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REPROCESSING URETERORENOSCOPE

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Infections after ureteroscopy are not uncommon. surprisingly most of such infections are preventable and the reason lies in improper reprocessing of ureteroscope after use. This presentation details principles and stepwise approach to high level disinfection / sterilization of ureterorenoscope.

Published in: Health & Medicine
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REPROCESSING URETERORENOSCOPE

  1. 1. REPROCESSING OF UPPER TRACT ENDOSCOPIC INSTRUMENTS ​Dr Mayank Mohan Agarwal MS, MRCS(Ed), ​DNB, MCh (PGI, Chd) ​VMMF and IAUA Fellowships Uro-Oncology, Pelvic Floor Reconstruction (MSKCC, NY; UCLA, LA; WFUBMC, NC)​ Formerly, Associate Professor of Urology (PGI, Chd) Formerly, Consultant & Head of Urology (NMCSH, Abu Dhabi) Senior Consultant and Head of Urology Aster Ramesh Hospitals Guntur (AP), India <mayank.mohan@rameshhospitals.com>
  2. 2. Introduction • Control of environment • Control of personnel – patient & HCW • Control of equipment • Disinfection / sterilization • Instrument reprocessing – principles
  3. 3. Sterilization and disinfection Enveloped viruses Vegetative Bacteria Fungi Mycobacteria Nonenveloped viruses spores Sterilizant + + + + + + HL Disinfectant + + + + + +/- IL Disinfectant + + + + - - LL disinfectant + + +/- - - - Rutala et al. CDC Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008
  4. 4. Spaulding Classification
  5. 5. Spaulding Classification
  6. 6. STEAM STERILIZATION • The best form of sterilization whenever permissible • 1210C 15min • 1340C 5min • Open instruments • Laparoscopic instruments • Modern telescopes • Long channels Flash sterilization – • Not a replacement • Do not pack instruments
  7. 7. ETHYLENE OXIDE (ETO) • Sterilizant for moisture and heat sensitive instruments • Gas concentration (450 to 1200 mg/l) • Temperature (37 to 63°C) • Relative humidity (40 to 80%) • Exposure time (1 to 6 hours) • Plastic wrapped stuff • Long channels • Problem – • Flammable • Environmental pollution • Neurotoxic and carcinogenic
  8. 8. ETHYLENE OXIDE (ETO) • Sterilizant for moisture and heat sensitive instruments • Gas concentration (450 to 1200 mg/l) • Temperature (37 to 63°C) • Relative humidity (40 to 80%) • Exposure time (1 to 6 hours) • Plastic wrapped stuff • Long channels • Problem – • Flammable • Environmental pollution • Neurotoxic and carcinogenic 125cm length, 3mm diameter – NOT EFFECTIVE 40cm lengh, 1mm diameter - EFFECTIVE
  9. 9. STERRAD® : H2O2 plasma • Sterilization of heat sensitive instruments • Temperature <55°C • Exposure time <60 min • Advantage – • Short cycle • Non-toxic effluent • Efficacy against PRION • Disadvantage – • Luminal instruments
  10. 10. STERRAD® : H2O2 plasma • Sterilization of heat sensitive instruments • Temperature <55°C • Exposure time <60 min • Advantage – • Short cycle • Non-toxic effluent • Efficacy against PRION • Disadvantage – • Luminal instruments
  11. 11. STERRAD® : H2O2 plasma • Sterilization of heat sensitive instruments • Temperature <55°C • Exposure time <60 min • Advantage – • Short cycle • Non-toxic effluent • Efficacy against PRION • Disadvantage – • Luminal instruments
  12. 12. CHEMICAL IMMERSION Gluteraldehyde O-pthalaldehyde Peracetic acid Level of disinfection HLD HLD HLD / Sterilizant Contact time for HLD 20 - 45 min 10 – 12 min 5 min Contact time for sterilization 10 hours 24 hours 10 min Specialized ventilation Required Required Not required Toxic to environment +++ + - Neutralization 25g/g GLYCINE 25g/g GLYCINE NA Rutala et al. CDC Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008
  13. 13. FORMALIN CHAMBER • No standardization • How many pills? May be 10-15 tabs • How frequent changes? May be 7-10 days • How much time? At least 24hrs for disinfection, 96hrs for sterilization • Penetration into lumens – uniformly poor • Pulmonary toxicity • carcinogenicity Suzuki A, Namba Y. Nagoya J Med Sci 1982
  14. 14. FORMALIN CHAMBER • No standardization • How many pills? May be 10-15 tabs • How frequent changes? May be 7-10 days • How much time? At least 24hrs for disinfection, 96hrs for sterilization • Penetration into lumens – uniformly poor • Pulmonary toxicity • carcinogenicity Suzuki A, Namba Y. Nagoya J Med Sci 1982
  15. 15. INSTRUMENT RE-PROCESSING
  16. 16. INSTRUMENT RE-PROCESSING
  17. 17. INSTRUMENT RE-PROCESSING • DISMANTLING • PRECLEANING • LEAK TESTING • MANUAL CLEANING • RINSING AND DRYING • DISINFECTION • RINSING AND DRYING • ALCOHOL FLUSH • STORAGE / USAGE
  18. 18. • DISMANTLING • PRECLEANING • LEAK TESTING • MANUAL CLEANING • RINSING AND DRYING • DISINFECTION • RINSING AND DRYING • ALCOHOL FLUSH • STORAGE / USAGE INSTRUMENT RE-PROCESSING
  19. 19. • DISMANTLING • PRECLEANING • LEAK TESTING • MANUAL CLEANING • RINSING AND DRYING • DISINFECTION • RINSING AND DRYING • ALCOHOL FLUSH • STORAGE / USAGE INSTRUMENT RE-PROCESSING
  20. 20. • DISMANTLING • PRECLEANING • LEAK TESTING • MANUAL CLEANING • RINSING AND DRYING • DISINFECTION • RINSING AND DRYING • ALCOHOL FLUSH • STORAGE / USAGE INSTRUMENT RE-PROCESSING
  21. 21. • DISMANTLING • PRECLEANING • LEAK TESTING • MANUAL CLEANING • RINSING AND DRYING • DISINFECTION • RINSING AND DRYING • ALCOHOL FLUSH • STORAGE / USAGE INSTRUMENT RE-PROCESSING
  22. 22. • DISMANTLING • PRECLEANING • LEAK TESTING • MANUAL CLEANING • RINSING AND DRYING • DISINFECTION • RINSING AND DRYING • ALCOHOL FLUSH • STORAGE / USAGE INSTRUMENT RE-PROCESSING ENZYME SOLUTION
  23. 23. • DISMANTLING • PRECLEANING • LEAK TESTING • MANUAL CLEANING • RINSING AND DRYING • DISINFECTION • RINSING AND DRYING • ALCOHOL FLUSH • STORAGE / USAGE INSTRUMENT RE-PROCESSING FLUSH BRUSH
  24. 24. • DISMANTLING • PRECLEANING • LEAK TESTING • MANUAL CLEANING • RINSING AND DRYING • DISINFECTION • RINSING AND DRYING • ALCOHOL FLUSH • STORAGE / USAGE INSTRUMENT RE-PROCESSING BRUSH BRUSH
  25. 25. • DISMANTLING • PRECLEANING • LEAK TESTING • MANUAL CLEANING • RINSING AND DRYING • DISINFECTION • RINSING AND DRYING • ALCOHOL FLUSH • STORAGE / USAGE INSTRUMENT RE-PROCESSING
  26. 26. • DISMANTLING • PRECLEANING • LEAK TESTING • MANUAL CLEANING • RINSING AND DRYING • DISINFECTION • RINSING AND DRYING • ALCOHOL FLUSH • STORAGE / USAGE INSTRUMENT RE-PROCESSING
  27. 27. • DISMANTLING • PRECLEANING • LEAK TESTING • MANUAL CLEANING • RINSING AND DRYING • DISINFECTION : LIQUID • RINSING AND DRYING • ALCOHOL FLUSH • STORAGE / USAGE INSTRUMENT RE-PROCESSING
  28. 28. • DISMANTLING • PRECLEANING • LEAK TESTING • MANUAL CLEANING • RINSING AND DRYING • DISINFECTION : LIQUID • RINSING AND DRYING • ALCOHOL FLUSH • STORAGE / USAGE INSTRUMENT RE-PROCESSING
  29. 29. • DISMANTLING • PRECLEANING • LEAK TESTING • MANUAL CLEANING • RINSING AND DRYING • DISINFECTION : GAS • RINSING AND DRYING • ALCOHOL FLUSH • STORAGE / USAGE INSTRUMENT RE-PROCESSING
  30. 30. • DISMANTLING • PRECLEANING • LEAK TESTING • MANUAL CLEANING • RINSING AND DRYING • DISINFECTION • RINSING AND DRYING • ALCOHOL FLUSH • STORAGE / USAGE INSTRUMENT RE-PROCESSING
  31. 31. • DISMANTLING • PRECLEANING • LEAK TESTING • MANUAL CLEANING • RINSING AND DRYING • DISINFECTION • RINSING AND DRYING • ALCOHOL FLUSH • STORAGE / USAGE INSTRUMENT RE-PROCESSING AIR FLUSH
  32. 32. • DISMANTLING • PRECLEANING • LEAK TESTING • MANUAL CLEANING • RINSING AND DRYING • DISINFECTION • RINSING AND DRYING • ALCOHOL FLUSH • STORAGE / USAGE INSTRUMENT RE-PROCESSING
  33. 33. Conclusion • Instrument mechanical cleaning is A MUST (not an option) • Never forget to FLUSH and BRUSH the channel • Sterilization and HLD is not a substitute of mechanical cleaning • Do not cut corners in immersion time
  34. 34. Conclusion • Instrument mechanical cleaning is A MUST (not an option) • Never forget to FLUSH and BRUSH the channel • Sterilization and HLD is not a substitute of mechanical cleaning • Do not cut corners in immersion time
  35. 35. Thank you

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