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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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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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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 –
approximately $22,000
Robotic Scopes –
approximately $18,000
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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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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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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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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
28
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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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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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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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
• Association for the Advancement of Medical Instrumentation.
(2014). AAMI TIR34:2014. Arlington, VA: Author.
Water for the reprocessing of medical devices
• Association for the Advancement of Medical Instrumentation.
(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:
• 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
68
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