Go EtO-Free—and Go Green—with Hydrogen Peroxide Gas Plasma Sterilization
For more than 50 years, ethylene oxide (EtO) gas has been an effective sterilization technology for heat- and moisture-sensitive medical devices and surgical instruments. While EtO is less harsh on instruments than dry heat, steam, or peracetic acid, there are, however significant disadvantages associated with its use in terms of patient and staff safety and the environment.
In particular, because EtO has been linked to cancer, its use raises concerns about employee health and safety as a result of exposure to the gas during the sterilization process, necessitating the use of personal protective equipment and exposure monitoring. In addition, long aeration times are required before instruments are safe for use on patients. As a result, since December 2008, hospitals installing new EtO sterilizers must comply with federal regulations that strictly limit the use of EtO and burden users with onerous record keeping and records storage requirements.1 In addition, EtO sterilization is associated with high levels of electricity and water usage, negatively impacting the environment and increasing costs. READ MORE…
What role does leak testing play in ensuring the proper function and maintenance of flexible endoscopes?
Leak testing, which detects damage to the interior or exterior of endoscopes, is crucial during reprocessing and should be performed after every procedure prior to immersing an endoscope in reprocessing solutions. Some of the most expensive repairs performed on flexible endoscopes are required to fix further damage caused by leaks, and a proactive approach to leak testing can help minimize such repairs. More importantly, leak testing ensures the integrity of the endoscope, thereby eliminating potential adverse patient outcomes such as cross-contamination of chemicals, as well as possible delays in procedures.1
There are two ways to detect leaks: manually and in automated systems. During manual leak testing, the Society of Gastroenterology Nurses and Associates (SGNA), recommends attaching the leak tester and pressurizing the endoscope before immersing it in water.2 It is important that staff members follow the manufacturer’s instructions to ensure accurate results, as eliminating or inadequately performing steps may cause a failure to detect a leak.
Leak detection also can be accomplished using automated systems such as the EVOTECH® Endoscope Cleaner and Reprocessor (ECR) from ASP. The EVOTECH® ECR tests an endoscope for gross leaks before introducing any liquid. When the system has established that the endoscope is intact, the reprocessing begins, and the system maintains positive pressure to protect scopes from damage due to fluid invasion. A final leak test is repeated prior to the end of the cycle to ensure that no leaks are missed. Automated systems can save time, enhance productivity, and eliminate human variation in performing leak testing. This can promote patient safety and the integrity of delicate, expensive flexible endoscopes.
1. Dix K. Scope leak testing. EndoNurse; March 2007. Available at: http://www.endonurse.com/articles/07aprfeat2.html. Accessed Sept. 24, 2009.
2. Standards of infection control in reprocessing of flexible gastrointestinal endoscopes. Gastroenterol Nurs. 2006;29:142–148.
Why is it important to thoroughly rinse endoscopes during reprocessing?
According to the Society of Gastroenterology Nurses and Associates (SGNA), proper reprocessing of endoscopes and accessories is critical to the safe and successful treatment of patients, including thorough rinsing after both cleaning and high-level disinfection.1
SGNA guidelines outline an eight-step protocol for the reprocessing of gastrointestinal endoscopes. Rinsing endoscopes after cleaning is a key step, as residual debris or detergent left on an endoscope can potentially harm patients. As a result, the guidelines require that an endoscope be thoroughly rinsed with clean water to eliminate residual debris and detergent following the cleaning process.1 In addition, once the endoscope has been high-level disinfected, thorough rinsing also is required to remove chemical residue, which has the potential to injure patients, such as causing disinfection-induced colitis.2 The guidelines recommend rinsing all surfaces and removable parts, as well as flushing the channels with either sterile, filtered, or tap water. The device manufacturer’s instructions for use should be closely followed.
Consistency is critical when cleaning, high-level disinfecting, and rinsing flexible endoscopes. If any element of the multi-step process is not performed correctly, the results could negatively impact patient safety. Automated systems now are available to ensure that the process is done accurately every time. For example, the EVOTECH® Endoscope Cleaner and Reprocessor from ASP automates all of the steps in the process once precleaning has been done in the patient room—from cleaning and high-level disinfecting, to rinsing and leak and blockage testing—ensuring consistent and reliable results.
1. Standards of infection control in reprocessing of flexible gastrointestinal endoscopes. Gastroenterol Nurs. 2006;29:142–148.
2. Rutala WA, Weber DJ. Reprocessing endoscopes: United States perspective. J Hosp Infect. 2004;56:S27–S39.
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CIDEX® OPA Test Strips
To ensure that CIDEX® OPA Solution efficiently destroys microorganisms, the minimum effective concentration (0.3%) required for high-level disinfection should be tested with CIDEX® OPA Test Strips prior to each use. To assure efficacy, follow three simple steps:
1. Completely submerge the indicating pad of the strip into CIDEX® OPA Solution for the specified time and remove. Do not shake strip.
2. Remove excess solution by standing strip upright on a paper towel.
3. Read results at specified time. Do not read past specified time.
The process must be followed when using both manual and automated endoscope reprocessers. (See the instructions for use for more information.)