DECONTAMINATION
Reprocessing of TOE probes
Cecile Paya provides an insight into the demands of reprocessing trans- oesophageal echocardiogram probes. She argues that automated solutions should be adopted to ensure both the safety of the probe and the safety of the patient.
Reprocessing probes for trans-oesophageal echocardiogram (TOE) probes is a major challenge. Over the past decade, there have been repeated reports of inadequate disinfection in the UK – resulting in cross- contamination1
and even death.2
TOE probes (also known as TEE probes in some other countries) are classified as “semi-critical” (as per the Spaulding Classification) as they are in contact with mucous membrane – thus requiring them to be systematically high level disinfected (HLD) between each patient. So, why has cross-contamination occurred? A possible cause might be linked to the different reprocessing methods still used today.
What are the existing methods for TOE probe reprocessing? 1. Manual reprocessing: Manual reprocessing is soaking then wipes. In the case of manual reprocessing procedures, correct reprocessing and traceability always depends on the person completing the task. Due to the lack of reproducibility for each reprocessing steps, human errors can occur.
2. Semi-automatic: Semi-automatic units have automated some steps of the reprocessing process but keep some manual aspects – such as the cleaning phase or the fact the operator should still pour the chemistry.
3. Automated reprocessing: Issues with manual reprocessing, in particular, prompted the publication of the British
Society of Echocardiography guideline,3 which recommends the use of the safest method available – automated reprocessing. Automated reprocessing methods offer benefits: a. For the user, as there is less handling required and there is no chemistry contact;
b. For the probe, as there is less risk of damage due to handling;
As a semi-critical medical device, the TOE probe should undergo effective cleaning, followed by high level disinfection, which should be validated. There should be an ‘electrical leak test’, for example, coupled with complete traceability.
JUNE 2022
c. For the organisation, as there is an automatic and systematic traceability;
d. The patient – in terms of reduced infection risk.
As a semi-critical medical device, the TOE probe should undergo effective cleaning, followed by high level disinfection, which should be validated. There should be an “electrical leak test”, for example, coupled with complete traceability. The use of a washer-disinfector ensures disinfection is particularly effective, easy to perform and safe for patients and users. It is important to be able to prove proper decontamination has taken place on each given TOE probe – not only for peace of mind and to protect patients, but also in the event of a patient being found to have a blood-borne infection. In such an event, the organisation will have the ability to demonstrate the procedure was not at fault.
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