Flexible Endoscope Care, and Handling

1. Flexible Endoscope Care, and Handling

2. Objective • Define specialty services and procedures that use flexible scopes. • Understand that there are many types of flexible endoscopes. • Identify that flexible endoscopes are made up of many different components, each requiring special attention. • Demonstrate steps in the cleaning process. • Determine causes of damage. • Explain what determines failure in the inspection process. • Develop a repair program that involves users in reducing incidents repair.

3. Endoscope • Endoscopy (en-dahs-kuh-pee) is a medical procedure that uses tube-like instruments (called endoscopes). Endoscopes are inserted into the body to diagnose, collect tissue for biopsy, and treat illnesses. • There are many types of endoscopes. Some scopes use fiber optics (flexible glass or plastic fibers) that transmit light and/or image. Other endoscopes can use a CCD chip (video) on the distal end. • Endoscopes vary in length. Each type is specially designed for looking at a certain part of the body. • Depending on the area of the body being examined, the endoscope is inserted into a particular area, such as, the mouth, anus or urethra.

4. Risks with infection The infection risks associated with both flexible and rigid scopes is a serious issue. Proper cleaning, disinfection, and sterilization of these instruments must be continually monitored and consistently maintained. AORN recommended practices state: • Personnel should demonstrate competency in the use, care, and processing of endoscopes and related equipment. • Equipment should be inspected in all stages of handling. • Equipment should be tested before use and used according to manufacturers’ instructions. • Endoscopes and related equipment should be cleaned and decontaminated immediately after use, following manufacturers’ written instructions. • Policies and procedures for the processing of endoscopes, accessories, and related equipment should be developed, reviewed regularly, revised as necessary, and readily available in the practice setting

5. Flexible Endoscope Non Video Video

6. Video scope

7. Control Knob, Angulation Gears, and Bending Section

8. Insertion Tube Top View Side View

9. Distal End

10. Important Angulation

11. Bronchoscopy, direct visualization of the trachea-bronchial tree through a bronchoscope, is performed for: • Diagnosis: securing an uncontaminated secretion for culture, taking a biopsy, or finding the cause of cough. • Treatment: removing a foreign body, excising a small tumor, applying medication, aspirating the bronchi, or providing an airway during performance of a tracheotomy. • Bronchoscopes have: • A small diameter tube that carries light. • Working channels for inserting tiny forceps, lasers, or aspiration needles. • Series of lenses and optics that allow for direct visualization or video projection to a monitor. • Control knobs for the surgeon to flex the tip of the scope to visualize in different directions. • Button to control video. • Suction valve.

12. Simple Steps to cleaning • Pre-Cleaning – The first essential step is to wipe down the scope and immerse in enzymatic detergent mixed with water immediately after the procedure to remove any bio burden or debris. • Leak Testing – Gauge the integrity of the scope to ensure that no fluids have leaked into the internal channels. Make sure that the scope is holding air when you put it through the cleaning process. • Cleaning – Soak the endoscope in enzymatic detergent, following the recommended time, dilution, and water temperature by the manufacturer. Manually brush all channels that can be brushed. • Rinsing – Rinsing flexible scopes with de-ionized water after disinfecting is an important means of removing any residual disinfectant. Must perform (3) separate rinses. • Drying – Thorough drying will break the chain of bacterial transmission from possibly contaminated water. • Storing – Hang (up off the bottom shelf) in a closed, dry cabinet.

13. Leak Test • Be sure to follow manufacturers’ recommendations. • Always leak test and pressurize the endoscope before immersing it in water and before cleaning. • Fill a sink with fresh, clear water. Do not use colored or soapy enzymatic cleaners; they will distort the interpretation of the leak test. • Immerse the entire scope, including the light guide connector and the connection with the leak tester. • Pressure must be maintained to ensure there is no fluid invasion. Every area of the scope is checked for the presence of air bubbles. • Even a slight loss of pressure on the gauge can help identify a small leak. By identifying minor leaks, major fluid invasion is prevented, and thousands of dollars can be saved.

14. Final Rinse • Rinsing flexible scopes after disinfecting is an important means of removing any residual disinfectant. Residual disinfectant or detergent must be rinsed because it can cause a reaction by the mucosa of the patient. • Water quality is very important. The water must be clean, free of chemical residue, minerals, and the possibility of bacteria. • Endoscopes and bronchoscopes may sit between uses, and any residual bacteria present will proliferate

15. Drying The Society of Gastroenterology Nurses and Associates (SGNA) recommends: • All channels are flushed with 70% isopropyl alcohol to assist with drying. • Careful air hose drying aids in removing any residual water left in the channels after reprocessing. • The exterior of the endoscope should be dried with a soft, lint-free towel, and all removable parts thoroughly dried. • Never squeeze or pull down as you wipe down the insertion tube. • The endoscope is now ready for use on a patient or to be put into storage.

16. Internal Damage /External Damage

17. Simple Handling BAD GREAT

18. Accessories • Can damage the internal channel of the scope if not use carefully. • Biopsy forceps & needles, if not introduced in the closed position, can scratch and gouge the inner working channel.

19. FDA • Studies have demonstrated that a final drying step that includes flushing all channels with alcohol, followed by purging the channels with air (to remove the alcohol), greatly reduces the possibility of recontamination of the endoscope by water-borne microorganisms. • After reprocessing, store endoscopes in a manner that will minimize the likelihood of contamination or collection/retention of moisture.

20. Storage • Proper scope storage is just one of the essential steps to ensure scope longevity and adequate drying after the sterilization process. • Ensure a minimum height of 92” to accommodate colonoscopes. • Hang scopes straight. • Prevent scopes from twisting and tangling. • Optional fan units increase air circulation and reduce the humidity around stored scopes. • Removable drip trays assist in keeping the bottom of the cabinet dry. • Roll down doors and locking cabinets are great for keeping scopes safe and reducing dust contamination.

21. Company Requirements • Repair technicians should have training in all brands of flexible scopes such as, Olympus, ACMI, Pentax, Karl Storz, Machida, and Fujinon. • Only the highest quality components should be used in the repair process. • Provide significant cost savings over new scope purchases. • Track repairs, frequency – look for patterns • Periodic testing and monitoring by supervisors to make sure that all scope models are understood is extremely important in keeping repair costs down. • Ensure staff are well trained and properly performing each reprocessing step in accordance with published reprocessing guidelines. • Follow manufacturer’s guidelines. • Train and educate. Thank You