Pre-cleaning, manual cleaning procedures for flexible endoscopes

Ronald Wassenburg

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At the end of this presentation you should be able to: - explore how manual pre-cleaning procedures developed over the years - recognize responsibilities regarding manual pre-cleaning - debate future developments in manual pre-cleaning

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INTRODUCTION

A CHALLENGE THE ENDOSCOPE

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1. Air channel

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1. Air channel 2. Water channel Air supply

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Channels interfering with each other

Special care for cleaning the valves

Pay attention to the disinfection or sterilization of the water bottle

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1. Air channel 2. Water channel

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1. Air channel 2. Water channel 3. Biopsy channel 4. Suction channel

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Use the right brushes

Nozzles: difficult accessible

Not all channels can be brushed

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1. Air channel 2. Water channel 3. Biopsy channel 4. Suction channel

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1. Air channel 2. Water channel 3. Biopsy channel 4. Suction channel 5. Water jet channel

Elevator channel of a duodenoscope

dont forget to flush possible auxilary channels

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THE CONSTRUCTION OF AN ENDOSCOPE A CHALLENGE? YES!

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Channels interfering each other Difficult accessible nozzles Different channel diameters Different soiling levels
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MANUAL PRE-CLEANING AND CLEANING

EVOLUTION

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1. Bed side cleaning (wiping)

2. Leakage test

3. Manual pre-cleaning
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4. Cleaning

preferred

5. Disinfection

preferred

6. Rinses

preferred

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1990

BED SIDE CLEANING LEAKAGE TEST PRE-CLEANING CLEANING DISINFECTION RINSES

2012 20XX
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MANUAL PRE-CLEANING PROCEDURES

HOW CAN STANDARDS HELP US?

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The Standard for Endoscope Reprocessing

Not easy to understand!

ISO 15883 - Requirements for EWDs - Instructions on how to use those

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NATIONAL GUIDELINES Like the SFERD PROFESSIONAL STANDARD HANDBOOK http://www.infectiepreventieopleidingen.nl/do wnloads/SFERD_handbook_2011.pdf

Practical national guidelines

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THE SFERD PROFESSIONAL STANDARD HANDBOOK:

1. 2. 3. 4. 5. 6. 7. 8. 9. LEADERSHIP: VISION AND ORGANIZATION STRATEGY & POLICY HUMAN RESOURCE MANAGEMENT RESOURCE MANAGEMENT PROCESS MANAGEMENT APPRECIATION BY CUSTOMERS APPRECIATION BY HEALTH CARE STAFF APPRECIATION BY SOCIETY RESULTS

Responsibilities!

10. IMPROVEMENT AND INNOVATION BY AUDIT & CONTROL APPENDIXES

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THE SFERD PROFESSIONAL STANDARD HANDBOOK:

1. 2. 3. 4. 5. 6. 7. 8. 9. LEADERSHIP: VISION AND ORGANIZATION STRATEGY & POLICY HUMAN RESOURCE MANAGEMENT RESOURCE MANAGEMENT PROCESS MANAGEMENT APPRECIATION BY CUSTOMERS APPRECIATION BY HEALTH CARE STAFF APPRECIATION BY SOCIETY RESULTS

Advice on room interior

10. IMPROVEMENT AND INNOVATION BY AUDIT & CONTROL APPENDIXES

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THE SFERD PROFESSIONAL STANDARD HANDBOOK:

1. 2. 3. 4. 5. 6. 7. 8. 9. LEADERSHIP: VISION AND ORGANIZATION STRATEGY & POLICY HUMAN RESOURCE MANAGEMENT RESOURCE MANAGEMENT PROCESS MANAGEMENT APPRECIATION BY CUSTOMERS APPRECIATION BY HEALTH CARE STAFF APPRECIATION BY SOCIETY RESULTS

!!!

10. IMPROVEMENT AND INNOVATION BY AUDIT & CONTROL APPENDIXES

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ENDOSCOPE REPROCESSING ON THE HIGHEST LEVEL

PRACTICAL EXAMPLE OF AN OPTIMUM ENDOSCOPE REPROCESSING DEPARTMENT

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After the procedure the endoscope is transported in a special transport tray to the central endoscope reprocessing department and with the usage of a pass through door placed into the reprocessing area.
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State-of-the-art pre-cleaning: the basin can be filled handsfree and the detergent is dosed automatically. Of course after the manual leakage test is performed.
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Using ISO 15883 compliant (pass through) systems for automatic endoscope reprocessing. The reprocessing room is separated by the machines into a contaminated and clean area.

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The processes in the endoscope washer disinfector can be remotely monitored with traceability and registration software.
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The pass through principle: after the cycle in the pass through EWD is finished successfully, the endoscope can be unloaded on the other side of the machine (clean area).

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On the clean side the hospital applied a strict hygienic regime, to ensure that once the endoscope has its reprocessed and disinfected status, it will keep it!
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After unloading from the EWD, the endoscope is placed for drying in one of the drying cabinets.
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or the endoscopes is directly needed within another procedure and with the use of the transport system through anothor pass through door safely transported to the treatment rooms.
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PRE-CLEANING, MANUAL PROCEDURES FOR FLEXIBLE ENDOSCOPES

CONCLUSION

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Pre-cleaning, manual cleaning procedures for flexible endoscopes: more and more automated.
Critical factors success: - Perfect controlled endoscope logistics - Implementing quality assurance systems

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THANK YOU FOR YOUR ATTENTION!

Ronald Wassenburg
Managing Director of Wassenburg Medical Devices B.V., The Netherlands Representative of the Dutch normalization committee, in the ISO TC198 working group 13 Active member of the Dutch Sterilisation and Sterility (NEN) normalization committee

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NEN-EN-ISO 15883-1 (en): Washer-disinfectors - Part 1: General requirements, terms and definitions and tests (ISO 15883-1:2006,IDT) (EUROPEAN COMMITTEE FOR STANDARDIZATION) NEN-EN-ISO 15883-4 (en): Washer-disinfectors - Part 4: Requirements and tests for washer-disinfectors employing chemical disinfection for thermolabile endoscopes (ISO 15883-4:2008,IDT) (EUROPEAN COMMITTEE FOR STANDARDIZATION) Technical Specification ISO/TS 15883-5 : Washer-disinfectors Part 5: Test soils and methods for demonstrating cleaning efficacy (EUROPEAN COMMITTEE FOR STANDARDIZATION) Health Technical Memorandum 2030: Washer-disinfectors, Design considerations (London: The Stationery Office) Health Technical Memorandum 2030: Washer-disinfectors, Operational management (London: The Stationery Office) Health Technical Memorandum 2030: Washer-disinfectors, Validation and verification (London: The Stationery Office) PROFESSIONAL STANDARD HANDBOOK FLEXIBELE ENDOSCOPES - Cleaning and Disinfection: Dutch Advisory Board Cleaning and Disinfection Flexible Endoscopes (SFERD) Leitlinie zur Validierung maschineller Reinigungs- Desinfektions- prozesse zur Aufbereitung thermolabiler Endoskope (German working group under the supervision of: Schmidt V. (AKI), Beilenhoff U. (DEGEA), Jones A. (DGSV), Krger S. (DGKH)) Cleaning and disinfection endoscopes (Infection Prevention Working Party (WIP)) Proper Maintenance of Instruments - Red Brochure (Arbeitskreis Instrumenten-Aufbereitung [Instrument Preparation Working Group]) ISO (International Organization for Standardization) http://www.iso.org/iso/home.html FDA (U.S. Food and Drug Administration) http://www.fda.gov/ User manual of the endoscope

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