Pre-cleaning and High Level Disinfection of

Flexible Endoscopes

The process of High Level Disinfection is an appropriate standard of treatment for heat sensitive, semi-critical medical instruments

(i.e. flexible, fiber optic endoscopes, bronchoscopes).

This is accomplished with powerful, sporicidal chemicals (e.g., glutaraldehyde, peracetic acid, Cidex OPA, and hydrogen peroxide).

∗ Endoscopes that are not required to be sterile for a procedure must still be subjected to HLD (High Level Disinfection) process before each use.

∗ High level disinfection consists of a 12-20 minute manual soaking in glutartldehyde or in an AER (Automatic Endoscope Reprocessor) the Cidex OPA is heated to 25°C and exposed for 5 minutes.

∗ All parts of the endoscope must be thoroughly and meticulously cleaned with soap, water, and brushes immediately after use to prevent drying of secretions.

Endoscope processing ∗ Pre-cleaning is the first step in washing and processing.

* Leak Testing is the first test* Examine the scopes thoroughly for leaks at

the distal and proximal tips.* Brush channels several

times as needed until brush tips are visually clean

* Wipe scope externally withsponge or soft towel

* Connect to Automatic Sink to purge channels

* Length of purging time 30 to 60 sec.and then rinse 30 sec.

* Transfer to reprocessor

Cleaning Processes

Brush Tips

Types of brushes used in pre-cleaning

Doubled ended brush

∗ Always wear Personal Protective Equipment (PPE). ∗ Use specific amount of Cidex OPA according to manufactures

guidelines and specifications. This is usually 7-8 Gallons in the reservoir.

∗ Visually check the Cidex for color changes∗ Test the disinfectant

concentrate with test strips daily foreach scope.

Some of the key points using Cidex OPA and any machine disinfector:

Before

After

∗ Keep a detailed Log of chemical usage and test strip results of each disinfecting procedure.

∗ According to State requirement; neutralization of OPA and record keeping is required.

∗ Reprocessor records show that the HLD passed the process standards

Record keeping is imperative for Patient Safety

∗ Drying Cabinet – Hang Vertical at set temperature

∗

∗ Before disconnecting from the reprocessor and hanging in the cabinet; flush each scope with 30cc’s of alcohol or per manufacture’s recommendations.

∗ Always use the proper methods and procedures when drying scopes, these can always be found in the manufacture’s recommendations.

∗ Scopes should be hung up to dry thoroughly and not placed in a storage container (a minimum 10 minute drying with air-circulation).

∗ Scopes in storage must be reprocessed every 14 days per your records.

Drying the scopes properly

∗ Treat each scope with universal precautions∗ Examine the disk filters in the reprocessors daily and change

as recommended∗ Always monitor the chemicals and record the processes∗ Never take short cuts or assume a scope is clean∗ Review each Log entry to make sure that all times,

temperatures, and rinses have met standards. ∗ Our “Quality Goal” is that each patient receive a High Level

Disinfected Scope for their procedure.

In Summary - final tips for reprocessing

SCOPE

Disk FiltersHigh PressurePort Tubing

Suction Channel Tubing

Air Channel TubingWater Channel

Tubing

Connecting to the Ultrasonic High Level Disinfector (HLD) or Automatic Endoscope Reprocessor (AER).

Block Clamp

*Attachments must fit properly/ secure * Attachments must be on correct Channel/ Port * Careful Positioning * Check for tubing flow