From Theory to Reality

Objectives

To understand the mechanics of an endoscope

To learn proper reprocessing methods for flexible endoscopes

To understand the day to day challenges with reprocessing endoscopes

An instrument/medical device designed to observe, diagnose and perform therapeutic procedures.

Anatomy of an Endoscope

Body Mechanics Control Section

• Angulation control knobs

• Free/engage lever

• Suction and air/water valves

• Switch unit (buttons)

• Biopsy port

• Stiffness control mechanism (colonoscopes)

• Auxiliary water port

• Special channel control (duodenoscopes)

Body Mechanics

Insertion Tube

• Includes the light guide tube boot

• Bending rubber

• Distal Tip

Umbilical Cable/Control Head

• Includes the light guide fibers

• Suction port

• Electrical connector

Insertion Tube

Umbilical Cable

Distal Tip

Suction Channel Flow

Air/Water Channel Flow

Air

Water

Auxiliary Channel Flow

• Pre-clean at the bedside

• Dry/Wet leakage testing and visual inspection

• Manual Cleaning

• Sterilization/High level Disinfection (Automated or Manual)

• Drying

• Alcohol Flush

• Storage

Bedside Pre-Cleaning

• Performed immediately after the procedure • The first step in removing organic and microbial bioburden

• Mandatory prior to automated or manual re-processing

Wipe the outside of the insertion tube with a clean, lint free cloth soaked in enzymatic

solution.

Cover Air/Water button hole to check for air flow. No air flow indicates a blockage. Inform your scope re-processor upon

delivery/pick up.

Press Air/Water button to check for water flow. No water flow indicates a blockage.

Inform your scope re-processor upon delivery/pickup.

Press suction button to test suction.

Alternate between enzymatic solution and air aspirating until flow is clear.

Day to Day Challenges

No Bedside Cleaning Bedside Cleaning

Dried Bioburden

• Endoscopes are to be transported to the re-processing room immediately following bed side cleaning

• One endoscope per bin

• Accessories are to be separated from the endoscope during transportation to reduce the risk of damage

Day to Day Challenges

Sharp Instruments such as Forceps could potentially damage the

scope during transport

Leakage Test

• Must be performed before each cleaning

• Turn on pump and check that air is emitting from it

• Attach tester outside of water

• Remove all detachable parts

• Perform dry leak test

• If leak is detected, proceed to clean the endoscope under pressure adhering to the regular steps in reprocessing if possible.

Visually check the insertion tube. Note any dents, bulges, or other irregularities.

Crushed Insertion Tube

Test the brakes to ensure they are not engaged.

Turn the angulation controls and release. If the brakes are not engaged,

the bending section will return to normal position.

• Fill sink with water

• Confirm leak tester is connected

• Completely immerse endoscope

• Perform wet leakage test

• Add enzymatic solution

• Brush all valves/buttons with valve brush

• Brush all channels (ie: Biopsy channel, Suction channel)

• With each passage, check the brush for visible bioburden before withdrawing through the scope

Wet Leakage Test

Valves/Buttons Removed

Leakage Test Connector

Brush the buttons in enzymatic solution paying close attention to all areas. Compress the spring loaded top

of both buttons for further cleaning.

Bioburden in Biopsy valve cap

Brush Suction Channel at 45 degree until brush appears clean.

Brush the Suction Channel at 90 degree until brush appears clean

Brush through the Biopsy Channel until brush appears clean.

• Attach all cleaning adapters including auxiliary water port adapter on certain scopes (ie: colonoscopes, duodenoscopes)

• Irrigate all channels with enzymatic solution and leave inside the scope for the manufacturer’s recommended time (usually 2-3 min.)

• Rinse all channels and valves/buttons with water

Cleaning Adapters (Manual)

Channel Plugs

Enzymatic Solution Connector

Cleaning Adapters (Automated)

Enzymatic Solution Connector

Channel Plugs

• The brush tip must be smooth and inspected before each use

• Reusable brushes must be disinfected with each endoscope

• Only use brushes recommended for channel cleaning

• Place endoscope in an automated re-processor or basin for manual disinfection

• Connect proper adapters to all channels

• For manual disinfection, the endoscope must be in contact with the disinfectant for the manufacturer’s recommended time

• After soaking, the endoscope and channels are then rinsed with bacteria-free water

Manual Process for High Level Disinfection

• High Level Disinfectant • Flush all channels

Rinsing after High Level Disinfection

• Bacteria free water • Rinse all channels

Endoscope placed in an Automated Re-processor

Day to Day Challenges

Crushed Umbilical Cable

Umbilical Cable damaged due to

Improper Loading

Missing Connector

Missing Sterilant

Missing Chemical Indicator

• Endoscopes must be dried after re-processing and before storing at the end on the day

• Purge endoscope channels with medical air

• Flush all channels with alcohol to assist in drying

• Purge endoscope channels with medical air

• Dry exterior of the endoscope with a clean, lint free cloth

• Dry buttons, do not put back into the endoscope during storage

STORAGE • Store in a well ventilated cabinet, free

of dust and in close proximity to the procedure rooms

• Remove all detachable parts including water proof cap and buttons

• Attach EtO/venting cap to open all internal channels

• Scopes must be hung vertically with

the control head supported on a smooth bracket

• Distal tips hanging freely

Day to Day Challenges

* Arrows indicate missing EtO/venting caps*

*Arrows indicate buttons and biopsy valve cap left

in during storage*

Bending Rubber 43%

Biopsy Channel 16%

Angulation 11%

Air/Water Repair 8%

CCD Replacement 7%

Bending Channel 7%

Suction Cylinder 2%

Light Guide Lens 2%

Adjust Forcep Elevator 2%

Repair Elevator Channel 1% Replace Light Guide

Bundle 1%

Damage Analysis Olympus Canada 2008