
Biofilm growth on endoscope channels
Damage to the scope general diagnostic scopes cost $25-35000 with repair costs ranging from $500-$10000 per repair Ultrasound scopes cost $40-50000 with average repair costs of $8-11000 per repair
Debris on distal tip (camera) could result in the surgeonrsquos inability to adequately see inside the patient
Patient harm due to damaged and dirty scopes
SOURCESContent Sourcesbull ANSIAAMI ST91 2015 Flexible and semi-rigid endoscope processing in health care facilitiesbull Society of Healthcare Epidemiology of America and American Society of Gastrointestinal Endoscopy 2011 bull CDC Guideline for Disinfection and Sterilization in Healthcare Facilities 2008bull AORN Guidelines for Recommended Practice Section 29 Recommendations Vbull SGNA Standards of Infection Control in processing of Flexible Gastrointestinal Endoscopes 2013bull IAHCSMM Central Service Technical Manual 2007bull AAMI Best Practices in Endoscope Reprocessing Webinar 2015bull AAMI Endoscope Reprocessing Critical Training Steps to Promote Patient Safety 2013bull httphealthnvgovhcqchaicleaning_sterilization_disinfection_healthcare_facilitiespdfbull httpwwwsgnaorgPortals0Standard20of20Infection20Prevention_FINALpdf
Image sourcesbull httpswwweducationaldimensionscomeLearnendoscopeanatomyphpbull httpssitesgooglecomsitevoicedisordernodulesdiagnosis-assessmentassessment-proceduresbull httpsurgicalendocombull http1technationcomroundtable-flexible-endoscopybull httpwwwmedical-hospitalbedscomsale-912541-abs-multi-functional-patient-transportation-cart-hospital-stretcher-trolley-als-st004htmlbull httpwwwusendoscopycomendoscopyendoscope-care-and-accessoriesprocedure-kitsVIA-bedside-precleaning-kitaspxVSVKLJNV1Zgbull httpwwwwashingtonpostcomnationalhealth-sciencein-effort-to-halt-outbreaks-protocol-for-cleaning-medical-scope-is-
updated201503262c0b5d8c-d3e8-11e4-ab77-9646eea6a4c7_storyhtmlbull httpwwwoutpatientsurgerynetsurgical-facility-administrationinfection-controlare-you-cleaning-gi-scopes-properly--10-14bull httpwwwprwebcomreleasesendoscoperepairsprweb11626296htmbull httpwwwmedivatorscomproductsendoscope-reprocessingbrushes-and-flushing-aidsscope-buddy-endoscope-flushing-aidbull httpwwwzutroncomendoscope-leak-testersphpbull httpwwwoptimaxonlinecomremote-visual-inspection-rigid-endoscope83swing-prism-
endoscopePHPSESSID=09ad5b323b4d40e885021856d65aa727bull httpwwwusendoscopycomurologystone-management-and-foreign-body-retrievalmoray-focepsMoray-biopsy-
forcepsaspxVUFVHpPe9Zgbull httpswwwtechno-aidecomstoreproducthydraulic_general_patient_stretcherVUFWXpPe9Zgbull httpswiley-vche-bookshelfdeproductsreading-epubproduct-
id600494titlePractical2BGastrointestinal2BEndoscopyhtmlautr=22Peter+B+Cotton22
CONTACT INFORMATION
Sarah Nolan CCSVP
952-288-2246 Direct
SarahNolanKeySurgicalcom
Key Surgical Inc
800-541-7995
infokeysurgicalcom
Keep Educating Yourself
LEAKPRESSURE TESTING CONTINUEDhellip
Make sure there is no detergent in the water as the foam could prevent you from seeing any air bubbles
If you see a leak keep the scope attached to the air pressure until it is completely removed from the water to keep water from entering the channels which could cause more damage
Common places for a leak bending section seams control knobs water cap
If you are using a leak test apparatus that doesnrsquot require water- complete leak testing before submerging scope in water or detergent A leak is present if you see a drop in pressure or if you donrsquot see inflation of the scope
IMPORTANT Never disconnect pressure while scope is fully immersed-only after it is completely depressurized to prevent damage
STEP 5 MANUAL CLEANING Manual cleaning always happens prior to high level disinfection
or entry into an automated endoscope reprocessor
Manual cleaning is more thorough than pre-cleaning
Wipe all external surfaces with a non-linting soft cloth or spongebull For cystoscopes and ureteroscopes use more of a milking action For
gastroscopes and colonoscopes slide the clothsponge down the length of the tubes
Submerge in enzymatic detergent solution as specified in manufacturerrsquos IFU
Consult the manufacturerrsquos IFU for correct measurements of enzymatic cleaners and water levels
MANUAL CLEANING CONTINUEDhellip
Cleaning brushes can be reusable or disposable be sure all brushes are of the correct size for the endoscope channel or port Inspect all reusable brushes to make sure they are in proper working order
Move any elevator cables up and down several times ndash helps to water pick this area with a syringe
Insert brush into submerged endoscope channel
Brush out all ports ndash under water at all times
Inspect brush and manipulate bristles under water to ensure that ALL bioburden saliva lubrication etc is removed before reintroducing brush into channel
Use your eyes Look for bioburdenresidue
STEP 6 DETERGENT FLUSHSUCTION AND WATER
FLUSHRINSE THE SCOPE
Wash the insertion tube and flush the channels using manufacturer issued cleaning adaptors to make sure all components are adequately flushed with detergent If using an automated flushing device like a Scope Buddyreg ndash refer to the manufacturer IFUs for proper flushing of your channels and ports
Airwater channels- one water stream and biopsy channel another water stream when you flush the scope
Flush the elevator channel with a syringe
Rinse scope with water after the detergentflushsuction- rinse off all detergent from the outside of the scope Flushsuction the channels with water
DETERGENT FLUSHSUCTION AND WATER
FLUSHRINSE THE SCOPE CONTINUEDhellip
If you have a smellydirty scope- it cannot safely be high-
level disinfected Use manufacturer recommended or
approved detergent that cleansdissolves fat cells that hold
onto and produce bad smells
Detergents should be used for only one scope and then
discarded
STEP 7 HIGH-LEVEL
DISINFECTIONSTERILIZATION
Flexible endoscopes can be disinfected manually or with an automated endoscope reprocessor
This step always happens AFTER manual cleaning
Immerse scope completely in solution or automated endoscope reprocessor- be sure to consult IFU for exposure times and temperatures
Check elevator channels before and after HLD
Gluteraldahyde OPA paracetic acid hydrogen peroxide can all be used to high level disinfect
Check with manufacturer IFU to see if scope can be put into a sterilizer
STEP 8 INSPECTION
Inspect flexible endoscopes and accessories of all components to determine damages loss of function gross soils as all of these things can result in patient harm
Inspect a scope Before use
During procedure
After procedure
Immediately after decontamination
Before disinfection or sterilization
Accessories to inspect Water bottle and tubing
Biopsy forceps
Cytology brushes
Cleaning brushes
INSPECTION CONTINUEDhellip
If you see damage remove scope from use and contact
service provider
If yoursquore sending your scope back to the manufacturer or a
third party provider package it in an impenetrable material
that complies with the Department of Transportation
shipping regulations and label as biohazard
STEP 9 STORAGE
Flush scope channel with 70-90 ethyl or isopropyl alcohol followed by
low-pressure forced air to dry internal channels
Store scopes in a closed cabinet with proper air circulation
Store scopes with all valvesaccessories removed
Hang scopes vertically without coiling or kinking
to facilitate any additional drying needed
Always store scopes in a way that protects the
scope and minimizes contamination
Be sure to clean and disinfect the storage
cabinets per manufacturerrsquos IFU
STORAGE CONTINUEDhellip
Storage time ranges between 5-24 days Always be sure to
document high-level disinfection dates and specifics
APIC suggests 7 days
AORN and AAMI recommend that each facility perform a risk
assessment to determine proper storage time
Multi-Society Guideline 2011 contamination during storage
negligible for 7-14 days contamination occurs only on exterior
SGNA supports 7 day storage intervals if scopes were
reprocessed and stored according to professional guidelines
and manufacturer IFU
INDUSTRY GUIDELINES
ENDOSCOPE PROCESSING
ldquoUse cleaning brushes appropriate for the size of the endoscope
channel or portrdquo
-CDC Guideline for Disinfection and Sterilization in Healthcare
Facilities 2008 pg 86
ldquoThorough cleaning is essential before high-level disinfection or
sterilization because inorganic or organic materials that remain on
surfaces of instruments interfere with the effectiveness of these
processesrdquo
-CDC Guideline for Disinfection and Sterilization in
Healthcare Facilities 2008
INDUSTRY GUIDELINES CONTINUEDhellip
ldquoCleaning and decontamination should occur as soon as possible after instruments and equipment are used to prevent the formation of biofilm Cleaning and decontamination must be thoroughly accomplished or disinfection and sterilization may not be effectiverdquo
-AORN Section 29 Recommendations V
ldquoManual cleaninghellipis the most important step in removing microbial burden from an endoscopehellipRetained debris may inactivate or interfere with the capabilityhellipto effectively kill andor inactivate microorganismsrdquo
-SGNA Standards of Infection Control in processing of Flexible Gastrointestinal Endoscopes 2013
ldquoCleaning refers to the removal of all visible and non-visible soil and any other foreign material from the medical device being processed It is the most important step in the disinfectionsterilization process Instruments must be thoroughly cleaned and rinsed for subsequent reprocessing steps to be effectiverdquo
-IAHCSMM Central Service Technical Manual 2007
INDUSTRY GUIDELINES CONTINUEDhellip
ldquoPersonnel involved in endoscope processing should be provided education
training and complete competency verification activities related to their duties upon
initial hire annually at designated intervals or whenever new endoscopic models
new processing equipment or products such as new chemicals are introduced for
processingrdquo
-ANSIAAMI ST91 2015 43
ldquoAt a minimum it is recommended that devices are subjected to high-level
disinfection after each use When possible and practical flexible and semi-rigid
endoscopes should be sterilized due to the greater margin of safety built into
sterilizationrdquo
-ANSIAAMI ST91 2015 43
RISKS INVOLVED WITH IMPROPER
PROCESSING OF ENDOSCOPES
Cross-contamination of harmful diseases like Hepatitis B Hepatitis C MRSA HIV CRE High rates of infection transmission
Biofilm growth on endoscope channels
Damage to the scope general diagnostic scopes cost $25-35000 with repair costs ranging from $500-$10000 per repair Ultrasound scopes cost $40-50000 with average repair costs of $8-11000 per repair
Debris on distal tip (camera) could result in the surgeonrsquos inability to adequately see inside the patient
Patient harm due to damaged and dirty scopes
SOURCESContent Sourcesbull ANSIAAMI ST91 2015 Flexible and semi-rigid endoscope processing in health care facilitiesbull Society of Healthcare Epidemiology of America and American Society of Gastrointestinal Endoscopy 2011 bull CDC Guideline for Disinfection and Sterilization in Healthcare Facilities 2008bull AORN Guidelines for Recommended Practice Section 29 Recommendations Vbull SGNA Standards of Infection Control in processing of Flexible Gastrointestinal Endoscopes 2013bull IAHCSMM Central Service Technical Manual 2007bull AAMI Best Practices in Endoscope Reprocessing Webinar 2015bull AAMI Endoscope Reprocessing Critical Training Steps to Promote Patient Safety 2013bull httphealthnvgovhcqchaicleaning_sterilization_disinfection_healthcare_facilitiespdfbull httpwwwsgnaorgPortals0Standard20of20Infection20Prevention_FINALpdf
Image sourcesbull httpswwweducationaldimensionscomeLearnendoscopeanatomyphpbull httpssitesgooglecomsitevoicedisordernodulesdiagnosis-assessmentassessment-proceduresbull httpsurgicalendocombull http1technationcomroundtable-flexible-endoscopybull httpwwwmedical-hospitalbedscomsale-912541-abs-multi-functional-patient-transportation-cart-hospital-stretcher-trolley-als-st004htmlbull httpwwwusendoscopycomendoscopyendoscope-care-and-accessoriesprocedure-kitsVIA-bedside-precleaning-kitaspxVSVKLJNV1Zgbull httpwwwwashingtonpostcomnationalhealth-sciencein-effort-to-halt-outbreaks-protocol-for-cleaning-medical-scope-is-
updated201503262c0b5d8c-d3e8-11e4-ab77-9646eea6a4c7_storyhtmlbull httpwwwoutpatientsurgerynetsurgical-facility-administrationinfection-controlare-you-cleaning-gi-scopes-properly--10-14bull httpwwwprwebcomreleasesendoscoperepairsprweb11626296htmbull httpwwwmedivatorscomproductsendoscope-reprocessingbrushes-and-flushing-aidsscope-buddy-endoscope-flushing-aidbull httpwwwzutroncomendoscope-leak-testersphpbull httpwwwoptimaxonlinecomremote-visual-inspection-rigid-endoscope83swing-prism-
endoscopePHPSESSID=09ad5b323b4d40e885021856d65aa727bull httpwwwusendoscopycomurologystone-management-and-foreign-body-retrievalmoray-focepsMoray-biopsy-
forcepsaspxVUFVHpPe9Zgbull httpswwwtechno-aidecomstoreproducthydraulic_general_patient_stretcherVUFWXpPe9Zgbull httpswiley-vche-bookshelfdeproductsreading-epubproduct-
id600494titlePractical2BGastrointestinal2BEndoscopyhtmlautr=22Peter+B+Cotton22
CONTACT INFORMATION
Sarah Nolan CCSVP
952-288-2246 Direct
SarahNolanKeySurgicalcom
Key Surgical Inc
800-541-7995
infokeysurgicalcom
Keep Educating Yourself
STEP 5 MANUAL CLEANING Manual cleaning always happens prior to high level disinfection
or entry into an automated endoscope reprocessor
Manual cleaning is more thorough than pre-cleaning
Wipe all external surfaces with a non-linting soft cloth or spongebull For cystoscopes and ureteroscopes use more of a milking action For
gastroscopes and colonoscopes slide the clothsponge down the length of the tubes
Submerge in enzymatic detergent solution as specified in manufacturerrsquos IFU
Consult the manufacturerrsquos IFU for correct measurements of enzymatic cleaners and water levels
MANUAL CLEANING CONTINUEDhellip
Cleaning brushes can be reusable or disposable be sure all brushes are of the correct size for the endoscope channel or port Inspect all reusable brushes to make sure they are in proper working order
Move any elevator cables up and down several times ndash helps to water pick this area with a syringe
Insert brush into submerged endoscope channel
Brush out all ports ndash under water at all times
Inspect brush and manipulate bristles under water to ensure that ALL bioburden saliva lubrication etc is removed before reintroducing brush into channel
Use your eyes Look for bioburdenresidue
STEP 6 DETERGENT FLUSHSUCTION AND WATER
FLUSHRINSE THE SCOPE
Wash the insertion tube and flush the channels using manufacturer issued cleaning adaptors to make sure all components are adequately flushed with detergent If using an automated flushing device like a Scope Buddyreg ndash refer to the manufacturer IFUs for proper flushing of your channels and ports
Airwater channels- one water stream and biopsy channel another water stream when you flush the scope
Flush the elevator channel with a syringe
Rinse scope with water after the detergentflushsuction- rinse off all detergent from the outside of the scope Flushsuction the channels with water
DETERGENT FLUSHSUCTION AND WATER
FLUSHRINSE THE SCOPE CONTINUEDhellip
If you have a smellydirty scope- it cannot safely be high-
level disinfected Use manufacturer recommended or
approved detergent that cleansdissolves fat cells that hold
onto and produce bad smells
Detergents should be used for only one scope and then
discarded
STEP 7 HIGH-LEVEL
DISINFECTIONSTERILIZATION
Flexible endoscopes can be disinfected manually or with an automated endoscope reprocessor
This step always happens AFTER manual cleaning
Immerse scope completely in solution or automated endoscope reprocessor- be sure to consult IFU for exposure times and temperatures
Check elevator channels before and after HLD
Gluteraldahyde OPA paracetic acid hydrogen peroxide can all be used to high level disinfect
Check with manufacturer IFU to see if scope can be put into a sterilizer
STEP 8 INSPECTION
Inspect flexible endoscopes and accessories of all components to determine damages loss of function gross soils as all of these things can result in patient harm
Inspect a scope Before use
During procedure
After procedure
Immediately after decontamination
Before disinfection or sterilization
Accessories to inspect Water bottle and tubing
Biopsy forceps
Cytology brushes
Cleaning brushes
INSPECTION CONTINUEDhellip
If you see damage remove scope from use and contact
service provider
If yoursquore sending your scope back to the manufacturer or a
third party provider package it in an impenetrable material
that complies with the Department of Transportation
shipping regulations and label as biohazard
STEP 9 STORAGE
Flush scope channel with 70-90 ethyl or isopropyl alcohol followed by
low-pressure forced air to dry internal channels
Store scopes in a closed cabinet with proper air circulation
Store scopes with all valvesaccessories removed
Hang scopes vertically without coiling or kinking
to facilitate any additional drying needed
Always store scopes in a way that protects the
scope and minimizes contamination
Be sure to clean and disinfect the storage
cabinets per manufacturerrsquos IFU
STORAGE CONTINUEDhellip
Storage time ranges between 5-24 days Always be sure to
document high-level disinfection dates and specifics
APIC suggests 7 days
AORN and AAMI recommend that each facility perform a risk
assessment to determine proper storage time
Multi-Society Guideline 2011 contamination during storage
negligible for 7-14 days contamination occurs only on exterior
SGNA supports 7 day storage intervals if scopes were
reprocessed and stored according to professional guidelines
and manufacturer IFU
INDUSTRY GUIDELINES
ENDOSCOPE PROCESSING
ldquoUse cleaning brushes appropriate for the size of the endoscope
channel or portrdquo
-CDC Guideline for Disinfection and Sterilization in Healthcare
Facilities 2008 pg 86
ldquoThorough cleaning is essential before high-level disinfection or
sterilization because inorganic or organic materials that remain on
surfaces of instruments interfere with the effectiveness of these
processesrdquo
-CDC Guideline for Disinfection and Sterilization in
Healthcare Facilities 2008
INDUSTRY GUIDELINES CONTINUEDhellip
ldquoCleaning and decontamination should occur as soon as possible after instruments and equipment are used to prevent the formation of biofilm Cleaning and decontamination must be thoroughly accomplished or disinfection and sterilization may not be effectiverdquo
-AORN Section 29 Recommendations V
ldquoManual cleaninghellipis the most important step in removing microbial burden from an endoscopehellipRetained debris may inactivate or interfere with the capabilityhellipto effectively kill andor inactivate microorganismsrdquo
-SGNA Standards of Infection Control in processing of Flexible Gastrointestinal Endoscopes 2013
ldquoCleaning refers to the removal of all visible and non-visible soil and any other foreign material from the medical device being processed It is the most important step in the disinfectionsterilization process Instruments must be thoroughly cleaned and rinsed for subsequent reprocessing steps to be effectiverdquo
-IAHCSMM Central Service Technical Manual 2007
INDUSTRY GUIDELINES CONTINUEDhellip
ldquoPersonnel involved in endoscope processing should be provided education
training and complete competency verification activities related to their duties upon
initial hire annually at designated intervals or whenever new endoscopic models
new processing equipment or products such as new chemicals are introduced for
processingrdquo
-ANSIAAMI ST91 2015 43
ldquoAt a minimum it is recommended that devices are subjected to high-level
disinfection after each use When possible and practical flexible and semi-rigid
endoscopes should be sterilized due to the greater margin of safety built into
sterilizationrdquo
-ANSIAAMI ST91 2015 43
RISKS INVOLVED WITH IMPROPER
PROCESSING OF ENDOSCOPES
Cross-contamination of harmful diseases like Hepatitis B Hepatitis C MRSA HIV CRE High rates of infection transmission
Biofilm growth on endoscope channels
Damage to the scope general diagnostic scopes cost $25-35000 with repair costs ranging from $500-$10000 per repair Ultrasound scopes cost $40-50000 with average repair costs of $8-11000 per repair
Debris on distal tip (camera) could result in the surgeonrsquos inability to adequately see inside the patient
Patient harm due to damaged and dirty scopes
SOURCESContent Sourcesbull ANSIAAMI ST91 2015 Flexible and semi-rigid endoscope processing in health care facilitiesbull Society of Healthcare Epidemiology of America and American Society of Gastrointestinal Endoscopy 2011 bull CDC Guideline for Disinfection and Sterilization in Healthcare Facilities 2008bull AORN Guidelines for Recommended Practice Section 29 Recommendations Vbull SGNA Standards of Infection Control in processing of Flexible Gastrointestinal Endoscopes 2013bull IAHCSMM Central Service Technical Manual 2007bull AAMI Best Practices in Endoscope Reprocessing Webinar 2015bull AAMI Endoscope Reprocessing Critical Training Steps to Promote Patient Safety 2013bull httphealthnvgovhcqchaicleaning_sterilization_disinfection_healthcare_facilitiespdfbull httpwwwsgnaorgPortals0Standard20of20Infection20Prevention_FINALpdf
Image sourcesbull httpswwweducationaldimensionscomeLearnendoscopeanatomyphpbull httpssitesgooglecomsitevoicedisordernodulesdiagnosis-assessmentassessment-proceduresbull httpsurgicalendocombull http1technationcomroundtable-flexible-endoscopybull httpwwwmedical-hospitalbedscomsale-912541-abs-multi-functional-patient-transportation-cart-hospital-stretcher-trolley-als-st004htmlbull httpwwwusendoscopycomendoscopyendoscope-care-and-accessoriesprocedure-kitsVIA-bedside-precleaning-kitaspxVSVKLJNV1Zgbull httpwwwwashingtonpostcomnationalhealth-sciencein-effort-to-halt-outbreaks-protocol-for-cleaning-medical-scope-is-
updated201503262c0b5d8c-d3e8-11e4-ab77-9646eea6a4c7_storyhtmlbull httpwwwoutpatientsurgerynetsurgical-facility-administrationinfection-controlare-you-cleaning-gi-scopes-properly--10-14bull httpwwwprwebcomreleasesendoscoperepairsprweb11626296htmbull httpwwwmedivatorscomproductsendoscope-reprocessingbrushes-and-flushing-aidsscope-buddy-endoscope-flushing-aidbull httpwwwzutroncomendoscope-leak-testersphpbull httpwwwoptimaxonlinecomremote-visual-inspection-rigid-endoscope83swing-prism-
endoscopePHPSESSID=09ad5b323b4d40e885021856d65aa727bull httpwwwusendoscopycomurologystone-management-and-foreign-body-retrievalmoray-focepsMoray-biopsy-
forcepsaspxVUFVHpPe9Zgbull httpswwwtechno-aidecomstoreproducthydraulic_general_patient_stretcherVUFWXpPe9Zgbull httpswiley-vche-bookshelfdeproductsreading-epubproduct-
id600494titlePractical2BGastrointestinal2BEndoscopyhtmlautr=22Peter+B+Cotton22
CONTACT INFORMATION
Sarah Nolan CCSVP
952-288-2246 Direct
SarahNolanKeySurgicalcom
Key Surgical Inc
800-541-7995
infokeysurgicalcom
Keep Educating Yourself
MANUAL CLEANING CONTINUEDhellip
Cleaning brushes can be reusable or disposable be sure all brushes are of the correct size for the endoscope channel or port Inspect all reusable brushes to make sure they are in proper working order
Move any elevator cables up and down several times ndash helps to water pick this area with a syringe
Insert brush into submerged endoscope channel
Brush out all ports ndash under water at all times
Inspect brush and manipulate bristles under water to ensure that ALL bioburden saliva lubrication etc is removed before reintroducing brush into channel
Use your eyes Look for bioburdenresidue
STEP 6 DETERGENT FLUSHSUCTION AND WATER
FLUSHRINSE THE SCOPE
Wash the insertion tube and flush the channels using manufacturer issued cleaning adaptors to make sure all components are adequately flushed with detergent If using an automated flushing device like a Scope Buddyreg ndash refer to the manufacturer IFUs for proper flushing of your channels and ports
Airwater channels- one water stream and biopsy channel another water stream when you flush the scope
Flush the elevator channel with a syringe
Rinse scope with water after the detergentflushsuction- rinse off all detergent from the outside of the scope Flushsuction the channels with water
DETERGENT FLUSHSUCTION AND WATER
FLUSHRINSE THE SCOPE CONTINUEDhellip
If you have a smellydirty scope- it cannot safely be high-
level disinfected Use manufacturer recommended or
approved detergent that cleansdissolves fat cells that hold
onto and produce bad smells
Detergents should be used for only one scope and then
discarded
STEP 7 HIGH-LEVEL
DISINFECTIONSTERILIZATION
Flexible endoscopes can be disinfected manually or with an automated endoscope reprocessor
This step always happens AFTER manual cleaning
Immerse scope completely in solution or automated endoscope reprocessor- be sure to consult IFU for exposure times and temperatures
Check elevator channels before and after HLD
Gluteraldahyde OPA paracetic acid hydrogen peroxide can all be used to high level disinfect
Check with manufacturer IFU to see if scope can be put into a sterilizer
STEP 8 INSPECTION
Inspect flexible endoscopes and accessories of all components to determine damages loss of function gross soils as all of these things can result in patient harm
Inspect a scope Before use
During procedure
After procedure
Immediately after decontamination
Before disinfection or sterilization
Accessories to inspect Water bottle and tubing
Biopsy forceps
Cytology brushes
Cleaning brushes
INSPECTION CONTINUEDhellip
If you see damage remove scope from use and contact
service provider
If yoursquore sending your scope back to the manufacturer or a
third party provider package it in an impenetrable material
that complies with the Department of Transportation
shipping regulations and label as biohazard
STEP 9 STORAGE
Flush scope channel with 70-90 ethyl or isopropyl alcohol followed by
low-pressure forced air to dry internal channels
Store scopes in a closed cabinet with proper air circulation
Store scopes with all valvesaccessories removed
Hang scopes vertically without coiling or kinking
to facilitate any additional drying needed
Always store scopes in a way that protects the
scope and minimizes contamination
Be sure to clean and disinfect the storage
cabinets per manufacturerrsquos IFU
STORAGE CONTINUEDhellip
Storage time ranges between 5-24 days Always be sure to
document high-level disinfection dates and specifics
APIC suggests 7 days
AORN and AAMI recommend that each facility perform a risk
assessment to determine proper storage time
Multi-Society Guideline 2011 contamination during storage
negligible for 7-14 days contamination occurs only on exterior
SGNA supports 7 day storage intervals if scopes were
reprocessed and stored according to professional guidelines
and manufacturer IFU
INDUSTRY GUIDELINES
ENDOSCOPE PROCESSING
ldquoUse cleaning brushes appropriate for the size of the endoscope
channel or portrdquo
-CDC Guideline for Disinfection and Sterilization in Healthcare
Facilities 2008 pg 86
ldquoThorough cleaning is essential before high-level disinfection or
sterilization because inorganic or organic materials that remain on
surfaces of instruments interfere with the effectiveness of these
processesrdquo
-CDC Guideline for Disinfection and Sterilization in
Healthcare Facilities 2008
INDUSTRY GUIDELINES CONTINUEDhellip
ldquoCleaning and decontamination should occur as soon as possible after instruments and equipment are used to prevent the formation of biofilm Cleaning and decontamination must be thoroughly accomplished or disinfection and sterilization may not be effectiverdquo
-AORN Section 29 Recommendations V
ldquoManual cleaninghellipis the most important step in removing microbial burden from an endoscopehellipRetained debris may inactivate or interfere with the capabilityhellipto effectively kill andor inactivate microorganismsrdquo
-SGNA Standards of Infection Control in processing of Flexible Gastrointestinal Endoscopes 2013
ldquoCleaning refers to the removal of all visible and non-visible soil and any other foreign material from the medical device being processed It is the most important step in the disinfectionsterilization process Instruments must be thoroughly cleaned and rinsed for subsequent reprocessing steps to be effectiverdquo
-IAHCSMM Central Service Technical Manual 2007
INDUSTRY GUIDELINES CONTINUEDhellip
ldquoPersonnel involved in endoscope processing should be provided education
training and complete competency verification activities related to their duties upon
initial hire annually at designated intervals or whenever new endoscopic models
new processing equipment or products such as new chemicals are introduced for
processingrdquo
-ANSIAAMI ST91 2015 43
ldquoAt a minimum it is recommended that devices are subjected to high-level
disinfection after each use When possible and practical flexible and semi-rigid
endoscopes should be sterilized due to the greater margin of safety built into
sterilizationrdquo
-ANSIAAMI ST91 2015 43
RISKS INVOLVED WITH IMPROPER
PROCESSING OF ENDOSCOPES
Cross-contamination of harmful diseases like Hepatitis B Hepatitis C MRSA HIV CRE High rates of infection transmission
Biofilm growth on endoscope channels
Damage to the scope general diagnostic scopes cost $25-35000 with repair costs ranging from $500-$10000 per repair Ultrasound scopes cost $40-50000 with average repair costs of $8-11000 per repair
Debris on distal tip (camera) could result in the surgeonrsquos inability to adequately see inside the patient
Patient harm due to damaged and dirty scopes
SOURCESContent Sourcesbull ANSIAAMI ST91 2015 Flexible and semi-rigid endoscope processing in health care facilitiesbull Society of Healthcare Epidemiology of America and American Society of Gastrointestinal Endoscopy 2011 bull CDC Guideline for Disinfection and Sterilization in Healthcare Facilities 2008bull AORN Guidelines for Recommended Practice Section 29 Recommendations Vbull SGNA Standards of Infection Control in processing of Flexible Gastrointestinal Endoscopes 2013bull IAHCSMM Central Service Technical Manual 2007bull AAMI Best Practices in Endoscope Reprocessing Webinar 2015bull AAMI Endoscope Reprocessing Critical Training Steps to Promote Patient Safety 2013bull httphealthnvgovhcqchaicleaning_sterilization_disinfection_healthcare_facilitiespdfbull httpwwwsgnaorgPortals0Standard20of20Infection20Prevention_FINALpdf
Image sourcesbull httpswwweducationaldimensionscomeLearnendoscopeanatomyphpbull httpssitesgooglecomsitevoicedisordernodulesdiagnosis-assessmentassessment-proceduresbull httpsurgicalendocombull http1technationcomroundtable-flexible-endoscopybull httpwwwmedical-hospitalbedscomsale-912541-abs-multi-functional-patient-transportation-cart-hospital-stretcher-trolley-als-st004htmlbull httpwwwusendoscopycomendoscopyendoscope-care-and-accessoriesprocedure-kitsVIA-bedside-precleaning-kitaspxVSVKLJNV1Zgbull httpwwwwashingtonpostcomnationalhealth-sciencein-effort-to-halt-outbreaks-protocol-for-cleaning-medical-scope-is-
updated201503262c0b5d8c-d3e8-11e4-ab77-9646eea6a4c7_storyhtmlbull httpwwwoutpatientsurgerynetsurgical-facility-administrationinfection-controlare-you-cleaning-gi-scopes-properly--10-14bull httpwwwprwebcomreleasesendoscoperepairsprweb11626296htmbull httpwwwmedivatorscomproductsendoscope-reprocessingbrushes-and-flushing-aidsscope-buddy-endoscope-flushing-aidbull httpwwwzutroncomendoscope-leak-testersphpbull httpwwwoptimaxonlinecomremote-visual-inspection-rigid-endoscope83swing-prism-
endoscopePHPSESSID=09ad5b323b4d40e885021856d65aa727bull httpwwwusendoscopycomurologystone-management-and-foreign-body-retrievalmoray-focepsMoray-biopsy-
forcepsaspxVUFVHpPe9Zgbull httpswwwtechno-aidecomstoreproducthydraulic_general_patient_stretcherVUFWXpPe9Zgbull httpswiley-vche-bookshelfdeproductsreading-epubproduct-
id600494titlePractical2BGastrointestinal2BEndoscopyhtmlautr=22Peter+B+Cotton22
CONTACT INFORMATION
Sarah Nolan CCSVP
952-288-2246 Direct
SarahNolanKeySurgicalcom
Key Surgical Inc
800-541-7995
infokeysurgicalcom
Keep Educating Yourself
STEP 6 DETERGENT FLUSHSUCTION AND WATER
FLUSHRINSE THE SCOPE
Wash the insertion tube and flush the channels using manufacturer issued cleaning adaptors to make sure all components are adequately flushed with detergent If using an automated flushing device like a Scope Buddyreg ndash refer to the manufacturer IFUs for proper flushing of your channels and ports
Airwater channels- one water stream and biopsy channel another water stream when you flush the scope
Flush the elevator channel with a syringe
Rinse scope with water after the detergentflushsuction- rinse off all detergent from the outside of the scope Flushsuction the channels with water
DETERGENT FLUSHSUCTION AND WATER
FLUSHRINSE THE SCOPE CONTINUEDhellip
If you have a smellydirty scope- it cannot safely be high-
level disinfected Use manufacturer recommended or
approved detergent that cleansdissolves fat cells that hold
onto and produce bad smells
Detergents should be used for only one scope and then
discarded
STEP 7 HIGH-LEVEL
DISINFECTIONSTERILIZATION
Flexible endoscopes can be disinfected manually or with an automated endoscope reprocessor
This step always happens AFTER manual cleaning
Immerse scope completely in solution or automated endoscope reprocessor- be sure to consult IFU for exposure times and temperatures
Check elevator channels before and after HLD
Gluteraldahyde OPA paracetic acid hydrogen peroxide can all be used to high level disinfect
Check with manufacturer IFU to see if scope can be put into a sterilizer
STEP 8 INSPECTION
Inspect flexible endoscopes and accessories of all components to determine damages loss of function gross soils as all of these things can result in patient harm
Inspect a scope Before use
During procedure
After procedure
Immediately after decontamination
Before disinfection or sterilization
Accessories to inspect Water bottle and tubing
Biopsy forceps
Cytology brushes
Cleaning brushes
INSPECTION CONTINUEDhellip
If you see damage remove scope from use and contact
service provider
If yoursquore sending your scope back to the manufacturer or a
third party provider package it in an impenetrable material
that complies with the Department of Transportation
shipping regulations and label as biohazard
STEP 9 STORAGE
Flush scope channel with 70-90 ethyl or isopropyl alcohol followed by
low-pressure forced air to dry internal channels
Store scopes in a closed cabinet with proper air circulation
Store scopes with all valvesaccessories removed
Hang scopes vertically without coiling or kinking
to facilitate any additional drying needed
Always store scopes in a way that protects the
scope and minimizes contamination
Be sure to clean and disinfect the storage
cabinets per manufacturerrsquos IFU
STORAGE CONTINUEDhellip
Storage time ranges between 5-24 days Always be sure to
document high-level disinfection dates and specifics
APIC suggests 7 days
AORN and AAMI recommend that each facility perform a risk
assessment to determine proper storage time
Multi-Society Guideline 2011 contamination during storage
negligible for 7-14 days contamination occurs only on exterior
SGNA supports 7 day storage intervals if scopes were
reprocessed and stored according to professional guidelines
and manufacturer IFU
INDUSTRY GUIDELINES
ENDOSCOPE PROCESSING
ldquoUse cleaning brushes appropriate for the size of the endoscope
channel or portrdquo
-CDC Guideline for Disinfection and Sterilization in Healthcare
Facilities 2008 pg 86
ldquoThorough cleaning is essential before high-level disinfection or
sterilization because inorganic or organic materials that remain on
surfaces of instruments interfere with the effectiveness of these
processesrdquo
-CDC Guideline for Disinfection and Sterilization in
Healthcare Facilities 2008
INDUSTRY GUIDELINES CONTINUEDhellip
ldquoCleaning and decontamination should occur as soon as possible after instruments and equipment are used to prevent the formation of biofilm Cleaning and decontamination must be thoroughly accomplished or disinfection and sterilization may not be effectiverdquo
-AORN Section 29 Recommendations V
ldquoManual cleaninghellipis the most important step in removing microbial burden from an endoscopehellipRetained debris may inactivate or interfere with the capabilityhellipto effectively kill andor inactivate microorganismsrdquo
-SGNA Standards of Infection Control in processing of Flexible Gastrointestinal Endoscopes 2013
ldquoCleaning refers to the removal of all visible and non-visible soil and any other foreign material from the medical device being processed It is the most important step in the disinfectionsterilization process Instruments must be thoroughly cleaned and rinsed for subsequent reprocessing steps to be effectiverdquo
-IAHCSMM Central Service Technical Manual 2007
INDUSTRY GUIDELINES CONTINUEDhellip
ldquoPersonnel involved in endoscope processing should be provided education
training and complete competency verification activities related to their duties upon
initial hire annually at designated intervals or whenever new endoscopic models
new processing equipment or products such as new chemicals are introduced for
processingrdquo
-ANSIAAMI ST91 2015 43
ldquoAt a minimum it is recommended that devices are subjected to high-level
disinfection after each use When possible and practical flexible and semi-rigid
endoscopes should be sterilized due to the greater margin of safety built into
sterilizationrdquo
-ANSIAAMI ST91 2015 43
RISKS INVOLVED WITH IMPROPER
PROCESSING OF ENDOSCOPES
Cross-contamination of harmful diseases like Hepatitis B Hepatitis C MRSA HIV CRE High rates of infection transmission
Biofilm growth on endoscope channels
Damage to the scope general diagnostic scopes cost $25-35000 with repair costs ranging from $500-$10000 per repair Ultrasound scopes cost $40-50000 with average repair costs of $8-11000 per repair
Debris on distal tip (camera) could result in the surgeonrsquos inability to adequately see inside the patient
Patient harm due to damaged and dirty scopes
SOURCESContent Sourcesbull ANSIAAMI ST91 2015 Flexible and semi-rigid endoscope processing in health care facilitiesbull Society of Healthcare Epidemiology of America and American Society of Gastrointestinal Endoscopy 2011 bull CDC Guideline for Disinfection and Sterilization in Healthcare Facilities 2008bull AORN Guidelines for Recommended Practice Section 29 Recommendations Vbull SGNA Standards of Infection Control in processing of Flexible Gastrointestinal Endoscopes 2013bull IAHCSMM Central Service Technical Manual 2007bull AAMI Best Practices in Endoscope Reprocessing Webinar 2015bull AAMI Endoscope Reprocessing Critical Training Steps to Promote Patient Safety 2013bull httphealthnvgovhcqchaicleaning_sterilization_disinfection_healthcare_facilitiespdfbull httpwwwsgnaorgPortals0Standard20of20Infection20Prevention_FINALpdf
Image sourcesbull httpswwweducationaldimensionscomeLearnendoscopeanatomyphpbull httpssitesgooglecomsitevoicedisordernodulesdiagnosis-assessmentassessment-proceduresbull httpsurgicalendocombull http1technationcomroundtable-flexible-endoscopybull httpwwwmedical-hospitalbedscomsale-912541-abs-multi-functional-patient-transportation-cart-hospital-stretcher-trolley-als-st004htmlbull httpwwwusendoscopycomendoscopyendoscope-care-and-accessoriesprocedure-kitsVIA-bedside-precleaning-kitaspxVSVKLJNV1Zgbull httpwwwwashingtonpostcomnationalhealth-sciencein-effort-to-halt-outbreaks-protocol-for-cleaning-medical-scope-is-
updated201503262c0b5d8c-d3e8-11e4-ab77-9646eea6a4c7_storyhtmlbull httpwwwoutpatientsurgerynetsurgical-facility-administrationinfection-controlare-you-cleaning-gi-scopes-properly--10-14bull httpwwwprwebcomreleasesendoscoperepairsprweb11626296htmbull httpwwwmedivatorscomproductsendoscope-reprocessingbrushes-and-flushing-aidsscope-buddy-endoscope-flushing-aidbull httpwwwzutroncomendoscope-leak-testersphpbull httpwwwoptimaxonlinecomremote-visual-inspection-rigid-endoscope83swing-prism-
endoscopePHPSESSID=09ad5b323b4d40e885021856d65aa727bull httpwwwusendoscopycomurologystone-management-and-foreign-body-retrievalmoray-focepsMoray-biopsy-
forcepsaspxVUFVHpPe9Zgbull httpswwwtechno-aidecomstoreproducthydraulic_general_patient_stretcherVUFWXpPe9Zgbull httpswiley-vche-bookshelfdeproductsreading-epubproduct-
id600494titlePractical2BGastrointestinal2BEndoscopyhtmlautr=22Peter+B+Cotton22
CONTACT INFORMATION
Sarah Nolan CCSVP
952-288-2246 Direct
SarahNolanKeySurgicalcom
Key Surgical Inc
800-541-7995
infokeysurgicalcom
Keep Educating Yourself
DETERGENT FLUSHSUCTION AND WATER
FLUSHRINSE THE SCOPE CONTINUEDhellip
If you have a smellydirty scope- it cannot safely be high-
level disinfected Use manufacturer recommended or
approved detergent that cleansdissolves fat cells that hold
onto and produce bad smells
Detergents should be used for only one scope and then
discarded
STEP 7 HIGH-LEVEL
DISINFECTIONSTERILIZATION
Flexible endoscopes can be disinfected manually or with an automated endoscope reprocessor
This step always happens AFTER manual cleaning
Immerse scope completely in solution or automated endoscope reprocessor- be sure to consult IFU for exposure times and temperatures
Check elevator channels before and after HLD
Gluteraldahyde OPA paracetic acid hydrogen peroxide can all be used to high level disinfect
Check with manufacturer IFU to see if scope can be put into a sterilizer
STEP 8 INSPECTION
Inspect flexible endoscopes and accessories of all components to determine damages loss of function gross soils as all of these things can result in patient harm
Inspect a scope Before use
During procedure
After procedure
Immediately after decontamination
Before disinfection or sterilization
Accessories to inspect Water bottle and tubing
Biopsy forceps
Cytology brushes
Cleaning brushes
INSPECTION CONTINUEDhellip
If you see damage remove scope from use and contact
service provider
If yoursquore sending your scope back to the manufacturer or a
third party provider package it in an impenetrable material
that complies with the Department of Transportation
shipping regulations and label as biohazard
STEP 9 STORAGE
Flush scope channel with 70-90 ethyl or isopropyl alcohol followed by
low-pressure forced air to dry internal channels
Store scopes in a closed cabinet with proper air circulation
Store scopes with all valvesaccessories removed
Hang scopes vertically without coiling or kinking
to facilitate any additional drying needed
Always store scopes in a way that protects the
scope and minimizes contamination
Be sure to clean and disinfect the storage
cabinets per manufacturerrsquos IFU
STORAGE CONTINUEDhellip
Storage time ranges between 5-24 days Always be sure to
document high-level disinfection dates and specifics
APIC suggests 7 days
AORN and AAMI recommend that each facility perform a risk
assessment to determine proper storage time
Multi-Society Guideline 2011 contamination during storage
negligible for 7-14 days contamination occurs only on exterior
SGNA supports 7 day storage intervals if scopes were
reprocessed and stored according to professional guidelines
and manufacturer IFU
INDUSTRY GUIDELINES
ENDOSCOPE PROCESSING
ldquoUse cleaning brushes appropriate for the size of the endoscope
channel or portrdquo
-CDC Guideline for Disinfection and Sterilization in Healthcare
Facilities 2008 pg 86
ldquoThorough cleaning is essential before high-level disinfection or
sterilization because inorganic or organic materials that remain on
surfaces of instruments interfere with the effectiveness of these
processesrdquo
-CDC Guideline for Disinfection and Sterilization in
Healthcare Facilities 2008
INDUSTRY GUIDELINES CONTINUEDhellip
ldquoCleaning and decontamination should occur as soon as possible after instruments and equipment are used to prevent the formation of biofilm Cleaning and decontamination must be thoroughly accomplished or disinfection and sterilization may not be effectiverdquo
-AORN Section 29 Recommendations V
ldquoManual cleaninghellipis the most important step in removing microbial burden from an endoscopehellipRetained debris may inactivate or interfere with the capabilityhellipto effectively kill andor inactivate microorganismsrdquo
-SGNA Standards of Infection Control in processing of Flexible Gastrointestinal Endoscopes 2013
ldquoCleaning refers to the removal of all visible and non-visible soil and any other foreign material from the medical device being processed It is the most important step in the disinfectionsterilization process Instruments must be thoroughly cleaned and rinsed for subsequent reprocessing steps to be effectiverdquo
-IAHCSMM Central Service Technical Manual 2007
INDUSTRY GUIDELINES CONTINUEDhellip
ldquoPersonnel involved in endoscope processing should be provided education
training and complete competency verification activities related to their duties upon
initial hire annually at designated intervals or whenever new endoscopic models
new processing equipment or products such as new chemicals are introduced for
processingrdquo
-ANSIAAMI ST91 2015 43
ldquoAt a minimum it is recommended that devices are subjected to high-level
disinfection after each use When possible and practical flexible and semi-rigid
endoscopes should be sterilized due to the greater margin of safety built into
sterilizationrdquo
-ANSIAAMI ST91 2015 43
RISKS INVOLVED WITH IMPROPER
PROCESSING OF ENDOSCOPES
Cross-contamination of harmful diseases like Hepatitis B Hepatitis C MRSA HIV CRE High rates of infection transmission
Biofilm growth on endoscope channels
Damage to the scope general diagnostic scopes cost $25-35000 with repair costs ranging from $500-$10000 per repair Ultrasound scopes cost $40-50000 with average repair costs of $8-11000 per repair
Debris on distal tip (camera) could result in the surgeonrsquos inability to adequately see inside the patient
Patient harm due to damaged and dirty scopes
SOURCESContent Sourcesbull ANSIAAMI ST91 2015 Flexible and semi-rigid endoscope processing in health care facilitiesbull Society of Healthcare Epidemiology of America and American Society of Gastrointestinal Endoscopy 2011 bull CDC Guideline for Disinfection and Sterilization in Healthcare Facilities 2008bull AORN Guidelines for Recommended Practice Section 29 Recommendations Vbull SGNA Standards of Infection Control in processing of Flexible Gastrointestinal Endoscopes 2013bull IAHCSMM Central Service Technical Manual 2007bull AAMI Best Practices in Endoscope Reprocessing Webinar 2015bull AAMI Endoscope Reprocessing Critical Training Steps to Promote Patient Safety 2013bull httphealthnvgovhcqchaicleaning_sterilization_disinfection_healthcare_facilitiespdfbull httpwwwsgnaorgPortals0Standard20of20Infection20Prevention_FINALpdf
Image sourcesbull httpswwweducationaldimensionscomeLearnendoscopeanatomyphpbull httpssitesgooglecomsitevoicedisordernodulesdiagnosis-assessmentassessment-proceduresbull httpsurgicalendocombull http1technationcomroundtable-flexible-endoscopybull httpwwwmedical-hospitalbedscomsale-912541-abs-multi-functional-patient-transportation-cart-hospital-stretcher-trolley-als-st004htmlbull httpwwwusendoscopycomendoscopyendoscope-care-and-accessoriesprocedure-kitsVIA-bedside-precleaning-kitaspxVSVKLJNV1Zgbull httpwwwwashingtonpostcomnationalhealth-sciencein-effort-to-halt-outbreaks-protocol-for-cleaning-medical-scope-is-
updated201503262c0b5d8c-d3e8-11e4-ab77-9646eea6a4c7_storyhtmlbull httpwwwoutpatientsurgerynetsurgical-facility-administrationinfection-controlare-you-cleaning-gi-scopes-properly--10-14bull httpwwwprwebcomreleasesendoscoperepairsprweb11626296htmbull httpwwwmedivatorscomproductsendoscope-reprocessingbrushes-and-flushing-aidsscope-buddy-endoscope-flushing-aidbull httpwwwzutroncomendoscope-leak-testersphpbull httpwwwoptimaxonlinecomremote-visual-inspection-rigid-endoscope83swing-prism-
endoscopePHPSESSID=09ad5b323b4d40e885021856d65aa727bull httpwwwusendoscopycomurologystone-management-and-foreign-body-retrievalmoray-focepsMoray-biopsy-
forcepsaspxVUFVHpPe9Zgbull httpswwwtechno-aidecomstoreproducthydraulic_general_patient_stretcherVUFWXpPe9Zgbull httpswiley-vche-bookshelfdeproductsreading-epubproduct-
id600494titlePractical2BGastrointestinal2BEndoscopyhtmlautr=22Peter+B+Cotton22
CONTACT INFORMATION
Sarah Nolan CCSVP
952-288-2246 Direct
SarahNolanKeySurgicalcom
Key Surgical Inc
800-541-7995
infokeysurgicalcom
Keep Educating Yourself
STEP 7 HIGH-LEVEL
DISINFECTIONSTERILIZATION
Flexible endoscopes can be disinfected manually or with an automated endoscope reprocessor
This step always happens AFTER manual cleaning
Immerse scope completely in solution or automated endoscope reprocessor- be sure to consult IFU for exposure times and temperatures
Check elevator channels before and after HLD
Gluteraldahyde OPA paracetic acid hydrogen peroxide can all be used to high level disinfect
Check with manufacturer IFU to see if scope can be put into a sterilizer
STEP 8 INSPECTION
Inspect flexible endoscopes and accessories of all components to determine damages loss of function gross soils as all of these things can result in patient harm
Inspect a scope Before use
During procedure
After procedure
Immediately after decontamination
Before disinfection or sterilization
Accessories to inspect Water bottle and tubing
Biopsy forceps
Cytology brushes
Cleaning brushes
INSPECTION CONTINUEDhellip
If you see damage remove scope from use and contact
service provider
If yoursquore sending your scope back to the manufacturer or a
third party provider package it in an impenetrable material
that complies with the Department of Transportation
shipping regulations and label as biohazard
STEP 9 STORAGE
Flush scope channel with 70-90 ethyl or isopropyl alcohol followed by
low-pressure forced air to dry internal channels
Store scopes in a closed cabinet with proper air circulation
Store scopes with all valvesaccessories removed
Hang scopes vertically without coiling or kinking
to facilitate any additional drying needed
Always store scopes in a way that protects the
scope and minimizes contamination
Be sure to clean and disinfect the storage
cabinets per manufacturerrsquos IFU
STORAGE CONTINUEDhellip
Storage time ranges between 5-24 days Always be sure to
document high-level disinfection dates and specifics
APIC suggests 7 days
AORN and AAMI recommend that each facility perform a risk
assessment to determine proper storage time
Multi-Society Guideline 2011 contamination during storage
negligible for 7-14 days contamination occurs only on exterior
SGNA supports 7 day storage intervals if scopes were
reprocessed and stored according to professional guidelines
and manufacturer IFU
INDUSTRY GUIDELINES
ENDOSCOPE PROCESSING
ldquoUse cleaning brushes appropriate for the size of the endoscope
channel or portrdquo
-CDC Guideline for Disinfection and Sterilization in Healthcare
Facilities 2008 pg 86
ldquoThorough cleaning is essential before high-level disinfection or
sterilization because inorganic or organic materials that remain on
surfaces of instruments interfere with the effectiveness of these
processesrdquo
-CDC Guideline for Disinfection and Sterilization in
Healthcare Facilities 2008
INDUSTRY GUIDELINES CONTINUEDhellip
ldquoCleaning and decontamination should occur as soon as possible after instruments and equipment are used to prevent the formation of biofilm Cleaning and decontamination must be thoroughly accomplished or disinfection and sterilization may not be effectiverdquo
-AORN Section 29 Recommendations V
ldquoManual cleaninghellipis the most important step in removing microbial burden from an endoscopehellipRetained debris may inactivate or interfere with the capabilityhellipto effectively kill andor inactivate microorganismsrdquo
-SGNA Standards of Infection Control in processing of Flexible Gastrointestinal Endoscopes 2013
ldquoCleaning refers to the removal of all visible and non-visible soil and any other foreign material from the medical device being processed It is the most important step in the disinfectionsterilization process Instruments must be thoroughly cleaned and rinsed for subsequent reprocessing steps to be effectiverdquo
-IAHCSMM Central Service Technical Manual 2007
INDUSTRY GUIDELINES CONTINUEDhellip
ldquoPersonnel involved in endoscope processing should be provided education
training and complete competency verification activities related to their duties upon
initial hire annually at designated intervals or whenever new endoscopic models
new processing equipment or products such as new chemicals are introduced for
processingrdquo
-ANSIAAMI ST91 2015 43
ldquoAt a minimum it is recommended that devices are subjected to high-level
disinfection after each use When possible and practical flexible and semi-rigid
endoscopes should be sterilized due to the greater margin of safety built into
sterilizationrdquo
-ANSIAAMI ST91 2015 43
RISKS INVOLVED WITH IMPROPER
PROCESSING OF ENDOSCOPES
Cross-contamination of harmful diseases like Hepatitis B Hepatitis C MRSA HIV CRE High rates of infection transmission
Biofilm growth on endoscope channels
Damage to the scope general diagnostic scopes cost $25-35000 with repair costs ranging from $500-$10000 per repair Ultrasound scopes cost $40-50000 with average repair costs of $8-11000 per repair
Debris on distal tip (camera) could result in the surgeonrsquos inability to adequately see inside the patient
Patient harm due to damaged and dirty scopes
SOURCESContent Sourcesbull ANSIAAMI ST91 2015 Flexible and semi-rigid endoscope processing in health care facilitiesbull Society of Healthcare Epidemiology of America and American Society of Gastrointestinal Endoscopy 2011 bull CDC Guideline for Disinfection and Sterilization in Healthcare Facilities 2008bull AORN Guidelines for Recommended Practice Section 29 Recommendations Vbull SGNA Standards of Infection Control in processing of Flexible Gastrointestinal Endoscopes 2013bull IAHCSMM Central Service Technical Manual 2007bull AAMI Best Practices in Endoscope Reprocessing Webinar 2015bull AAMI Endoscope Reprocessing Critical Training Steps to Promote Patient Safety 2013bull httphealthnvgovhcqchaicleaning_sterilization_disinfection_healthcare_facilitiespdfbull httpwwwsgnaorgPortals0Standard20of20Infection20Prevention_FINALpdf
Image sourcesbull httpswwweducationaldimensionscomeLearnendoscopeanatomyphpbull httpssitesgooglecomsitevoicedisordernodulesdiagnosis-assessmentassessment-proceduresbull httpsurgicalendocombull http1technationcomroundtable-flexible-endoscopybull httpwwwmedical-hospitalbedscomsale-912541-abs-multi-functional-patient-transportation-cart-hospital-stretcher-trolley-als-st004htmlbull httpwwwusendoscopycomendoscopyendoscope-care-and-accessoriesprocedure-kitsVIA-bedside-precleaning-kitaspxVSVKLJNV1Zgbull httpwwwwashingtonpostcomnationalhealth-sciencein-effort-to-halt-outbreaks-protocol-for-cleaning-medical-scope-is-
updated201503262c0b5d8c-d3e8-11e4-ab77-9646eea6a4c7_storyhtmlbull httpwwwoutpatientsurgerynetsurgical-facility-administrationinfection-controlare-you-cleaning-gi-scopes-properly--10-14bull httpwwwprwebcomreleasesendoscoperepairsprweb11626296htmbull httpwwwmedivatorscomproductsendoscope-reprocessingbrushes-and-flushing-aidsscope-buddy-endoscope-flushing-aidbull httpwwwzutroncomendoscope-leak-testersphpbull httpwwwoptimaxonlinecomremote-visual-inspection-rigid-endoscope83swing-prism-
endoscopePHPSESSID=09ad5b323b4d40e885021856d65aa727bull httpwwwusendoscopycomurologystone-management-and-foreign-body-retrievalmoray-focepsMoray-biopsy-
forcepsaspxVUFVHpPe9Zgbull httpswwwtechno-aidecomstoreproducthydraulic_general_patient_stretcherVUFWXpPe9Zgbull httpswiley-vche-bookshelfdeproductsreading-epubproduct-
id600494titlePractical2BGastrointestinal2BEndoscopyhtmlautr=22Peter+B+Cotton22
CONTACT INFORMATION
Sarah Nolan CCSVP
952-288-2246 Direct
SarahNolanKeySurgicalcom
Key Surgical Inc
800-541-7995
infokeysurgicalcom
Keep Educating Yourself
STEP 8 INSPECTION
Inspect flexible endoscopes and accessories of all components to determine damages loss of function gross soils as all of these things can result in patient harm
Inspect a scope Before use
During procedure
After procedure
Immediately after decontamination
Before disinfection or sterilization
Accessories to inspect Water bottle and tubing
Biopsy forceps
Cytology brushes
Cleaning brushes
INSPECTION CONTINUEDhellip
If you see damage remove scope from use and contact
service provider
If yoursquore sending your scope back to the manufacturer or a
third party provider package it in an impenetrable material
that complies with the Department of Transportation
shipping regulations and label as biohazard
STEP 9 STORAGE
Flush scope channel with 70-90 ethyl or isopropyl alcohol followed by
low-pressure forced air to dry internal channels
Store scopes in a closed cabinet with proper air circulation
Store scopes with all valvesaccessories removed
Hang scopes vertically without coiling or kinking
to facilitate any additional drying needed
Always store scopes in a way that protects the
scope and minimizes contamination
Be sure to clean and disinfect the storage
cabinets per manufacturerrsquos IFU
STORAGE CONTINUEDhellip
Storage time ranges between 5-24 days Always be sure to
document high-level disinfection dates and specifics
APIC suggests 7 days
AORN and AAMI recommend that each facility perform a risk
assessment to determine proper storage time
Multi-Society Guideline 2011 contamination during storage
negligible for 7-14 days contamination occurs only on exterior
SGNA supports 7 day storage intervals if scopes were
reprocessed and stored according to professional guidelines
and manufacturer IFU
INDUSTRY GUIDELINES
ENDOSCOPE PROCESSING
ldquoUse cleaning brushes appropriate for the size of the endoscope
channel or portrdquo
-CDC Guideline for Disinfection and Sterilization in Healthcare
Facilities 2008 pg 86
ldquoThorough cleaning is essential before high-level disinfection or
sterilization because inorganic or organic materials that remain on
surfaces of instruments interfere with the effectiveness of these
processesrdquo
-CDC Guideline for Disinfection and Sterilization in
Healthcare Facilities 2008
INDUSTRY GUIDELINES CONTINUEDhellip
ldquoCleaning and decontamination should occur as soon as possible after instruments and equipment are used to prevent the formation of biofilm Cleaning and decontamination must be thoroughly accomplished or disinfection and sterilization may not be effectiverdquo
-AORN Section 29 Recommendations V
ldquoManual cleaninghellipis the most important step in removing microbial burden from an endoscopehellipRetained debris may inactivate or interfere with the capabilityhellipto effectively kill andor inactivate microorganismsrdquo
-SGNA Standards of Infection Control in processing of Flexible Gastrointestinal Endoscopes 2013
ldquoCleaning refers to the removal of all visible and non-visible soil and any other foreign material from the medical device being processed It is the most important step in the disinfectionsterilization process Instruments must be thoroughly cleaned and rinsed for subsequent reprocessing steps to be effectiverdquo
-IAHCSMM Central Service Technical Manual 2007
INDUSTRY GUIDELINES CONTINUEDhellip
ldquoPersonnel involved in endoscope processing should be provided education
training and complete competency verification activities related to their duties upon
initial hire annually at designated intervals or whenever new endoscopic models
new processing equipment or products such as new chemicals are introduced for
processingrdquo
-ANSIAAMI ST91 2015 43
ldquoAt a minimum it is recommended that devices are subjected to high-level
disinfection after each use When possible and practical flexible and semi-rigid
endoscopes should be sterilized due to the greater margin of safety built into
sterilizationrdquo
-ANSIAAMI ST91 2015 43
RISKS INVOLVED WITH IMPROPER
PROCESSING OF ENDOSCOPES
Cross-contamination of harmful diseases like Hepatitis B Hepatitis C MRSA HIV CRE High rates of infection transmission
Biofilm growth on endoscope channels
Damage to the scope general diagnostic scopes cost $25-35000 with repair costs ranging from $500-$10000 per repair Ultrasound scopes cost $40-50000 with average repair costs of $8-11000 per repair
Debris on distal tip (camera) could result in the surgeonrsquos inability to adequately see inside the patient
Patient harm due to damaged and dirty scopes
SOURCESContent Sourcesbull ANSIAAMI ST91 2015 Flexible and semi-rigid endoscope processing in health care facilitiesbull Society of Healthcare Epidemiology of America and American Society of Gastrointestinal Endoscopy 2011 bull CDC Guideline for Disinfection and Sterilization in Healthcare Facilities 2008bull AORN Guidelines for Recommended Practice Section 29 Recommendations Vbull SGNA Standards of Infection Control in processing of Flexible Gastrointestinal Endoscopes 2013bull IAHCSMM Central Service Technical Manual 2007bull AAMI Best Practices in Endoscope Reprocessing Webinar 2015bull AAMI Endoscope Reprocessing Critical Training Steps to Promote Patient Safety 2013bull httphealthnvgovhcqchaicleaning_sterilization_disinfection_healthcare_facilitiespdfbull httpwwwsgnaorgPortals0Standard20of20Infection20Prevention_FINALpdf
Image sourcesbull httpswwweducationaldimensionscomeLearnendoscopeanatomyphpbull httpssitesgooglecomsitevoicedisordernodulesdiagnosis-assessmentassessment-proceduresbull httpsurgicalendocombull http1technationcomroundtable-flexible-endoscopybull httpwwwmedical-hospitalbedscomsale-912541-abs-multi-functional-patient-transportation-cart-hospital-stretcher-trolley-als-st004htmlbull httpwwwusendoscopycomendoscopyendoscope-care-and-accessoriesprocedure-kitsVIA-bedside-precleaning-kitaspxVSVKLJNV1Zgbull httpwwwwashingtonpostcomnationalhealth-sciencein-effort-to-halt-outbreaks-protocol-for-cleaning-medical-scope-is-
updated201503262c0b5d8c-d3e8-11e4-ab77-9646eea6a4c7_storyhtmlbull httpwwwoutpatientsurgerynetsurgical-facility-administrationinfection-controlare-you-cleaning-gi-scopes-properly--10-14bull httpwwwprwebcomreleasesendoscoperepairsprweb11626296htmbull httpwwwmedivatorscomproductsendoscope-reprocessingbrushes-and-flushing-aidsscope-buddy-endoscope-flushing-aidbull httpwwwzutroncomendoscope-leak-testersphpbull httpwwwoptimaxonlinecomremote-visual-inspection-rigid-endoscope83swing-prism-
endoscopePHPSESSID=09ad5b323b4d40e885021856d65aa727bull httpwwwusendoscopycomurologystone-management-and-foreign-body-retrievalmoray-focepsMoray-biopsy-
forcepsaspxVUFVHpPe9Zgbull httpswwwtechno-aidecomstoreproducthydraulic_general_patient_stretcherVUFWXpPe9Zgbull httpswiley-vche-bookshelfdeproductsreading-epubproduct-
id600494titlePractical2BGastrointestinal2BEndoscopyhtmlautr=22Peter+B+Cotton22
CONTACT INFORMATION
Sarah Nolan CCSVP
952-288-2246 Direct
SarahNolanKeySurgicalcom
Key Surgical Inc
800-541-7995
infokeysurgicalcom
Keep Educating Yourself
INSPECTION CONTINUEDhellip
If you see damage remove scope from use and contact
service provider
If yoursquore sending your scope back to the manufacturer or a
third party provider package it in an impenetrable material
that complies with the Department of Transportation
shipping regulations and label as biohazard
STEP 9 STORAGE
Flush scope channel with 70-90 ethyl or isopropyl alcohol followed by
low-pressure forced air to dry internal channels
Store scopes in a closed cabinet with proper air circulation
Store scopes with all valvesaccessories removed
Hang scopes vertically without coiling or kinking
to facilitate any additional drying needed
Always store scopes in a way that protects the
scope and minimizes contamination
Be sure to clean and disinfect the storage
cabinets per manufacturerrsquos IFU
STORAGE CONTINUEDhellip
Storage time ranges between 5-24 days Always be sure to
document high-level disinfection dates and specifics
APIC suggests 7 days
AORN and AAMI recommend that each facility perform a risk
assessment to determine proper storage time
Multi-Society Guideline 2011 contamination during storage
negligible for 7-14 days contamination occurs only on exterior
SGNA supports 7 day storage intervals if scopes were
reprocessed and stored according to professional guidelines
and manufacturer IFU
INDUSTRY GUIDELINES
ENDOSCOPE PROCESSING
ldquoUse cleaning brushes appropriate for the size of the endoscope
channel or portrdquo
-CDC Guideline for Disinfection and Sterilization in Healthcare
Facilities 2008 pg 86
ldquoThorough cleaning is essential before high-level disinfection or
sterilization because inorganic or organic materials that remain on
surfaces of instruments interfere with the effectiveness of these
processesrdquo
-CDC Guideline for Disinfection and Sterilization in
Healthcare Facilities 2008
INDUSTRY GUIDELINES CONTINUEDhellip
ldquoCleaning and decontamination should occur as soon as possible after instruments and equipment are used to prevent the formation of biofilm Cleaning and decontamination must be thoroughly accomplished or disinfection and sterilization may not be effectiverdquo
-AORN Section 29 Recommendations V
ldquoManual cleaninghellipis the most important step in removing microbial burden from an endoscopehellipRetained debris may inactivate or interfere with the capabilityhellipto effectively kill andor inactivate microorganismsrdquo
-SGNA Standards of Infection Control in processing of Flexible Gastrointestinal Endoscopes 2013
ldquoCleaning refers to the removal of all visible and non-visible soil and any other foreign material from the medical device being processed It is the most important step in the disinfectionsterilization process Instruments must be thoroughly cleaned and rinsed for subsequent reprocessing steps to be effectiverdquo
-IAHCSMM Central Service Technical Manual 2007
INDUSTRY GUIDELINES CONTINUEDhellip
ldquoPersonnel involved in endoscope processing should be provided education
training and complete competency verification activities related to their duties upon
initial hire annually at designated intervals or whenever new endoscopic models
new processing equipment or products such as new chemicals are introduced for
processingrdquo
-ANSIAAMI ST91 2015 43
ldquoAt a minimum it is recommended that devices are subjected to high-level
disinfection after each use When possible and practical flexible and semi-rigid
endoscopes should be sterilized due to the greater margin of safety built into
sterilizationrdquo
-ANSIAAMI ST91 2015 43
RISKS INVOLVED WITH IMPROPER
PROCESSING OF ENDOSCOPES
Cross-contamination of harmful diseases like Hepatitis B Hepatitis C MRSA HIV CRE High rates of infection transmission
Biofilm growth on endoscope channels
Damage to the scope general diagnostic scopes cost $25-35000 with repair costs ranging from $500-$10000 per repair Ultrasound scopes cost $40-50000 with average repair costs of $8-11000 per repair
Debris on distal tip (camera) could result in the surgeonrsquos inability to adequately see inside the patient
Patient harm due to damaged and dirty scopes
SOURCESContent Sourcesbull ANSIAAMI ST91 2015 Flexible and semi-rigid endoscope processing in health care facilitiesbull Society of Healthcare Epidemiology of America and American Society of Gastrointestinal Endoscopy 2011 bull CDC Guideline for Disinfection and Sterilization in Healthcare Facilities 2008bull AORN Guidelines for Recommended Practice Section 29 Recommendations Vbull SGNA Standards of Infection Control in processing of Flexible Gastrointestinal Endoscopes 2013bull IAHCSMM Central Service Technical Manual 2007bull AAMI Best Practices in Endoscope Reprocessing Webinar 2015bull AAMI Endoscope Reprocessing Critical Training Steps to Promote Patient Safety 2013bull httphealthnvgovhcqchaicleaning_sterilization_disinfection_healthcare_facilitiespdfbull httpwwwsgnaorgPortals0Standard20of20Infection20Prevention_FINALpdf
Image sourcesbull httpswwweducationaldimensionscomeLearnendoscopeanatomyphpbull httpssitesgooglecomsitevoicedisordernodulesdiagnosis-assessmentassessment-proceduresbull httpsurgicalendocombull http1technationcomroundtable-flexible-endoscopybull httpwwwmedical-hospitalbedscomsale-912541-abs-multi-functional-patient-transportation-cart-hospital-stretcher-trolley-als-st004htmlbull httpwwwusendoscopycomendoscopyendoscope-care-and-accessoriesprocedure-kitsVIA-bedside-precleaning-kitaspxVSVKLJNV1Zgbull httpwwwwashingtonpostcomnationalhealth-sciencein-effort-to-halt-outbreaks-protocol-for-cleaning-medical-scope-is-
updated201503262c0b5d8c-d3e8-11e4-ab77-9646eea6a4c7_storyhtmlbull httpwwwoutpatientsurgerynetsurgical-facility-administrationinfection-controlare-you-cleaning-gi-scopes-properly--10-14bull httpwwwprwebcomreleasesendoscoperepairsprweb11626296htmbull httpwwwmedivatorscomproductsendoscope-reprocessingbrushes-and-flushing-aidsscope-buddy-endoscope-flushing-aidbull httpwwwzutroncomendoscope-leak-testersphpbull httpwwwoptimaxonlinecomremote-visual-inspection-rigid-endoscope83swing-prism-
endoscopePHPSESSID=09ad5b323b4d40e885021856d65aa727bull httpwwwusendoscopycomurologystone-management-and-foreign-body-retrievalmoray-focepsMoray-biopsy-
forcepsaspxVUFVHpPe9Zgbull httpswwwtechno-aidecomstoreproducthydraulic_general_patient_stretcherVUFWXpPe9Zgbull httpswiley-vche-bookshelfdeproductsreading-epubproduct-
id600494titlePractical2BGastrointestinal2BEndoscopyhtmlautr=22Peter+B+Cotton22
CONTACT INFORMATION
Sarah Nolan CCSVP
952-288-2246 Direct
SarahNolanKeySurgicalcom
Key Surgical Inc
800-541-7995
infokeysurgicalcom
Keep Educating Yourself
STEP 9 STORAGE
Flush scope channel with 70-90 ethyl or isopropyl alcohol followed by
low-pressure forced air to dry internal channels
Store scopes in a closed cabinet with proper air circulation
Store scopes with all valvesaccessories removed
Hang scopes vertically without coiling or kinking
to facilitate any additional drying needed
Always store scopes in a way that protects the
scope and minimizes contamination
Be sure to clean and disinfect the storage
cabinets per manufacturerrsquos IFU
STORAGE CONTINUEDhellip
Storage time ranges between 5-24 days Always be sure to
document high-level disinfection dates and specifics
APIC suggests 7 days
AORN and AAMI recommend that each facility perform a risk
assessment to determine proper storage time
Multi-Society Guideline 2011 contamination during storage
negligible for 7-14 days contamination occurs only on exterior
SGNA supports 7 day storage intervals if scopes were
reprocessed and stored according to professional guidelines
and manufacturer IFU
INDUSTRY GUIDELINES
ENDOSCOPE PROCESSING
ldquoUse cleaning brushes appropriate for the size of the endoscope
channel or portrdquo
-CDC Guideline for Disinfection and Sterilization in Healthcare
Facilities 2008 pg 86
ldquoThorough cleaning is essential before high-level disinfection or
sterilization because inorganic or organic materials that remain on
surfaces of instruments interfere with the effectiveness of these
processesrdquo
-CDC Guideline for Disinfection and Sterilization in
Healthcare Facilities 2008
INDUSTRY GUIDELINES CONTINUEDhellip
ldquoCleaning and decontamination should occur as soon as possible after instruments and equipment are used to prevent the formation of biofilm Cleaning and decontamination must be thoroughly accomplished or disinfection and sterilization may not be effectiverdquo
-AORN Section 29 Recommendations V
ldquoManual cleaninghellipis the most important step in removing microbial burden from an endoscopehellipRetained debris may inactivate or interfere with the capabilityhellipto effectively kill andor inactivate microorganismsrdquo
-SGNA Standards of Infection Control in processing of Flexible Gastrointestinal Endoscopes 2013
ldquoCleaning refers to the removal of all visible and non-visible soil and any other foreign material from the medical device being processed It is the most important step in the disinfectionsterilization process Instruments must be thoroughly cleaned and rinsed for subsequent reprocessing steps to be effectiverdquo
-IAHCSMM Central Service Technical Manual 2007
INDUSTRY GUIDELINES CONTINUEDhellip
ldquoPersonnel involved in endoscope processing should be provided education
training and complete competency verification activities related to their duties upon
initial hire annually at designated intervals or whenever new endoscopic models
new processing equipment or products such as new chemicals are introduced for
processingrdquo
-ANSIAAMI ST91 2015 43
ldquoAt a minimum it is recommended that devices are subjected to high-level
disinfection after each use When possible and practical flexible and semi-rigid
endoscopes should be sterilized due to the greater margin of safety built into
sterilizationrdquo
-ANSIAAMI ST91 2015 43
RISKS INVOLVED WITH IMPROPER
PROCESSING OF ENDOSCOPES
Cross-contamination of harmful diseases like Hepatitis B Hepatitis C MRSA HIV CRE High rates of infection transmission
Biofilm growth on endoscope channels
Damage to the scope general diagnostic scopes cost $25-35000 with repair costs ranging from $500-$10000 per repair Ultrasound scopes cost $40-50000 with average repair costs of $8-11000 per repair
Debris on distal tip (camera) could result in the surgeonrsquos inability to adequately see inside the patient
Patient harm due to damaged and dirty scopes
SOURCESContent Sourcesbull ANSIAAMI ST91 2015 Flexible and semi-rigid endoscope processing in health care facilitiesbull Society of Healthcare Epidemiology of America and American Society of Gastrointestinal Endoscopy 2011 bull CDC Guideline for Disinfection and Sterilization in Healthcare Facilities 2008bull AORN Guidelines for Recommended Practice Section 29 Recommendations Vbull SGNA Standards of Infection Control in processing of Flexible Gastrointestinal Endoscopes 2013bull IAHCSMM Central Service Technical Manual 2007bull AAMI Best Practices in Endoscope Reprocessing Webinar 2015bull AAMI Endoscope Reprocessing Critical Training Steps to Promote Patient Safety 2013bull httphealthnvgovhcqchaicleaning_sterilization_disinfection_healthcare_facilitiespdfbull httpwwwsgnaorgPortals0Standard20of20Infection20Prevention_FINALpdf
Image sourcesbull httpswwweducationaldimensionscomeLearnendoscopeanatomyphpbull httpssitesgooglecomsitevoicedisordernodulesdiagnosis-assessmentassessment-proceduresbull httpsurgicalendocombull http1technationcomroundtable-flexible-endoscopybull httpwwwmedical-hospitalbedscomsale-912541-abs-multi-functional-patient-transportation-cart-hospital-stretcher-trolley-als-st004htmlbull httpwwwusendoscopycomendoscopyendoscope-care-and-accessoriesprocedure-kitsVIA-bedside-precleaning-kitaspxVSVKLJNV1Zgbull httpwwwwashingtonpostcomnationalhealth-sciencein-effort-to-halt-outbreaks-protocol-for-cleaning-medical-scope-is-
updated201503262c0b5d8c-d3e8-11e4-ab77-9646eea6a4c7_storyhtmlbull httpwwwoutpatientsurgerynetsurgical-facility-administrationinfection-controlare-you-cleaning-gi-scopes-properly--10-14bull httpwwwprwebcomreleasesendoscoperepairsprweb11626296htmbull httpwwwmedivatorscomproductsendoscope-reprocessingbrushes-and-flushing-aidsscope-buddy-endoscope-flushing-aidbull httpwwwzutroncomendoscope-leak-testersphpbull httpwwwoptimaxonlinecomremote-visual-inspection-rigid-endoscope83swing-prism-
endoscopePHPSESSID=09ad5b323b4d40e885021856d65aa727bull httpwwwusendoscopycomurologystone-management-and-foreign-body-retrievalmoray-focepsMoray-biopsy-
forcepsaspxVUFVHpPe9Zgbull httpswwwtechno-aidecomstoreproducthydraulic_general_patient_stretcherVUFWXpPe9Zgbull httpswiley-vche-bookshelfdeproductsreading-epubproduct-
id600494titlePractical2BGastrointestinal2BEndoscopyhtmlautr=22Peter+B+Cotton22
CONTACT INFORMATION
Sarah Nolan CCSVP
952-288-2246 Direct
SarahNolanKeySurgicalcom
Key Surgical Inc
800-541-7995
infokeysurgicalcom
Keep Educating Yourself
STORAGE CONTINUEDhellip
Storage time ranges between 5-24 days Always be sure to
document high-level disinfection dates and specifics
APIC suggests 7 days
AORN and AAMI recommend that each facility perform a risk
assessment to determine proper storage time
Multi-Society Guideline 2011 contamination during storage
negligible for 7-14 days contamination occurs only on exterior
SGNA supports 7 day storage intervals if scopes were
reprocessed and stored according to professional guidelines
and manufacturer IFU
INDUSTRY GUIDELINES
ENDOSCOPE PROCESSING
ldquoUse cleaning brushes appropriate for the size of the endoscope
channel or portrdquo
-CDC Guideline for Disinfection and Sterilization in Healthcare
Facilities 2008 pg 86
ldquoThorough cleaning is essential before high-level disinfection or
sterilization because inorganic or organic materials that remain on
surfaces of instruments interfere with the effectiveness of these
processesrdquo
-CDC Guideline for Disinfection and Sterilization in
Healthcare Facilities 2008
INDUSTRY GUIDELINES CONTINUEDhellip
ldquoCleaning and decontamination should occur as soon as possible after instruments and equipment are used to prevent the formation of biofilm Cleaning and decontamination must be thoroughly accomplished or disinfection and sterilization may not be effectiverdquo
-AORN Section 29 Recommendations V
ldquoManual cleaninghellipis the most important step in removing microbial burden from an endoscopehellipRetained debris may inactivate or interfere with the capabilityhellipto effectively kill andor inactivate microorganismsrdquo
-SGNA Standards of Infection Control in processing of Flexible Gastrointestinal Endoscopes 2013
ldquoCleaning refers to the removal of all visible and non-visible soil and any other foreign material from the medical device being processed It is the most important step in the disinfectionsterilization process Instruments must be thoroughly cleaned and rinsed for subsequent reprocessing steps to be effectiverdquo
-IAHCSMM Central Service Technical Manual 2007
INDUSTRY GUIDELINES CONTINUEDhellip
ldquoPersonnel involved in endoscope processing should be provided education
training and complete competency verification activities related to their duties upon
initial hire annually at designated intervals or whenever new endoscopic models
new processing equipment or products such as new chemicals are introduced for
processingrdquo
-ANSIAAMI ST91 2015 43
ldquoAt a minimum it is recommended that devices are subjected to high-level
disinfection after each use When possible and practical flexible and semi-rigid
endoscopes should be sterilized due to the greater margin of safety built into
sterilizationrdquo
-ANSIAAMI ST91 2015 43
RISKS INVOLVED WITH IMPROPER
PROCESSING OF ENDOSCOPES
Cross-contamination of harmful diseases like Hepatitis B Hepatitis C MRSA HIV CRE High rates of infection transmission
Biofilm growth on endoscope channels
Damage to the scope general diagnostic scopes cost $25-35000 with repair costs ranging from $500-$10000 per repair Ultrasound scopes cost $40-50000 with average repair costs of $8-11000 per repair
Debris on distal tip (camera) could result in the surgeonrsquos inability to adequately see inside the patient
Patient harm due to damaged and dirty scopes
SOURCESContent Sourcesbull ANSIAAMI ST91 2015 Flexible and semi-rigid endoscope processing in health care facilitiesbull Society of Healthcare Epidemiology of America and American Society of Gastrointestinal Endoscopy 2011 bull CDC Guideline for Disinfection and Sterilization in Healthcare Facilities 2008bull AORN Guidelines for Recommended Practice Section 29 Recommendations Vbull SGNA Standards of Infection Control in processing of Flexible Gastrointestinal Endoscopes 2013bull IAHCSMM Central Service Technical Manual 2007bull AAMI Best Practices in Endoscope Reprocessing Webinar 2015bull AAMI Endoscope Reprocessing Critical Training Steps to Promote Patient Safety 2013bull httphealthnvgovhcqchaicleaning_sterilization_disinfection_healthcare_facilitiespdfbull httpwwwsgnaorgPortals0Standard20of20Infection20Prevention_FINALpdf
Image sourcesbull httpswwweducationaldimensionscomeLearnendoscopeanatomyphpbull httpssitesgooglecomsitevoicedisordernodulesdiagnosis-assessmentassessment-proceduresbull httpsurgicalendocombull http1technationcomroundtable-flexible-endoscopybull httpwwwmedical-hospitalbedscomsale-912541-abs-multi-functional-patient-transportation-cart-hospital-stretcher-trolley-als-st004htmlbull httpwwwusendoscopycomendoscopyendoscope-care-and-accessoriesprocedure-kitsVIA-bedside-precleaning-kitaspxVSVKLJNV1Zgbull httpwwwwashingtonpostcomnationalhealth-sciencein-effort-to-halt-outbreaks-protocol-for-cleaning-medical-scope-is-
updated201503262c0b5d8c-d3e8-11e4-ab77-9646eea6a4c7_storyhtmlbull httpwwwoutpatientsurgerynetsurgical-facility-administrationinfection-controlare-you-cleaning-gi-scopes-properly--10-14bull httpwwwprwebcomreleasesendoscoperepairsprweb11626296htmbull httpwwwmedivatorscomproductsendoscope-reprocessingbrushes-and-flushing-aidsscope-buddy-endoscope-flushing-aidbull httpwwwzutroncomendoscope-leak-testersphpbull httpwwwoptimaxonlinecomremote-visual-inspection-rigid-endoscope83swing-prism-
endoscopePHPSESSID=09ad5b323b4d40e885021856d65aa727bull httpwwwusendoscopycomurologystone-management-and-foreign-body-retrievalmoray-focepsMoray-biopsy-
forcepsaspxVUFVHpPe9Zgbull httpswwwtechno-aidecomstoreproducthydraulic_general_patient_stretcherVUFWXpPe9Zgbull httpswiley-vche-bookshelfdeproductsreading-epubproduct-
id600494titlePractical2BGastrointestinal2BEndoscopyhtmlautr=22Peter+B+Cotton22
CONTACT INFORMATION
Sarah Nolan CCSVP
952-288-2246 Direct
SarahNolanKeySurgicalcom
Key Surgical Inc
800-541-7995
infokeysurgicalcom
Keep Educating Yourself
INDUSTRY GUIDELINES
ENDOSCOPE PROCESSING
ldquoUse cleaning brushes appropriate for the size of the endoscope
channel or portrdquo
-CDC Guideline for Disinfection and Sterilization in Healthcare
Facilities 2008 pg 86
ldquoThorough cleaning is essential before high-level disinfection or
sterilization because inorganic or organic materials that remain on
surfaces of instruments interfere with the effectiveness of these
processesrdquo
-CDC Guideline for Disinfection and Sterilization in
Healthcare Facilities 2008
INDUSTRY GUIDELINES CONTINUEDhellip
ldquoCleaning and decontamination should occur as soon as possible after instruments and equipment are used to prevent the formation of biofilm Cleaning and decontamination must be thoroughly accomplished or disinfection and sterilization may not be effectiverdquo
-AORN Section 29 Recommendations V
ldquoManual cleaninghellipis the most important step in removing microbial burden from an endoscopehellipRetained debris may inactivate or interfere with the capabilityhellipto effectively kill andor inactivate microorganismsrdquo
-SGNA Standards of Infection Control in processing of Flexible Gastrointestinal Endoscopes 2013
ldquoCleaning refers to the removal of all visible and non-visible soil and any other foreign material from the medical device being processed It is the most important step in the disinfectionsterilization process Instruments must be thoroughly cleaned and rinsed for subsequent reprocessing steps to be effectiverdquo
-IAHCSMM Central Service Technical Manual 2007
INDUSTRY GUIDELINES CONTINUEDhellip
ldquoPersonnel involved in endoscope processing should be provided education
training and complete competency verification activities related to their duties upon
initial hire annually at designated intervals or whenever new endoscopic models
new processing equipment or products such as new chemicals are introduced for
processingrdquo
-ANSIAAMI ST91 2015 43
ldquoAt a minimum it is recommended that devices are subjected to high-level
disinfection after each use When possible and practical flexible and semi-rigid
endoscopes should be sterilized due to the greater margin of safety built into
sterilizationrdquo
-ANSIAAMI ST91 2015 43
RISKS INVOLVED WITH IMPROPER
PROCESSING OF ENDOSCOPES
Cross-contamination of harmful diseases like Hepatitis B Hepatitis C MRSA HIV CRE High rates of infection transmission
Biofilm growth on endoscope channels
Damage to the scope general diagnostic scopes cost $25-35000 with repair costs ranging from $500-$10000 per repair Ultrasound scopes cost $40-50000 with average repair costs of $8-11000 per repair
Debris on distal tip (camera) could result in the surgeonrsquos inability to adequately see inside the patient
Patient harm due to damaged and dirty scopes
SOURCESContent Sourcesbull ANSIAAMI ST91 2015 Flexible and semi-rigid endoscope processing in health care facilitiesbull Society of Healthcare Epidemiology of America and American Society of Gastrointestinal Endoscopy 2011 bull CDC Guideline for Disinfection and Sterilization in Healthcare Facilities 2008bull AORN Guidelines for Recommended Practice Section 29 Recommendations Vbull SGNA Standards of Infection Control in processing of Flexible Gastrointestinal Endoscopes 2013bull IAHCSMM Central Service Technical Manual 2007bull AAMI Best Practices in Endoscope Reprocessing Webinar 2015bull AAMI Endoscope Reprocessing Critical Training Steps to Promote Patient Safety 2013bull httphealthnvgovhcqchaicleaning_sterilization_disinfection_healthcare_facilitiespdfbull httpwwwsgnaorgPortals0Standard20of20Infection20Prevention_FINALpdf
Image sourcesbull httpswwweducationaldimensionscomeLearnendoscopeanatomyphpbull httpssitesgooglecomsitevoicedisordernodulesdiagnosis-assessmentassessment-proceduresbull httpsurgicalendocombull http1technationcomroundtable-flexible-endoscopybull httpwwwmedical-hospitalbedscomsale-912541-abs-multi-functional-patient-transportation-cart-hospital-stretcher-trolley-als-st004htmlbull httpwwwusendoscopycomendoscopyendoscope-care-and-accessoriesprocedure-kitsVIA-bedside-precleaning-kitaspxVSVKLJNV1Zgbull httpwwwwashingtonpostcomnationalhealth-sciencein-effort-to-halt-outbreaks-protocol-for-cleaning-medical-scope-is-
updated201503262c0b5d8c-d3e8-11e4-ab77-9646eea6a4c7_storyhtmlbull httpwwwoutpatientsurgerynetsurgical-facility-administrationinfection-controlare-you-cleaning-gi-scopes-properly--10-14bull httpwwwprwebcomreleasesendoscoperepairsprweb11626296htmbull httpwwwmedivatorscomproductsendoscope-reprocessingbrushes-and-flushing-aidsscope-buddy-endoscope-flushing-aidbull httpwwwzutroncomendoscope-leak-testersphpbull httpwwwoptimaxonlinecomremote-visual-inspection-rigid-endoscope83swing-prism-
endoscopePHPSESSID=09ad5b323b4d40e885021856d65aa727bull httpwwwusendoscopycomurologystone-management-and-foreign-body-retrievalmoray-focepsMoray-biopsy-
forcepsaspxVUFVHpPe9Zgbull httpswwwtechno-aidecomstoreproducthydraulic_general_patient_stretcherVUFWXpPe9Zgbull httpswiley-vche-bookshelfdeproductsreading-epubproduct-
id600494titlePractical2BGastrointestinal2BEndoscopyhtmlautr=22Peter+B+Cotton22
CONTACT INFORMATION
Sarah Nolan CCSVP
952-288-2246 Direct
SarahNolanKeySurgicalcom
Key Surgical Inc
800-541-7995
infokeysurgicalcom
Keep Educating Yourself
INDUSTRY GUIDELINES CONTINUEDhellip
ldquoCleaning and decontamination should occur as soon as possible after instruments and equipment are used to prevent the formation of biofilm Cleaning and decontamination must be thoroughly accomplished or disinfection and sterilization may not be effectiverdquo
-AORN Section 29 Recommendations V
ldquoManual cleaninghellipis the most important step in removing microbial burden from an endoscopehellipRetained debris may inactivate or interfere with the capabilityhellipto effectively kill andor inactivate microorganismsrdquo
-SGNA Standards of Infection Control in processing of Flexible Gastrointestinal Endoscopes 2013
ldquoCleaning refers to the removal of all visible and non-visible soil and any other foreign material from the medical device being processed It is the most important step in the disinfectionsterilization process Instruments must be thoroughly cleaned and rinsed for subsequent reprocessing steps to be effectiverdquo
-IAHCSMM Central Service Technical Manual 2007
INDUSTRY GUIDELINES CONTINUEDhellip
ldquoPersonnel involved in endoscope processing should be provided education
training and complete competency verification activities related to their duties upon
initial hire annually at designated intervals or whenever new endoscopic models
new processing equipment or products such as new chemicals are introduced for
processingrdquo
-ANSIAAMI ST91 2015 43
ldquoAt a minimum it is recommended that devices are subjected to high-level
disinfection after each use When possible and practical flexible and semi-rigid
endoscopes should be sterilized due to the greater margin of safety built into
sterilizationrdquo
-ANSIAAMI ST91 2015 43
RISKS INVOLVED WITH IMPROPER
PROCESSING OF ENDOSCOPES
Cross-contamination of harmful diseases like Hepatitis B Hepatitis C MRSA HIV CRE High rates of infection transmission
Biofilm growth on endoscope channels
Damage to the scope general diagnostic scopes cost $25-35000 with repair costs ranging from $500-$10000 per repair Ultrasound scopes cost $40-50000 with average repair costs of $8-11000 per repair
Debris on distal tip (camera) could result in the surgeonrsquos inability to adequately see inside the patient
Patient harm due to damaged and dirty scopes
SOURCESContent Sourcesbull ANSIAAMI ST91 2015 Flexible and semi-rigid endoscope processing in health care facilitiesbull Society of Healthcare Epidemiology of America and American Society of Gastrointestinal Endoscopy 2011 bull CDC Guideline for Disinfection and Sterilization in Healthcare Facilities 2008bull AORN Guidelines for Recommended Practice Section 29 Recommendations Vbull SGNA Standards of Infection Control in processing of Flexible Gastrointestinal Endoscopes 2013bull IAHCSMM Central Service Technical Manual 2007bull AAMI Best Practices in Endoscope Reprocessing Webinar 2015bull AAMI Endoscope Reprocessing Critical Training Steps to Promote Patient Safety 2013bull httphealthnvgovhcqchaicleaning_sterilization_disinfection_healthcare_facilitiespdfbull httpwwwsgnaorgPortals0Standard20of20Infection20Prevention_FINALpdf
Image sourcesbull httpswwweducationaldimensionscomeLearnendoscopeanatomyphpbull httpssitesgooglecomsitevoicedisordernodulesdiagnosis-assessmentassessment-proceduresbull httpsurgicalendocombull http1technationcomroundtable-flexible-endoscopybull httpwwwmedical-hospitalbedscomsale-912541-abs-multi-functional-patient-transportation-cart-hospital-stretcher-trolley-als-st004htmlbull httpwwwusendoscopycomendoscopyendoscope-care-and-accessoriesprocedure-kitsVIA-bedside-precleaning-kitaspxVSVKLJNV1Zgbull httpwwwwashingtonpostcomnationalhealth-sciencein-effort-to-halt-outbreaks-protocol-for-cleaning-medical-scope-is-
updated201503262c0b5d8c-d3e8-11e4-ab77-9646eea6a4c7_storyhtmlbull httpwwwoutpatientsurgerynetsurgical-facility-administrationinfection-controlare-you-cleaning-gi-scopes-properly--10-14bull httpwwwprwebcomreleasesendoscoperepairsprweb11626296htmbull httpwwwmedivatorscomproductsendoscope-reprocessingbrushes-and-flushing-aidsscope-buddy-endoscope-flushing-aidbull httpwwwzutroncomendoscope-leak-testersphpbull httpwwwoptimaxonlinecomremote-visual-inspection-rigid-endoscope83swing-prism-
endoscopePHPSESSID=09ad5b323b4d40e885021856d65aa727bull httpwwwusendoscopycomurologystone-management-and-foreign-body-retrievalmoray-focepsMoray-biopsy-
forcepsaspxVUFVHpPe9Zgbull httpswwwtechno-aidecomstoreproducthydraulic_general_patient_stretcherVUFWXpPe9Zgbull httpswiley-vche-bookshelfdeproductsreading-epubproduct-
id600494titlePractical2BGastrointestinal2BEndoscopyhtmlautr=22Peter+B+Cotton22
CONTACT INFORMATION
Sarah Nolan CCSVP
952-288-2246 Direct
SarahNolanKeySurgicalcom
Key Surgical Inc
800-541-7995
infokeysurgicalcom
Keep Educating Yourself
INDUSTRY GUIDELINES CONTINUEDhellip
ldquoPersonnel involved in endoscope processing should be provided education
training and complete competency verification activities related to their duties upon
initial hire annually at designated intervals or whenever new endoscopic models
new processing equipment or products such as new chemicals are introduced for
processingrdquo
-ANSIAAMI ST91 2015 43
ldquoAt a minimum it is recommended that devices are subjected to high-level
disinfection after each use When possible and practical flexible and semi-rigid
endoscopes should be sterilized due to the greater margin of safety built into
sterilizationrdquo
-ANSIAAMI ST91 2015 43
RISKS INVOLVED WITH IMPROPER
PROCESSING OF ENDOSCOPES
Cross-contamination of harmful diseases like Hepatitis B Hepatitis C MRSA HIV CRE High rates of infection transmission
Biofilm growth on endoscope channels
Damage to the scope general diagnostic scopes cost $25-35000 with repair costs ranging from $500-$10000 per repair Ultrasound scopes cost $40-50000 with average repair costs of $8-11000 per repair
Debris on distal tip (camera) could result in the surgeonrsquos inability to adequately see inside the patient
Patient harm due to damaged and dirty scopes
SOURCESContent Sourcesbull ANSIAAMI ST91 2015 Flexible and semi-rigid endoscope processing in health care facilitiesbull Society of Healthcare Epidemiology of America and American Society of Gastrointestinal Endoscopy 2011 bull CDC Guideline for Disinfection and Sterilization in Healthcare Facilities 2008bull AORN Guidelines for Recommended Practice Section 29 Recommendations Vbull SGNA Standards of Infection Control in processing of Flexible Gastrointestinal Endoscopes 2013bull IAHCSMM Central Service Technical Manual 2007bull AAMI Best Practices in Endoscope Reprocessing Webinar 2015bull AAMI Endoscope Reprocessing Critical Training Steps to Promote Patient Safety 2013bull httphealthnvgovhcqchaicleaning_sterilization_disinfection_healthcare_facilitiespdfbull httpwwwsgnaorgPortals0Standard20of20Infection20Prevention_FINALpdf
Image sourcesbull httpswwweducationaldimensionscomeLearnendoscopeanatomyphpbull httpssitesgooglecomsitevoicedisordernodulesdiagnosis-assessmentassessment-proceduresbull httpsurgicalendocombull http1technationcomroundtable-flexible-endoscopybull httpwwwmedical-hospitalbedscomsale-912541-abs-multi-functional-patient-transportation-cart-hospital-stretcher-trolley-als-st004htmlbull httpwwwusendoscopycomendoscopyendoscope-care-and-accessoriesprocedure-kitsVIA-bedside-precleaning-kitaspxVSVKLJNV1Zgbull httpwwwwashingtonpostcomnationalhealth-sciencein-effort-to-halt-outbreaks-protocol-for-cleaning-medical-scope-is-
updated201503262c0b5d8c-d3e8-11e4-ab77-9646eea6a4c7_storyhtmlbull httpwwwoutpatientsurgerynetsurgical-facility-administrationinfection-controlare-you-cleaning-gi-scopes-properly--10-14bull httpwwwprwebcomreleasesendoscoperepairsprweb11626296htmbull httpwwwmedivatorscomproductsendoscope-reprocessingbrushes-and-flushing-aidsscope-buddy-endoscope-flushing-aidbull httpwwwzutroncomendoscope-leak-testersphpbull httpwwwoptimaxonlinecomremote-visual-inspection-rigid-endoscope83swing-prism-
endoscopePHPSESSID=09ad5b323b4d40e885021856d65aa727bull httpwwwusendoscopycomurologystone-management-and-foreign-body-retrievalmoray-focepsMoray-biopsy-
forcepsaspxVUFVHpPe9Zgbull httpswwwtechno-aidecomstoreproducthydraulic_general_patient_stretcherVUFWXpPe9Zgbull httpswiley-vche-bookshelfdeproductsreading-epubproduct-
id600494titlePractical2BGastrointestinal2BEndoscopyhtmlautr=22Peter+B+Cotton22
CONTACT INFORMATION
Sarah Nolan CCSVP
952-288-2246 Direct
SarahNolanKeySurgicalcom
Key Surgical Inc
800-541-7995
infokeysurgicalcom
Keep Educating Yourself
RISKS INVOLVED WITH IMPROPER
PROCESSING OF ENDOSCOPES
Cross-contamination of harmful diseases like Hepatitis B Hepatitis C MRSA HIV CRE High rates of infection transmission
Biofilm growth on endoscope channels
Damage to the scope general diagnostic scopes cost $25-35000 with repair costs ranging from $500-$10000 per repair Ultrasound scopes cost $40-50000 with average repair costs of $8-11000 per repair
Debris on distal tip (camera) could result in the surgeonrsquos inability to adequately see inside the patient
Patient harm due to damaged and dirty scopes
SOURCESContent Sourcesbull ANSIAAMI ST91 2015 Flexible and semi-rigid endoscope processing in health care facilitiesbull Society of Healthcare Epidemiology of America and American Society of Gastrointestinal Endoscopy 2011 bull CDC Guideline for Disinfection and Sterilization in Healthcare Facilities 2008bull AORN Guidelines for Recommended Practice Section 29 Recommendations Vbull SGNA Standards of Infection Control in processing of Flexible Gastrointestinal Endoscopes 2013bull IAHCSMM Central Service Technical Manual 2007bull AAMI Best Practices in Endoscope Reprocessing Webinar 2015bull AAMI Endoscope Reprocessing Critical Training Steps to Promote Patient Safety 2013bull httphealthnvgovhcqchaicleaning_sterilization_disinfection_healthcare_facilitiespdfbull httpwwwsgnaorgPortals0Standard20of20Infection20Prevention_FINALpdf
Image sourcesbull httpswwweducationaldimensionscomeLearnendoscopeanatomyphpbull httpssitesgooglecomsitevoicedisordernodulesdiagnosis-assessmentassessment-proceduresbull httpsurgicalendocombull http1technationcomroundtable-flexible-endoscopybull httpwwwmedical-hospitalbedscomsale-912541-abs-multi-functional-patient-transportation-cart-hospital-stretcher-trolley-als-st004htmlbull httpwwwusendoscopycomendoscopyendoscope-care-and-accessoriesprocedure-kitsVIA-bedside-precleaning-kitaspxVSVKLJNV1Zgbull httpwwwwashingtonpostcomnationalhealth-sciencein-effort-to-halt-outbreaks-protocol-for-cleaning-medical-scope-is-
updated201503262c0b5d8c-d3e8-11e4-ab77-9646eea6a4c7_storyhtmlbull httpwwwoutpatientsurgerynetsurgical-facility-administrationinfection-controlare-you-cleaning-gi-scopes-properly--10-14bull httpwwwprwebcomreleasesendoscoperepairsprweb11626296htmbull httpwwwmedivatorscomproductsendoscope-reprocessingbrushes-and-flushing-aidsscope-buddy-endoscope-flushing-aidbull httpwwwzutroncomendoscope-leak-testersphpbull httpwwwoptimaxonlinecomremote-visual-inspection-rigid-endoscope83swing-prism-
endoscopePHPSESSID=09ad5b323b4d40e885021856d65aa727bull httpwwwusendoscopycomurologystone-management-and-foreign-body-retrievalmoray-focepsMoray-biopsy-
forcepsaspxVUFVHpPe9Zgbull httpswwwtechno-aidecomstoreproducthydraulic_general_patient_stretcherVUFWXpPe9Zgbull httpswiley-vche-bookshelfdeproductsreading-epubproduct-
id600494titlePractical2BGastrointestinal2BEndoscopyhtmlautr=22Peter+B+Cotton22
CONTACT INFORMATION
Sarah Nolan CCSVP
952-288-2246 Direct
SarahNolanKeySurgicalcom
Key Surgical Inc
800-541-7995
infokeysurgicalcom
Keep Educating Yourself
SOURCESContent Sourcesbull ANSIAAMI ST91 2015 Flexible and semi-rigid endoscope processing in health care facilitiesbull Society of Healthcare Epidemiology of America and American Society of Gastrointestinal Endoscopy 2011 bull CDC Guideline for Disinfection and Sterilization in Healthcare Facilities 2008bull AORN Guidelines for Recommended Practice Section 29 Recommendations Vbull SGNA Standards of Infection Control in processing of Flexible Gastrointestinal Endoscopes 2013bull IAHCSMM Central Service Technical Manual 2007bull AAMI Best Practices in Endoscope Reprocessing Webinar 2015bull AAMI Endoscope Reprocessing Critical Training Steps to Promote Patient Safety 2013bull httphealthnvgovhcqchaicleaning_sterilization_disinfection_healthcare_facilitiespdfbull httpwwwsgnaorgPortals0Standard20of20Infection20Prevention_FINALpdf
Image sourcesbull httpswwweducationaldimensionscomeLearnendoscopeanatomyphpbull httpssitesgooglecomsitevoicedisordernodulesdiagnosis-assessmentassessment-proceduresbull httpsurgicalendocombull http1technationcomroundtable-flexible-endoscopybull httpwwwmedical-hospitalbedscomsale-912541-abs-multi-functional-patient-transportation-cart-hospital-stretcher-trolley-als-st004htmlbull httpwwwusendoscopycomendoscopyendoscope-care-and-accessoriesprocedure-kitsVIA-bedside-precleaning-kitaspxVSVKLJNV1Zgbull httpwwwwashingtonpostcomnationalhealth-sciencein-effort-to-halt-outbreaks-protocol-for-cleaning-medical-scope-is-
updated201503262c0b5d8c-d3e8-11e4-ab77-9646eea6a4c7_storyhtmlbull httpwwwoutpatientsurgerynetsurgical-facility-administrationinfection-controlare-you-cleaning-gi-scopes-properly--10-14bull httpwwwprwebcomreleasesendoscoperepairsprweb11626296htmbull httpwwwmedivatorscomproductsendoscope-reprocessingbrushes-and-flushing-aidsscope-buddy-endoscope-flushing-aidbull httpwwwzutroncomendoscope-leak-testersphpbull httpwwwoptimaxonlinecomremote-visual-inspection-rigid-endoscope83swing-prism-
endoscopePHPSESSID=09ad5b323b4d40e885021856d65aa727bull httpwwwusendoscopycomurologystone-management-and-foreign-body-retrievalmoray-focepsMoray-biopsy-
forcepsaspxVUFVHpPe9Zgbull httpswwwtechno-aidecomstoreproducthydraulic_general_patient_stretcherVUFWXpPe9Zgbull httpswiley-vche-bookshelfdeproductsreading-epubproduct-
id600494titlePractical2BGastrointestinal2BEndoscopyhtmlautr=22Peter+B+Cotton22
CONTACT INFORMATION
Sarah Nolan CCSVP
952-288-2246 Direct
SarahNolanKeySurgicalcom
Key Surgical Inc
800-541-7995
infokeysurgicalcom
Keep Educating Yourself
CONTACT INFORMATION
Sarah Nolan CCSVP
952-288-2246 Direct
SarahNolanKeySurgicalcom
Key Surgical Inc
800-541-7995
infokeysurgicalcom
Keep Educating Yourself
Keep Educating Yourself
