Recommended practices for cleaning and processing endoscopes and endoscope accessories

AORN Journal, Feb, 2003

The following recommended practices were developed by the AORN Recommended Practices Committee and have been approved by the AORN Board of Directors. They were presented as proposed recommended practices for comments by members and others. They are effective Jan 1, 2003.

These recommended practices are intended as achievable recommendations representing what is believed to be an optimal level of practice. Policies and procedures will reflect variations in practice settings and/or clinical situations that determine the degree to which the recommended practices can be implemented.

AORN recognizes the numerous different settings in which perioperative nurses practice. These recommended practices are intended as guidelines adaptable to various practice settings. These practice settings include traditional ORs, ambulatory surgery units, physicians' offices, cardiac catheterization suites, endoscopy suites, radiology departments, and all other areas where operative and other invasive procedures may be performed.

Purpose: These recommended practices provide guidelines to assist personnel in the care, cleaning, decontamination, maintenance, handling, storage, and sterilization and/or disinfection of flexible and rigid endoscopes and related accessories. Use of these recommended practices will assist personnel in providing a safe environment for patients and health care workers. These recommended practices are based on the most current literature and thinking at the time of their development. They should be used to develop policies and procedures for care of endoscopes and accessories in the practice setting. As new information becomes available, perioperative nurses should consult with infection control professionals and epidemiologists to review and revise procedures as appropriate.

RECOMMENDED PRACTICE I

Personnel should demonstrate competency in the use, care, and processing of endoscopes and related equipment.

1. Each facility should develop a system for measuring and documenting personnel competency, (1) Personnel working with endoscopes and endoscopic accessories should demonstrate competency commensurate with their responsibilities. Education programs should be specific to the type and design of endoscopes used and the procedures performed in the facility. Manufacturers' specific instructions for endoscope care and use will be an important component of the education program. Personnel should be required to demonstrate competency periodically and when new endoscopic equipment and/or accessories are introduced into the practice setting. Educational activities should be documented and maintained on file in the facility. (2)

2. Personnel should practice standard and transmission-based/expanded precautions during endoscopy procedures and when handling and processing contaminated endoscopes and related equipment. (3) Standard precautions include the use of personal protective equipment. Personal protective equipment reduces the risk of direct exposure to blood, body fluids, or other fluids that may contain potentially infectious microorganisms. (4)

RECOMMENDED PRACTICE II

Endoscopes and related equipment should be inspected at all stages of handling.

1. Endoscopes and related equipment should be inspected for integrity, function, and cleanliness at the following times:

* before use,

* during the procedure,

* after the procedure,

* immediately after decontamination, and

* before disinfection or sterilization.

Visual inspection helps personnel detect structural damage, loss of function, and/or gross soil that may impact further processing and/or patient outcome. (5)

2. Damaged and/or soiled endoscopes and/or accessories should be removed from service. A damaged instrument that has been used should be considered contaminated and treated accordingly, using the appropriate level of precaution to protect personnel from exposure to potentially harmful microorganisms. (6)

RECOMMENDED PRACTICE III

Endoscopes and related equipment should be tested before use and used according to manufacturers' instructions.

1. Pressure (ie, leak) tests should be performed on used flexible fiber-optic endoscopes with leak testing capabilities before they are immersed in cleaning solutions or water. Leaks in either the covering or one or more of the inside channels can be determined by the presence of air bubbles when air pressure is applied to the inside of the insertion tube. If using a leak test system not requiring water, follow manufacturers' instructions. Unless otherwise specified in manufacturers' instructions, a damaged endoscope should not be submerged. If damage is detected, the endoscope should be removed from service before it is cleaned, and the manufacturer should be consulted for directions regarding further action to be taken. If the pressure test identifies interstitial space damage to a fiber-optic endoscope, the endoscope requires repair. An endoscope being returned to the manufacturer for repair is considered a contaminated medical device and should be labeled accordingly for shipping. The endoscope must be packaged in impervious material and labeled with a biohazard symbol for transport. The biohazard label will act as a warning of potentially infectious material. Refer to Occupational Safety and Health Administration regulations for preventing exposure to bloodborne pathogens for specific information on labeling contaminated equipment being shipped for repair. (7)