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HIRL Birmingham 1
CORRECT ENDOSCOPE REPROCESSING
Christina BradleyLaboratory Manager
Hospital Infection Research LaboratoryQueen Elizabeth Hospital
Birmingham
HIRL Birmingham
�“Inadequate decontamination procedures and equipment malfunction were two leading causes of post endoscopic infection and contamination. More than 91% of the infections could be prevented if quality control systems were improved”
Kovaleva J et al Clin Microbiol Rev 2013;26(2):231-54
HIRL Birmingham
Transmission of infection by flexible gastrointesti nal endoscopy and bronchoscopy
TYPE OF FLEXIBLE ENDOSCOPIES
No. of REPORTED
INFECTIONS/OUTBREAKS
REASONS FOR FAILURE
BRONCHOSCOPY 51 • Inapprpopriate cleaning and disinfection – povidone iodine• Contaminated AER• Incorrect connectors• Rinsing with tap water• Hole in the endoscope sheath (no leak testing)
ERCPEndoscopic Retrograde CholangioPancreaticography
23 • Inapprpopriate cleaning and disinfection – povidone iodine, cetrimide• Contaminated AER• Incorrect connectors• Failure to irrigate all channels• Rinsing with tap water• Contaminated water bottle
UPPER GASTROINTESTINAL ENDOSCOPY
19 • Inapprpopriate cleaning and disinfection – povidone iodine• Contaminated AER• Incorrect connectors• Rinsing with tap water• Hole in the endoscope sheath (no leak testing)
SIGMOIDOSCOPY &COLONOSCOPY
5 • Inapprpopriate cleaning and disinfection – povidone iodine, BKC, cetrimide• Contaminated AER• Incorrect connectors• Contaminated water bottle• Biopsy forceps not sterilized
Kovaleva J et al Clin Microbiol Rev 2013;26(2):231-54
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DECONTAMINATION OF FLEXIBLE ENDOSCOPES
�Meticulous cleaning�Proper immersion in disinfectant�Thorough rinsing after disinfection
�Endoscope Washer Disinfectors are the preferred option
HIRL Birmingham
ENDOSCOPE DECONTAMINATION PROBLEMS
� Instruments and accessories are expensive� Damaged by heat and pressure� Complex, difficult to clean and dry� Penetration of channels uncertain� Rapid throughput� Risk of recontamination during final rinse
from water supply/EWD
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ENVIRONMENT DESIGN AND LAYOUT
� Designated and dedicated decontamination area
� Separate dirty, clean and storage areas� One-way flow for equipment� Suitable facilities for manual cleaning� Dedicated hand wash basin
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ENDOSCOPE CHANNELS
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DECONTAMINATION STAGES
�Pre clean at patient bed side�Leak test�Manual clean�Endoscope Washer Disinfector�Storage
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CLEANING
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PRE CLEANING
� At point of use– Air/water channel– External surfaces– Suction channel
� Manufacturers instructions areessential
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MANUAL CLEANING� At the sink in dedicated decontamination room
– Brushing Flushing
� Single use brushes must be used for cleaning at all times (UK recommendation)
� Staff must ensure meticulous adherence to manufacturers instructions for cleaning
Important to ensure� Access to all channels whether they have been used or not e.g. forceps
raiser channel, auxiliary water channel� Irrigation of all channels that cannot be brushed
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DISINFECTANTS
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ENDOSCOPE DISINFECTANTS
�Glutaraldehyde�Peracetic acid�Chlorine dioxide�Superoxidised water�OPA�Etc, etc ……….
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DISINFECTANTS AND ENDOSCOPE DECONTAMINATION
Ensure disinfectant�has broad spectrum of antimicrobial
activity� is compatible with instruments and
processing equipment� is used at effective concentration� is in contact with all surfaces
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CHANNEL IRRIGATION DEVICES
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ENDOSCOPE DECONTAMINATION : POTENTIAL PROBLEMS
� Disinfectant– Spectrum of activity– Over use
� Water quality– Bacterial contamination– Chemical contamination
� Training� Accessories e.g. water bottle, biopsy forceps
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BACTERIA FREE WATER
�Cystoscopes�Bronchoscopes�ERCP
�Potential for infection and/or misdiagnosis of infection
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ENDOSCOPE WASHER DISINFECTORS
The WD440 machines:The WD440 machines:
�Single chamber �Twin chamber (independent operated)
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ENDOSCOPE WASHER DISINFECTORS : PROBLEMS
�Disinfectant concentration�Machine contamination�Water quality�Maintenance�Validation
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ENDOSCOPE STORAGE
Endoscopes which have been reprocessed by high level disinfection and have been left for periods >3 hours should be reprocessed.
MDA DB2002(05)
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TRANSPORTATION
�Protection of endoscopes and the environment from contamination and/or possible damage
�Separation of dirty and clean endoscopes
HIRL Birmingham
DOCUMENTATION
Types:-� Policies: Statement of intent e.g. ‘We will “Provide
decontaminated endoscopes”� Procedures: Sets of instructions – How policy
is implemented e.g. ‘How to decontaminate endoscopes’
� Forms: Evidence that procedures are carried out. e.g. ‘List of items processed’
� Others: Info, Guidelines, standards etc
HIRL Birmingham
STANDARD OPERATING PROCEDURES
� Purpose of SOPs– SOP’s are required for all tasks which could have an
effect on the quality of the decontamination process
� SOP’s– Must clearly describe specific tasks– Must be easy to understand– Must change if the task changes– Are an essential tool in training
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STAFF TRAINING
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STAFF TRAINING
� At induction and regular updates� Anatomy/construction of endoscopes� Use of washer disinfectors (if applicable)� Traceability systems� Importance of decontamination record
keeping
� Records kept of individuals training� Sufficient time allowed for training
HIRL Birmingham
SUMMARY
It is important to ensure that� Staff receive comprehensive training � Cleaning takes place prior to sterilization or
disinfection� All surfaces of the endoscope are exposed during the
decontamination procedure� An effective disinfectant is used at the correct
concentration� The final rinse does not re-contaminate the
endoscope� Testing, in accordance with national guidance, takes
place and is audited
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THANK YOU FOR LISTENING