CORRECT ENDOSCOPE REPROCESSING

Transcription

1 CORRECT ENDOSCOPE REPROCESSING Christina Bradley Laboratory Manager Hospital Infection Research Laboratory Queen Elizabeth Hospital Birmingham HIRL Birmingham 1

2 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): HIRL Birmingham

3 Transmission of infection by flexible gastrointestinal 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) ERCP Endoscopic Retrograde Cholangio Pancreaticography UPPER GASTROINTESTINAL ENDOSCOPY 23 Inapprpopriate cleaning and disinfection povidone iodine, cetrimide Contaminated AER Incorrect connectors Failure to irrigate all channels Rinsing with tap water Contaminated water bottle 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 HIRL Birmingham 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

4 HIRL Birmingham 4

5 DECONTAMINATION OF FLEXIBLE ENDOSCOPES Meticulous cleaning Proper immersion in disinfectant Thorough rinsing after disinfection Endoscope Washer Disinfectors are the preferred option HIRL Birmingham 5

6 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 HIRL Birmingham

7 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 HIRL Birmingham

8 ENDOSCOPE CHANNELS HIRL Birmingham

9 DECONTAMINATION STAGES Pre clean at patient bed side Leak test Manual clean Endoscope Washer Disinfector Storage HIRL Birmingham

10 HIRL Birmingham CLEANING

11 PRE CLEANING At point of use Air/water channel External surfaces Suction channel Manufacturers instructions are essential HIRL Birmingham

12 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 HIRL Birmingham

13 HIRL Birmingham DISINFECTANTS

14 ENDOSCOPE DISINFECTANTS Glutaraldehyde Peracetic acid Chlorine dioxide Superoxidised water OPA Etc, etc. HIRL Birmingham 14

15 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 HIRL Birmingham 15

16 CHANNEL IRRIGATION DEVICES HIRL Birmingham 16

17 HIRL Birmingham 17

18 ENDOSCOPE DECONTAMINATION : POTENTIAL PROBLEMS Disinfectant Spectrum of activity Over use Water quality Bacterial contamination Chemical contamination Training Accessories e.g. water bottle, biopsy forceps HIRL Birmingham 18

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21 BACTERIA FREE WATER Cystoscopes Bronchoscopes ERCP Potential for infection and/or misdiagnosis of infection HIRL Birmingham 21

22 HIRL Birmingham 22

23 ENDOSCOPE WASHER DISINFECTORS The WD440 machines: Single chamber Twin chamber (independent operated) HIRL Birmingham 23

24 ENDOSCOPE WASHER DISINFECTORS : PROBLEMS Disinfectant concentration Machine contamination Water quality Maintenance Validation HIRL Birmingham

25 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) HIRL Birmingham 25

26 TRANSPORTATION Protection of endoscopes and the environment from contamination and/or possible damage Separation of dirty and clean endoscopes HIRL Birmingham

27 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

28 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 HIRL Birmingham

29 STAFF TRAINING HIRL Birmingham 29

30 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 30

31 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 HIRL Birmingham

32 THANK YOU FOR LISTENING HIRL Birmingham 32