Stage 3 Drying

The third and final stage of an effective endoscope reprocessing procedure is as essential to the prevention of patient infection as cleaning and high-level disinfection. Drying can be easily and inexpensively achieved by flushing the endoscope's channels with 70% alcohol (to facilitate drying), followed by forced air. Like a plugged drinking straw, endoscope channels can retain rinse water after reprocessing, providing the ideal environment for waterborne microorganisms to colonize during storage. The transmission of waterborne bacteria via inadequately dried GI endoscopes has been reported. After drying, the endoscope is hung vertically with its valves and biopsy cap removed, to prevent moisture buildup and to permit ventilation of its internal channels. Proper storage of the endoscope in a dry and dust-free environment is recommended. Refer to the endoscope manufacturer's instructions and published guidelines for the specific steps that are required to dry and properly store the endoscope, its channels, and its removable components.

LCSs

There are several LCSs currently on the market that are indicated for reprocessing flexible GI endoscopes. In general, LCSs are sterilants during long exposure times (8 to 10 hours), but achieve high-level disinfection during shorter immersion times of 5 to 20 minutes. As a sterilant, an LCS is capable of destroying high numbers of bacterial spores, an important factor that distinguishes sterilization from high-level disinfection. It is important to note that

TABLE 4-1. A List of Some of the Liquid Chemical Sterilants/Disinfectants Used to Reprocess Flexible Gastrointestinal Endoscopes in the United States

Product

(Active Ingredient)

Manufacturer

Trade Name

Sterilant Contact Conditions

High-Level Disinfectant Contact Conditions

Maximum Days of Reuse

0.55% ortfiophthalaldehyde Advanced Sterilization Products

Cidex OPA Solution High Level Disinfectant

No indication for sterilization (Passes the AOAC Sporicidal Activity Test in 32 hours at 20°C and 25°C.)

Manual processing: 12 minutes at 20°C

AER: 5 minutes at 25°C

14 14

Hypochlorite 650 - 675 parts per million of active free chlorine

Sterilox

Technologies, Inc.

Sterilox Liquid High Level Disinfectant System

No indication for sterilization (Passes the modified AOAC Sporicidal Activity Test in 24 hours at 25°C

10 minutes at 25°C.

Single use

1.12% glutaraldehyde, 1.93% phenol/phena

Sporicidin International

Sporicidin Sterilizing and Disinfecting Solution

12 hours at 25°C

20 minutes at 25°C

14

2.5% glutaraldehyde

MediVators, Inc.

Rapicide High Level Disinfectant and Sterilant

7 hours 40 minutes at 35°C

AER: 5 min at 35°C

28

7.35% hydrogen peroxide, 0.23% peracetic acid

Cottrell Limited

EndoSpor Plus Sterilizing and Disinfecting Solution

3 hours at 20°C

15 minutes at 20°C

14

7.5% hydrogen peroxide

Reckitt & Colman Inc.

Sporox Sterilizing and Disinfecting Solution

6 hours at 20°C

30 minutes at 20°C

21

1.0% hydrogen peroxide, 0.08% peracetic acid

Minntech Corporation

Peract 20 Liquid Sterilant/ Disinfectant

8 hours at 20°C

25 minutes at 20°C

14

2.4% glutaraldehyde

Advanced Sterilization Products

Cidex Activated Dialdehyde Solution

10 hours at 25°C

45 minutes at 25°C

14

2.6% glutaraldehyde

Metrex Research, Inc.

Metricide Activated Dialdehyde Solution

10 hours at 25°C

45 minutes at 25°C

14

2.5% glutaraldehyde

Wave Energy Systems

Wavicide -01

10 hours at 22°C

45 minutes at 22°C

30

0.2% peracetic acide

STERIS Corporation

Steris 20 Sterilant

No indication for highlevel disinfection

12 minutes at 50-56°C

Single use

Refer to the Food and Drug Administration's (FDA) website for a complete list of liquid chemical sterilants/disinfectants cleared by the FDA as of March 2003: http://www.fda.gov/cdrh/ode/germlab.html. AER = automated endoscope reprocessors; AOAC = Association of Official Analytical Chemists.

Refer to the Food and Drug Administration's (FDA) website for a complete list of liquid chemical sterilants/disinfectants cleared by the FDA as of March 2003: http://www.fda.gov/cdrh/ode/germlab.html. AER = automated endoscope reprocessors; AOAC = Association of Official Analytical Chemists.

no clinical differences between processes that achieve highlevel disinfection of GI endoscopes (and bronchoscopes) and those labeled to achieve sterilization, such as ethylene oxide gas, have been demonstrated. In the endoscopic setting, the clinical outcomes of high-level disinfection and sterilization, although academically distinguished from one another, are virtually identical. As a result, health care facilities that use high-level disinfection on GI endoscopes while sterilizing surgical instruments are not practicing two standards of care. Each LCS on the market is associated with its own unique set of advantages and disadvantages. Factors to consider when selecting a LCS include its exposure time and temperature required to achieve high-level disinfection, its environmental friendliness or associated hazards (eg, bad odor, irritating vapors, or the need for neutralization before disposal), its ease of use, its documented compatibility with the endoscope (and, if used, the AER), its use/reuse life, its tendency to stain the endoscope, its required number of water rinses, and its initial cost and cost per cycle.*

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