We have several non-lumened endoscopes in the trust - nasal endoscopes and flexible laryngoscopes. These are used mostly in OPD areas and also sometimes in theatres. As they are non-lumened they do not need decontamination in the (expensive) endoscope processors. They do however still need effective decontamination between uses. Usual practice is a wipe process which has been in place for ages. However this is not validatable.

Can anyone advise what best practice is for decontamination of these scopes?

John,
Validation is the key word. Manual cleaning/reprocessing cannot be validated and effectiveness is only as good as the person doing the cleaning. We use sheaths for such scopes, they can however work out expensive. There is a small automated table top washer/disinfector available from Dawmed, they did a costing exercise against the use of sheaths which showed some savings, the main advantage would be that you get a printount (validation)for the reprocessing cycle. We did not persue the offer therefore I am unable to give an opinion about the machine. We are currently looking to centralise all endscope reprocessing.

John,
The watchwords are Validation/ Automation (as stated already).

Have a word with your sterilizer 'AP' for specific advice and thoughts on current practices in use. Many of them will advise directly on these issues as will your Microbiologists.

We are considering bench top machines for this type of thing (Nasendoscopes) although costs are high for such things.Current practice is sheaths and manual cleaning techniques.
Turnaround and throughput of scopes in our ENT clinic/s is very high negating any centralisation option.

I'm farly new to a direct (full-on) decontamination remit but have become aware, quite quickly, that there are many important issues to consider in such cases as this.

Overall - i feel that issues around all aspects of Scope decontamination will go the way of SSD processes for surgical intstrumentation - it's a matter of time before central guidance comes out more fully as a way of improving general standards across the board.

Thanks BK & Darlo,

I'll look Dawmed up on Google and give them a ring, but it would probably be cheaper to put them through SSD. (If they will do them)

John,
Yes, but whatch your temperatures for any chosen automatic process versus equipment compatibility and keep an eye on the turnaround issue from busy clinics. It's the required throughput in the departments that affects number of scopes required by the users.
Imagine a 'quick wipe down' (1 minute duration?) versus a validated disinfection process (25 mins plus?) for a scope.

You can quickly imagine how this could impact on the patient throughput in the clinic.

Regards - Steve

Yes, Steve is right. Flexible endoscopes should not be subjected to temperatures above 50 - 60C (depending on manufacturer) and so are not usually handled by SSD departments. Some trusts are going down the washer disinfector route for ENT outpatients, but are having to double or triple their scope fleets just to maintain lists. In my experience, ENT outpatients see lots of cases with little time in between for washing scopes. www.entuk.org has some good basic disinfection guidelines for this type of endoscope.
Regards, Andy

All looks very expensive - whatever i do

Our disinfection committee went down the washer disinfector route in our ASDU. Due to the time of the process we have gone from 1 to 6 scopes. Not cheap. Anybody with Keymed flexible scopes should go to Keymed for advice on the use of Sterilox. The last PPQ I have, dated Jan 2008, states that it known to cause functional damage.

When you think about it, stuff that powerful is bound to cause some sort of deteriorations! All disinfection chemicals (even the bleach under the kitchen sink) needs to be used with care. To me, that's the real issue right there ... the "quality" of CSD (insert whichever acronym you prefer) staff themselves! I well remember a guy who never bothered to close the main water valve every evening ... then went off on holiday ... a plastic connector, under pressure, "popped-off" ... and no-one phoned us until there was water running into the elevator shaft (and still none of the staff had the nous to simply wade in there and close the stop-valve)! What a mess!

Graham,
That is the point I made in "Sterilox" thread.
I would recommend obtaining written confirmation from scope manufacturers that their scopes are compatible with the disinfectant being used

sorry to sound thick, but could you post a link re the "wipe" method not bieng validated please.
I am looking at this at the mo, and ive got the Tristel rep coming to see me next week.
Would be good to have some outside info.

With our new decontamination guidelines here the only option is automation - Wassenburg in our case.

Hi Quinny,

The issue around a validated process is for example, akin to your sterilizer processes (in CSSD etc).

The validation aspect is to do with processes that are agreed as time and temperature effective at killing/removing bacteria so that equipment is deemed safe for use.

Automated Endoscope washers or Instrument washers are subjected to many conformance test requirements and ultimately these tests form the validation compliance. As such the results of testing are traceable and repeatable, and to some degree are scientific in nature (Time/temperature hold time = defined kill rate to render bacteria ineffective or Dead!).

So maybe a clean down with a disinfection wipe is not as effective as a Validated automated process?
I'll tell you one thing though, it's a darn site cheaper !

Horses for courses is the name of the game at present and you need advice from your 'micro' guys and IC team so that everyone doen't go running round in a panic. Assess the likelihood of cross infection and consider the type of procedure as to how invasive it is (What micro-organisms live in the body cavity in question for example).

As i have said - just wait and see how these things will evolve in time as standards are deemed to be raised. I think it's a matter of time until validated processes are decreed to exist in a lot more areas than at present.We'll see?
Good luck with it all.
Steve.

Quinny,

Have a look at:
Health Technical Memorandum (HTM) 2010. Good practice Guide: Sterilization. NHS Estates (1995)
and
Health Technical Memorandum (HTM) 2030. Washer – Disinfectors. Operational management. NHS Estates (1997)

HTM 2030 explains all about validation

Regards
Robert

Thanks,
I had the Tristel rep in today to give me a demo of the very very easy way of wipe clean decontamination of the TOE probe that we have. As the Docs wont use sheaths over the probes, it will be left for the nurses to clean all the snot and stuff off it.....Athough i could actually get the Docs to do it as they will be using the bloody thing and it literally is a 2 min job to do.
i have contacted Philips who manufacture the probe and they have emailed me the decontamination recomendations from thier point of view.
However, when i printed it out, it is illegible so i am going to have to trawl through it on the screen.
I will need to train some staff up on this now.....wish me luck!

Quinny,
Do you electically safety test the TOE probes?
In my experience they fail electrical leakage tests if they do not have a sheath on, it is considered as part of the whole?
Micro current electrical leakage right next to the heart - not a thing to be toyed with.
Robert

Hello Guys,

Not my area of expertise, so thank you for all your advice. I had a medical devices committee meeting last friday where i put some of your points and we have decided to buy a washer/disinfector (as recommended by BK). It was much cheaper than i expected. If my memory serves me right - under £3K. (But i expect the company will make its profits on the chemicals)

does any one know where i can source the sheaths for these probes?
Am about to google it but would appreciate some tips.
Ta

Dare I say the suppliers of the TOE probes......
Robert

You dare, but from expeience there is a huge market out there for such consumables and some one somewhere has already done the searching and has come across the best/cheepest/easiest to access to save me the hassle.........


but im going to have to face the hassle arent i, good place to start would be philips.....

thankyou RoJo........