all of the presenters are employees of steris corporation

1

Care and Handling of

Endoscopes:Flexible and Rigid

• Participants must complete the entire presentation/seminar to

achieve successful completion and receive contact hour credit.

Partial credit will not be given.

• All of the presenters are employees of STERIS Corporation and

receive no direct compensation other than their normal salaries for

participation in this activity.

• STERIS Corporation is an approved provider of continuing nursing

education by the California Board of Registered Nursing, provider

number CEP11681 for 1 contact hour along with IAHCSMM and

CBSPD.

• STERIS Corporation is providing the speakers and contact hours for

this activity. However, products referred to or seen during this

presentation do not constitute a commercial support by the speakers.

Continuing Education Contact Hours

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Learning ObjectivesUpon completion of this course, you will be able to:

• Discuss current healthcare trends in endoscopy

• Compare and contrast flexible and rigid endoscopes

• Name the major parts and functions of endoscopes

• Review key steps in point of use preparation,

transport, reprocessing and storage to prevent

endoscope damage

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Current Trends in Endoscopy

• U.S. endoscope market valued at $2 billion

• Technology advances in diagnostics

• Advanced visualization for complex procedures

• Improved diagnostic and therapeutic capabilities

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endoscope damage

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Flexible Endoscope

Suction and Air/

water channel ports

Distal tip

Biopsy port

Directional Lever

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2

Camera –

approximately $15,000

Small Flexible Endoscope –


Robotic Scopes –


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Flexible and Rigid Endoscope

Characteristics

• Delicate, complex,

expensive

• Require special care

and handling

• Access internal

structures/cavities

• Lens system for

image

• Fiberoptic cable for

light

• Internal lumens and

channels

• Insuffulation component

• Suction and irrigation

systems

• Monitors connected

through cable system to

carry signals

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Types of Flexible Endoscopes

Fiberscope Videoscope

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Flexible Endoscopes• Complex devices

− Mechanical, electrical, plumbing systems working in

unison

• Advanced visualization

• Delicate design

• Unique components

• Constant changing technology means:

− New endoscopes

− New design features

− New challenges

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Flexible Endoscope Anatomy

• Mechanical system

− Control body, insertion and light guide tubes,

bending section

• Image

− Fiberoptic cable, video electronics,

connector, water resistant caps

• Channels

− Suction/biopsy, air/water, irrigation, water-jet, elevator

wire

• Accessories

− Valves, suction, air/water, biopsy port

− Biopsy forceps, snares, guide wires, irrigators, dilators

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Effects on Repair Costs

• Level of care and handling

• Short turnover times

• Inadequate inventory

• Rush, skip steps during processing

• Cutting corners to please internal customers

• Lack of training/experience/expertise

• Poorly managed internal procedures and training

• Number of people handling and reprocessing

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3

Mechanical System

• Control mechanism, insertion tube,

bending section

• Coiled wires connect to directional knobs

• Work together to angulate and move

bending section

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Mechanical System, continued

• Insertion tube

− Portion inserted into patient

− Markings act as reference points

− Bending section covers end of insertion tube

Working component

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Bending Section

• Flexible component for positioning

• Contains channels, lens, CCD chip

Outer rubber sheath

Metal spiral coil Steel mesh

Glue joints

Resin

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Mechanical System

• Light guide tube

• Connects control body to light guide connector

• Houses wiring, tubing, fiber bundle, channels

• Incorporates connections

− suction, air/water bottle

− light fiber bundle

− electrical contacts

• ETO venting valve (fiberscopes)

• Electrical connector (video scopes)

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Illumination - Fiberscope

• Fiber bundle carries light

• Image viewed directly through eyepiece

• Broken fibers diminish light

• New fiber bundle = total repair

Fiber bundle

Eye piece

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Video Image System

• Chip located in distal tip

• Image bundle with video

camera unit

• Video lens system reduces

and focuses image onto

electronic chip

• Signals transmitted to

electrical connector/

processor

• Image viewed on video

screen

Load wires

CCD

Bending

Section

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4

Video Connector

Light Guide Connector Fluid Resistant Caps

Electrical Connector

Contact Pins

O-Ring

ScrewsLeak Tester Port

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Rigid Endoscopes

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Types of Rigid Endoscopes

• Arthroscopes

• Laparoscopes

• Cystoscopes

• Bronchoscopes

• Sinuscopes

• Hysterscopes

• Ureteroscopes

• Esophagoscopes

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endoscope damage

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Rigid Endoscope Anatomy

Assembled View

Endoscopic Body & Shaft

Rod Lenses

Objective

Spacers

Light Post

Fiber Guide

Eye Piece

Focus Lens

Retainer

Ring/Spring

Alignment/Focus Mechanism

Expanded View

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Rigid Endoscope Anatomy, continued

Objective

LensBody

Eye

Piece

Light Post

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5

Scope Damage

• 30% scope damage = normal wear and tear

• 70% scope damage = within our control

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Contributing Factors Towards

Repair Costs

• Improper care and handling

• Expedited room turnovers

• Insufficient inventory

• Pressure to quickly reprocess devices;

skipped steps

• Inadequate training/diminished competency

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Effects on Repair Costs

• Routine use

• Fluid invasion

− Failed leak tests

• Mishandling/misuse

− During procedures

− Transport

− Cleaning, disinfection/sterilization

− Storage

• Broken fibers, cracked lenses

• Bent rods

• Punctures in internal lumens

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endoscope damage

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Proper Handling

• Insertion tube coiled loosely

• Support control body, light guide

• Components separated

• No accessories

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Poor Handling Practices

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Poor Handling Practices, continued

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Poor Practices • Avoid the “pretzel” syndrome

− Excessive coiling, twisting

− Not following natural curvature of endoscope

• Crushing injuries

• Stacking

• Buckling

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Endoscope Damage • Most Vulnerable:

• Distal tip - houses CCD, light guide lens, air water nozzle

− Avoid striking or dropping

− Place tip down carefully, gently, avoid stacking

• Electronics and optics

− Keep fluid from internal workings

− No impact or trauma

• Channels

− Smaller have more kinds and curves

− More difficult to clean

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Correct Handling Practices

• Protect eyepiece and body

• Avoid damage to lens

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Endoscope Damage

• Routine use

• Fluid invasion

− Failed leak tests

• Mishandling/misuse

− During procedures

− Transport

− Cleaning, disinfection/sterilization

− Storage

• Broken fibers, cracked lenses

• Bent rods

• Punctures in internal lumens

35 36

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Pre-Cleaning at the Point of Use

• Keep devices free of soil and blood during use

− Reduce microorganisms

− Reduce potential for environmental contamination

• Wipe surfaces with gauze/non-lint sponges

• Flush lumens and cannulas with water

• Separate endoscope from other instruments

− Avoid damage

• Prepare for transport

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Containment and Transport

• Closed/covered container

• Mark with biohazard label

• Regular scheduled pick-up

• Avoid high traffic areas

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Repair Issues Related to Transport

• Excessive coiling

• Devices not safely secured

• Transported with accessories/sharps

• Twists, bends in bag

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Leak Testing

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Leak Testing, continued

• Check leak tester for functionality

• Preformed prior to cleaning

• Pressurize prior to immersion in water

• Follow device manufacturer’s instructions

Electric Manual41

Air Pressurization

Air Around Internal Components

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8

Indications of a Leak

Control body Channels

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Fluid Invasion

• Frequent repair – over half of total repair costs

• Requires immediate identification and repair

• If undetected = greater damage

− Image stains

− Foggy images

− Transmission of infection

− Fluid, biologic materials, biofilm collect

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Cleaning

• Multi-step process

• 2 sinks of adequate size for flexible

endoscopes

− First sink: soak/wash with cleaning

solution to remove soil

− Second sink: rinse

− Third sink for treated water rinse

• Work flow dirty to clean 45

Cleaning Methods

• Follow manufacturer IFUs

− Manual

− Mechanical

− Combination of both

− Mechanical friction

• Physically remove debris

− Wiping, brushing, spraying, flushing lumens

• Should not damage endoscope

• Safe for the worker performing the task

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Manual Cleaning• Non-lint cloths

• Identify models and channels

• ALL channels accessed

• Channel irrigators used

• Brush inventory

− Correct brush sizes for

channels

− Varying diameters and lengths

− Single use are disposable!

− Disinfect reusable brushes

• Flush channels to remove

loosened soil47

Appropriate Cleaning Chemistry

• Fresh solution

• READ THE LABEL!

• Follow manufacturer IFUs

• Neutral pH

• Compatible with endoscopes

• Dilute correctly

• Check water temperature

• Mark water line on sink

• Soak time

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9

Mechanical Cleaning Options

• Flushes internal channels

• Consistent process

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Manual Cleaning:Rinse in Second Sink

• Clean, fresh, warm water

• Thorough rinsing

• Immersed in water

• Flush all instrument channels

• Rinse to irrigate the challenging design features

• Remove soil and cleaning chemistry

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Manual Cleaning: Third Sink with treated water

for rinsing

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Inappropriate Cleaning Chemistry

and Inadequate Rinsing

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Mechanical Cleaning

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Ultrasonic Cleaning

• Utilized for fine cleaning of rigid devices

• Gross debris removed

• Effective cleaning chemistry

• Cavitation process

− Sonic energy created bubbles

− Unstable bubbles implode

− Dislodges soil from surfaces

• Degas prior to use

• Change solution regularly

• No optical devices, mixed metals

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10

Mechanical CleaningAutomated Endoscope Reprocessor

• Wash phase during cycle

• Augments manual cleaning for consistent outcome

• Cleaning chemistry labeled for endoscopes

• FDA cleared wash phase with minimal pre-cleaning

− Pre-cleaning steps MUST be followed

• Follow endoscope manufacturer instructions

• Follow AER manufacturer instructions

• IFUs may be in conflict

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Endoscope Accessories

• Reusable accessories, valves, tubing processed

per manufacturer instructions

• Disassembled and cleaned

• Inspect for integrity

• AER manufacturer validates processing

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Inspection

• Examine line of shaft

• External damage

• Check vision

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Disinfection vs. Sterilization

• Endoscope’s intended use

• Critical, semi-critical

• Sterilization preferred

− Vaporized Hydrogen

Peroxide

− Hydrogen Peroxide gas

plasma

− Liquid chemical

sterilization

• Follow manufacturer‘s

guidelines

• Individual facility policy

**Add Image of LCS

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High Level Disinfection

• Follow manufacturer’s

instructions

• Manual soaking and

adequate rinsing

• Automated Endoscope

Reprocessor

− Careful placement in

Reprocessor

− Use validated

adapters as needed

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Storage

• Remove residual water

• Purge all channels with alcohol and

(compressed) air

• Detach removable parts, valves, biopsy caps

• Angulation locks in free position

• Variable stiffness knob in neutral position

• Detach water resistant cap

• Well-ventilated cabinet

• Hang freely

• Distal tip not touching bottom of cabinet

• Processed scopes labeled as ‘patient ready’60

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Incorrect Storage

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Storage Time

Endoscope Shelf Life prior to reprocessing:

• AAMI ST 91: based on risk assessment

• AORN: based on risk assessment

• SGNA: up to 7 days

• CDC: based on risk assessment

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Preventative Maintenance

for all Endoscopes

• Check for signs of wear and tear

• Scope intact after repairs

• Prevent damage

• Trained and qualified staff

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Action Plan

• Continuing education to staff on proper care,

handling and maintenance of all scopes

• Refer to scope manufacturer’s instructions for

proper use and handling

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References• Alfa, M. J. (2013). Monitoring and improving the effectiveness of

cleaning medical and surgical devices. American Journal of Infection

Control, 41(5), S56-S59. doi:10.1016/j.ajic.2012.12.006

• Association for the Advancement of Medical Instrumentation.

(2013). ANSI/AAMI ST58: 2013. Arlington, VA: Author.

Chemical sterilization and high-level disinfection in health care

facilities


(2014). AAMI TIR34:2014. Arlington, VA: Author.

Water for the reprocessing of medical devices


(2015). ANSI/AAMI ST91:2015. Arlington, VA: Author.

Flexible and semi-rigid endoscope processing in health care facilities

• Association of periOperative Registered Nurses, Burlingame, B.,

Denholm, B., Kovac, M., Link, T., Ogg, M. J., … Wood, A.

(2016). Guidelines For PERIOPERATIVE PRACTICE (2016 ed.).

Dever, CO: Author.

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References• Endoscope care guide. (2015). HEALTHCARE PURCHASING

NEWS, 39(11), 34-57.

• Flood, A., Huslage, D. K., & Myers, F. (2015). Endoscope crosswalk:

Critical guideline review.Prevention Strategist, 8(4), 52-54.

• Herrin, A., Loyola, M., Bocian, S., Diskey, A., Friis, C., Herron-Rice, L.,

& Selking, S. (2015).Standards of infection prevention in reprocessing

flexible gastrointestinal endoscopes. Retrieved February 29, 2016,

from

http://www.sgna.org/Portals/0/Standards%20for%20reprocessing%20

endoscopes_FINAL_2.22.pdf

• Kulkarni, K. (2013). Endoscope care guide. HEALTHCARE

PURCHASING NEWS, 37(11), 10-29.

• McDonnell, G. (2014). Chemical disinfection and

sterilization. Healthcare Purchasing News,38(3), 50-53.

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References• McDonnell, G. E., & Sheard, D. (2012). A practical guide to

decontamination in healthcare. Chichester, U.K: Wiley-Blackwell.

• Reprocessing medical devices in health care settings: Validation

methods and Labeling guidance for industry and food and drug

administration staff. (2015, March 17). Retrieved February 29, 2016,

from

http://www.fda.gov/downloads/medicaldevices/deviceregulationandgui

dance/guidancedocuments/ucm253010.pdf

• Society of Gastroenterology Nurses and Associates, Inc. (2014,

September). Position statement reprocessing of endoscopic

accessories and valves. Retrieved February 29, 2016, from

http://www.sgna.org/Portals/0/Education/PDF/Position-

Statements/Reprocessingvalvesdocument_FINAL.pdf

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Summary

Now that you have completed this course, you can:






endoscope damage

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all of the presenters are employees of steris corporation

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