Christina Bradley Hospital Infection Research Laboratory Queen Elizabeth Hospital Birmingham, UK

Transcription

1 Christina Bradley Hospital Infection Research Laboratory Queen Elizabeth Hospital Birmingham, UK

2 Inadequate decontamination procedures and equipment malfunction were two leading causes of post endoscopic infection and contamination. More than 91% of the infections could be prevented if quality control systems were improved Kovaleva J et al Clin Microbiol Rev 2013;26(2):231-54

3 Instruments and accessories are expensive Damaged by heat and pressure Complex, difficult to clean and dry Penetration of channels uncertain Disinfectants often toxic, damaging or ineffective Short periods only available for decontamination Automated systems and environmental controls are expensive Rapidly advancing technology

4 Dedicated room Trained staff Defined procedures

5 Dedicated decontamination area with restricted access Separate dirty, clean and storage areas One-way flow for equipment Suitable facilities for manual cleaning Dedicated hand wash basin

6 Dirty Dirty receipt Manual cleaning and leak test Loading of AER/immersion in disinfectant Clean Unloading from AER/removal from disinfectant and rinsing Storage

7 Hand washing Protective clothing gloves, apron, visor Manual cleaning sink Detergent dispenser Sufficient depth and diameter to accommodate the endoscope without excessive coiling Leak test equipment Rinsing sink

8 At point of use Air/water channel External surfaces Suction channel Important to follow manufacturers instructions

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11 At the sink in dedicated decontamination room Brushing Flushing Brushes must be fit for purpose Staff must ensure meticulous adherence to manufacturers instructions for cleaning Access to all channels whether they have been used or not e.g. forceps raiser channel, auxiliary water channel Irrigation of all channels that cannot be brushed

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15 What type of endoscopes are to be processed lumened or non-lumened Capable of processing all endoscopes within the department Single or double door? What chemical disinfectant? Compliant with national standards and guidelines?

16 Compliance with EN ISO and 4 Foot print h, w, d Single door or double door Service requirements power, water, drainage, ventilation Quality of water supply Cycle length

17 Number of endoscopes processed Capacity for larger endoscopes Connectors for all endoscopes Chemicals single or multi use Chemical compatibility with endoscopes Ease of use

18 Workload Per day Distribution during the day Downtime for servicing, testing and breakdowns Time for machine disinfection Cycle length Number of endoscopes per chamber Use of endoscope drying cabinets

19 Hand washing Tables Trolleys Trays Storage/drying cabinets Documentation Hatch

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22 Endoscopes stored vertically and not in suitcases Stored for >3 hours reprocess BSG Guidance (2009) MDA DB 2002(06) Decontamination of Endoscopes Stored in cabinets with a constant flow of clean air through all lumens to keep them dry, the time before reprocessing can be extended to 72 hours or more (individual manufacturer s recommendation).

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24 SINGLE-ROOM DECONTAMINATION AREA The decontamination room should have two entrances/exits. These may be in the form of hatches for the endoscopes and a door for staff: * one hatch or door used for dirty endoscopes returning from the treatment area; and * one hatch or door for the delivery of reprocessed clean endoscopes for the next procedure.

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26 Reduce risk of cross contamination Aerosol production Hand contamination No shared surfaces Reduce risk of using an unprocessed endoscope Direct from procedure room After manual cleaning prior to AER

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31 Ensure sufficient storage for chemicals and other consumables Installation of traceability system to coincide with opening of unit Good communications with endoscope users Correct number of staff but distribution of hours under review

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