Articles

How Often Should Endoscopes Be Reprocessed?

by Raynetta Stansil Independent Healthcare Consultant
An endoscopy is a minimally invasive procedure that allows a doctor or consultant to use an endoscope—a thin rigid, semi rigid or flexible tube-like device with a light source and a small camera on the end—to see inside the body. The endoscope itself can be modified and used for a variety of procedures, and the purpose for it will dictate what it is called. For example, whereas laparoscopic instruments are used to examine the organs inside the abdomen, gastroscopic instruments are used to examine the esophagus, stomach and first part of the small intestine.

After use, endoscopic instruments are reprocessed and either stored for later use, or taken to endoscope repair for servicing. This action—endoscope reprocessing—refers to the process of cleaning, disinfecting and sterilizing endoscopes and their accessories:

  • Cleaning: Cleaning eliminates any debris that may interfere with the chemical solution used in the sanitizing process.

  • Disinfection: After cleaning, disinfection kills vegetative bacteria, viruses, fungi and mycobacteria that may have remained on the equipment.

  • Sterilization: Sterilization is the final step in the endoscope reprocessing procedure that eliminates any leftover microorganisms.

As part of the entire endoscopic process, these steps are equally important as its actual use because it eliminates the risks associated with the transmission of patient-borne or environmental microorganisms, which can lead to infections and even death.

Relating to the question of how often should endoscopes be reprocessed, they should be reprocessed after every use, and during or after a reprocessing if something goes amiss, such as an improper drying that can lead to bacterial growth. To fully understand the frequency of endoscope reprocessing, it will be beneficial to go through the actual process and see exactly what is accomplished in each step.

Endoscope Reprocessing

The endoscope reprocessing process typically has eight steps, which can be categorized as:

  1. Pre-cleaning 
  2. Leak Testing
  3. Manual Cleaning
  4. Rinsing After Manual Cleaning
  5. High-Level Disinfection
  6. Rinsing After Manual Disinfection
  7. Drying 
  8. Storage 

The first step—pre-cleaning—begins when the insertion tube is removed from the patient (prior to disconnecting the endoscope from the power source), and should be performed at point of use, before bioburden can dry and before complete decontamination. 

The second step—leak testing—detects damage to the interior or exterior of the endoscope by immersing the endoscope in reprocessing solutions to minimize damage to parts of the endoscope not designed for fluid exposure.

The third step—manual cleaning—is necessary before any disinfection or sanitization can take place because it removes both the microbial burden from an endoscope and retained debris that may interfere with the chemical solution used in later processes.

The fourth step—rinsing after manual cleaning—removes any residual debris and detergent, and must be followed by drying to prevent dilution of the liquid chemical germicide used in subsequent steps.

The fifth step—high-level disinfection—destroys all viable microorganisms, but not necessarily all bacterial spores. To eliminate these, a chemical germicide called a sterilant is used.

The sixth step—rinsing after manual disinfection—prevents exposure and potential injury of skin and mucous membranes from chemical residue.

The seventh step—drying—is essential in the prevention of bacterial growth that can lead to bacterial transmission and nosocomial infection.

The eighth step—storage—ensures that the endoscope is stored in a manner that protects it from contamination and maintain dryness.

Your Endoscope Reprocessing Checklist

Before you start the reprocessing, make sure to use the following checklist to make sure that your facility is in compliance with the SGNA’s Standards of Infection Control in Reprocessing of Flexible Gastrointestinal Endoscopes:

Pre-Cleaning

  • Appropriate proper protective equipment (PPE) is worn and the endoscope MFR’s instructions for use (IFU) are available?
  • Endoscope is wiped immediately after removal from the patient with a wet cloth or sponge?
  • Distal tip of endoscope is placed in an appropriate detergent solution and suctioned until clear?
  • Finish by suctioning air?
  • Air, water and auxiliary channels are flushed according to endoscope manufacturer’s (MFR) written IFU?
  • Detach the endoscope from the light source and suction lamp?
  • If video source is used, the protective video cap is attached to the endoscope?
  • Soiled endoscopes are transported to a separate reprocessing area in a closed container?
  • Transport containers are large enough not to damage endoscope by coiled too tightly?
  • Transport containers are labeled to indicate hazardous contents, i.e. sticker or sign?

Leak Testing

  • Suction valves, air water valves and biopsy valves are removed prior to leak testing?
  • Leak tester is attached and endoscope is pressurized before submerging into tap water?
  • While submerged, the distal portion is flexed in all directions, observing for bubbles?
  • The freeze and release buttons are depressed while observing the control head for bubbles?
  • The insertion tube, the distal bending section and universal cord are checked for bubbles?
  • After testing, the endoscope is removed from the basin and the leak tester is turned off?
  • If applicable, the video cap is disconnected after the leak tester is turned off?
  • The endoscope is allowed to depressurize (if applicable, the video cap is secure)?
  • If leak is detected or damage to the endoscope is observed, the reprocessing is stopped?

Manual Cleaning and Rinsing

  • Basin is filled with fresh water and appropriate detergent (i.e. neutral pH, low foaming)?
  • If applicable, video cap is secured prior to immersion into the detergent solution?
  • All debris is washed and wiped from the exterior while submerged in the detergent solution?
  • Removal parts and all channels brushed, including the body insertion tube and the umbilicus?
  • After each passage, the cleaning brush is rinsed in detergent solution to remove visible debris?
  • Cleaning adapters are attached for suction, biopsy, air and water channels per the MFR’s IFU?
  • All channels are flushed with detergent solution and soaked for a specified period of time?
  • Endoscope and all removable parts are thoroughly rinsed with clean water to remove debris?
  • Forced air is used to purge water from all channels of the thoroughly rinsed endoscope?
  • The exterior of the endoscope is dried with a soft, lint-free cloth?

High-Level Disinfection and Rinsing

  • HLD solution is prepared according to MFR’s IFU and in an appropriate sized basin?
       ○    HLD refers to the destruction of all microorganisms with the exception of low levels of bacterial spores.

  • The date the HLD solution is poured and the date the reuse life ends is documented?
  • Prior to use, the HLD solution is tested for minimum recommended concentration (MRC)?
  • The test strip is appropriate for the HLD solution and test results are documented?
  • The endoscope and all accessories are completely immersed into the HLD solution?
  • The HLD solution is flushed into all channels until a steady flow is seen exiting each channel?
  • The HLD solution is covered with a tight fitting lid for time and temperature per MFR’s IFU?
  • If automated HLD is used, the automated endoscope reprocessor (AER) use is per MFR’s IFU?
       ○    AER refers to machines designed for the purpose of cleaning and disinfecting endoscopes and accessories.

  • After HLD, all surfaces and removable parts are thoroughly rinsed per MFR’s IFU?
  • All channels are flushed with fresh, clean water for each rinse?

Drying and Storage

  • All channels are purged with air until dry?
  • All channels are flushed with alcohol until the alcohol exits the opposite end of each channel?
  • 70% alcohol is used and properly stored in a closed container between uses?
  • All channels are purged with air?
  • All channel adapters are removed?
  • The exterior of the endoscope is dried with a soft, clean, lint-free cloth?
  • All removable parts are thoroughly rinsed and dried?
  • Removable parts are not attached for storage and all valves are in the open position?
  • Endoscopes are stored in a closed cabinet with venting that allows air circulation around them?
  • Endoscopes are hung in a vertical position and caps, valves and other detachable parts removed?
  • There is adequate height for endoscopes to hang without touching bottom or each other?
  • Cabinet is kept clean and well ventilated?
  • Endoscopes are not allowed to be stored in their original shipment cases?
  • Storage time before next use is monitored?
  • Endoscopes are reprocessed before use if evidence of improper drying exists?

Record Keeping

  • The date and time of reprocessing is documented?
  • Each endoscope is identified, along with method of cleaning and name of technician?
  • HLD test strip quality control and MRC test results are documented?
  • Routine and unscheduled maintenance or repairs are documented?
       ○    Disposition of defective equipment is documented?


Final Thoughts

Proper surgical instrument sterilization is imperative in any healthcare setting, and when done in accordance to infection control measures, endoscope reprocessing prevents the transmission of patient borne or environmental organisms. 


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About Raynetta Stansil Freshman   Independent Healthcare Consultant

9 connections, 0 recommendations, 38 honor points.
Joined APSense since, January 15th, 2019, From Deerfield, United States.

Created on Jan 29th 2019 08:13. Viewed 658 times.

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