Stage 2 High Level Disinfection

During this second reprocessing stage, the endoscope is exposed to a LCS to achieve high-level disinfection. This stage, which can be performed either manually or using an AER, destroys potentially pathogenic microorganisms that may remain on the endoscope after cleaning. Immersing the entire endoscope in the LCS and flushing each of its channels with the LCS is necessary to achieve high-level disinfection. If reused, it is important that the LCS be periodically monitored (ie, once a day or more often) using test strips to ensure its concentration has not dropped below the level required to achieve high-level disinfection. Because some LCSs are not effective at room temperature, their temperature may also have to be elevated and monitored. In addition, the amount of time the endoscope is immersed in the LCS requires monitoring to achieve highlevel disinfection. Whereas too short an immersion time can result in cross-infection due to ineffective high-level disinfection, too long an immersion time can also result in serious patient complications and adverse reactions. Some instruments, such as the probes used during trans-esophageal echocardiography, may be constructed of materials that, if immersed in the LCS for a period of time longer than indicated to achieve high-level disinfection, can absorb and retain residues of the LCS that are not easily rinsed off with water and can be toxic to the patient.

After high-level disinfection, the endoscope is rinsed with a large volume of clean water. Most LCSs recommend that the endoscope be rinsed using three separate water rinses to thoroughly remove any remaining chemical residue following high-level disinfection. Whereas during manual reprocessing, tap water or bottled sterile water may be used for rinsing, during automated reprocessing, the AER typically rinses the endoscope with water that has been filtered through a 5.0 | sediment prefilter and a 0.2 | bacterial postfilter. Although often overlooked, the quality of the rinse water is crucial to the outcome of the reprocessing procedure. Contaminated rinse water can result in contaminated endoscopes, despite effective high-level disinfection. Because of the significance of the quality of the rinse water, it has been recommended that the rinse water be microbiologically monitored to prevent recontamination of the endoscope, after high-level disinfection, with waterborne bacteria and atypical mycobacteria that could be transmitted to the patient during GI endoscopy. Refer to the endoscope manufacturer's instructions and published guidelines for the specific steps that are required for high-level disinfection, and proper rinsing of the endoscope, its channels, and its removable components.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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