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(which require sterilization).30 The following steps must be included in the disinfection/sterilization
procedure16, 28, 30:
a) choose a disinfectant that is compatible with the endoscope;
b) monitor the efficacy of the disinfectant before each use with test strips available from the product
manufacturer;
c) maintain a written log of monitoring test results;
d) do not use disinfectants past their expiry date;
e) carefully follow the manufacturer s directions regarding the ambient temperature and duration of
contact for the disinfectant (e.g., 2% glutaraldehyde = 20 minutes at 20°C);
f) completely immerse the endoscope and endoscope components in the high-level
disinfectant/sterilant and ensure all channels are perfused; and
g) following disinfection, rinse the endoscope and flush the channels with bacteria-free or sterile
water.
Disposable sheaths/condoms placed over the endoscope reduce the numbers of microorganisms
on the scope but do not eliminate the need for cleaning/disinfection/sterilization between uses.
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Best Practices for Cleaning, Disinfection and Sterilization in All Health Care Settings February, 2010
E. Accessories
Endoscopic accessories (e.g., biopsy forceps and brushes) that break the mucosal barrier must be
sterilized after each use30:
a) because of the difficulty cleaning biopsy forceps/brushes, it is strongly recommended that
disposable items be used; and
b) if reusable biopsy forceps/brushes are used, they must be meticulously cleaned prior to
sterilization using ultrasonic cleaning.
F. Automated Endoscope Reprocessor (AER)
If an automated endoscope reprocessor (AER) is used, the following must be included in the procedure30:
a) follow the manufacturer s instructions for use of the AER;
b) ensure that the endoscope and endoscope components to be reprocessed are compatible with
the AER used;
c) ensure that channel connectors and caps for both the AER and the endoscope are compatible;
d) place brushes and instruments used to clean the endoscope in the AER for disinfection;
e) do not open or stop the AER once started; if an AER cycle is interrupted, high-level disinfection
cannot be assured;
f) routinely review Health Canada/OHA alerts and advisories and the scientific literature for reports
of AER deficiencies that may lead to infection (reprocessing and infection prevention and control
staff); and
g) implement and document preventive maintenance program(s) for the AER(s).
G. Drying and Storage of Endoscopes
Steps in the final drying of semicritical endoscopes include16:
a) initial flushing of all channels with medical or filtered air;
b) flushing all channels with 70% isopropyl alcohol to aid in the drying process; and
c) second flushing of the channels with medical or filtered air.16
Storage procedures must include the following16:
a) remove caps, valves and other detachable components during storage and reassemble just
before use30; store close to the endoscope in a manner that minimizes contamination;
b) store semicritical endoscopes by hanging vertically in a well-ventilated area in a manner that
minimizes contamination or damage;
c) store endoscopes that have been sterilized in their sterilization containers;
d) do not allow endoscopes to coil, touch the floor or bottom of the cabinet while handing, or be
stored in their cases;
e) ensure that endoscope storage cabinets are constructed of non-porous material that can be
cleaned; and
f) clean and disinfect endoscope storage cabinets at least weekly.
Colonoscopes have a maximum shelf life of 7 days, if stored dry.32 There are no recommendations
regarding shelf life of other types of endoscopes.
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Best Practices for Cleaning, Disinfection and Sterilization in All Health Care Settings February, 2010
H. Equipment Used for Cleaning
The water bottle and its connecting tube, used for cleaning the endoscope lens and irrigation during the
procedure, should receive high-level disinfection or sterilization at least daily.30 Sterile water shall be used
to fill the water bottle.
I. Record-keeping
An accurate, permanent record of endoscope use and reprocessing will assist in tracking endoscopes
and clients/patients/residents in the event of a recall or follow-up:
a) for each procedure, document the client/patient/resident s name and record number, the date and
time of the procedure, the type of procedure, the endoscopist, and the serial number or other
identifier of both the endoscope and the AER (if used) to assist in outbreak investigation16, 30;
b) record the endoscope number in the client/patient/resident record16, 30; and
c) retain records according to the policy of the facility.16
For more information regarding reprocessing of endoscopes, see the CSA s  Z314.8-08
Decontamination of Reusable Medical Devices , Section 13.16
Recommendations:
53. Individuals responsible for reprocessing endoscopes shall be specially trained and shall
meet the facility s written endoscope processing competency requirements, including
ongoing education and training and annual competency testing.
54. Each health care setting in which endoscopic procedures are performed shall have
written, detailed procedures for the cleaning and handling of endoscopes.
55. Ventilation shall be such as to remove toxic vapours generated by, or emitted from,
cleaning or disinfecting agents.
56. Endoscope cleaning shall commence immediately following completion of the clinical
procedure.
57. Patency and integrity of the endoscope sheath should be verified through leak testing,
performed after each use.
58. Endoscopic equipment/devices shall be rinsed and dried prior to disinfection or
sterilization.
59. Critical endoscopes shall be sterilized.
60. Semicritical endoscopes and accessories (excluding biopsy forceps and brushes) must
receive at least high-level disinfection after each use.
61. Endoscopic accessories (e.g., biopsy forceps and brushes) that break the mucosal barrier
must be disposable or sterilized after each use.
62. If an automated endoscope reprocessor (AER) is used, ensure that the endoscope and
endoscope components are compatible with the AER.
63. Final drying of semicritical endoscopes shall be facilitated by flushing all channels with
70% isopropyl alcohol, followed by forced air purging of the channels.
64. Semicritical endoscopes shall be stored hanging vertically in a well-ventilated area in a
manner that minimizes contamination or damage. Endoscopes shall not be coiled,
allowed to touch the floor or bottom of the cabinet while hanging, or stored in their cases.
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