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DECONTAMINATION


Market review TEE probe-


Cleaning specific devices


Soluscope Serie TEE


CS Medical Sidem BM-33T Germitec Antigermix E1


Solutions to adapt to automated endoscope washer-disinfectors Steelco Safe Case


Neo-Care Scope Vault


TOE probes, to an automated washer- disinfector (Soluscope Serie TEE).


Important steps The important steps in TOE probe reprocessing are: l Electrical insulation testing: Because of its proximity to the heart, the electrical insulation integrity of the transducer is of paramount concern. Leakage testing not only protects patients from an electrical hazard, it also detects probe damage that may result in a biologic hazard to patients and damage that may significantly shorten the life of the probe.9,13-15


Leakage testing is required between each use by IAC.16


l Cleaning: Timely and meticulous cleaning prior to disinfection is the most important component of decontamination, because it removes the organic and inorganic materials which can interfere with the efficacy of subsequent disinfection.17-21 Whether enzymatic, alkaline or acidic, cleaners need to prevent biofilm formation and/or eliminate existing biofilm.19-30


l Disinfection: TOE is associated with a low rate of patient infection7-10


and should


not occur if the process has been properly validated. Single-shot disinfectants are discarded after each use and are the preferred method.31


The required level of


disinfection or sterilisation is dependent on the intended use of the device: critical items (such as surgical instruments, which contact sterile tissue) require sterilisation; semicritical items (such as TOE probes and endoscopes, which contact mucous membranes) require high-level disinfection; noncritical items (such as stethoscopes, which contact only intact skin) require low-level disinfection.32 Biocidal efficacy must be validated according to EN 13727, EN 13624, EN 14348,


Disinfection


Type of chemicals


User protection


Pre-disinfectant Peracetic acid Single-shot Closed chamber, cleaner


Enzymatic TD100/TEE Clean cleaner Open choice No GTA or OPA no fumes or splashes


Single-shot Open chamber, risk of fumes and splashes


Open choice Reusable UVC radiation Closed chamber, no fumes or splashes 5 min Optional Yes No No 17/27 min 30 min


Electrical Yes


Self-disinfection of Cycle time leakage test washer-disinfector Chemical 14 min


Waterproof casings for probe handle and plug that can be loaded in automated endoscope washer-disinfectors


EN 14476, EN 14561, EN 14562 and EN 14563 and then tested within the automated washer-disinfector according to EN ISO 15883-1 and EN ISO 15883-4 (the latter is optional for automated TOE probe washer-disinfectors but provides extra performance assurance).


l Chemical residuals: TOE probes can remain in the patient for prolonged periods of time. Chemical residuals can cause oesophageal ulceration, odynophagia and dysphagia.33-36


The automated


washer-disinfector manufacturer must set the maximum acceptable residual concentrations and ensure these are not exceeded in the final rinse water.


l Water treatment system and rinse water: Water is used to prepare detergent solutions, to clean instruments and to rinse traces of disinfectant which could be hazardous to patients and staff. Contaminated water can promote growth of biofilm. Automated washer- disinfectors must have a means to provide safe water (filters) and to self-disinfect. The self-disinfection can be thermal or chemical and should be performed daily. The microbiological safety of the rinse water must be monitored regularly through routine sampling, and filters


CS Medical TEE Clean


replaced according to manufacturer-set intervals.37-40


l Personal protection: Due to concerns about glutaraldehyde toxicity and serious health problems to health workers (dermatitis, occupational asthma), more and more centers and even countries are switching from aldehydes to peracetic acid. It is of paramount importance that users are qualified and well trained in operating and maintaining the automated washer-disinfector in conformity with the manufacturer’s instructions. Use suitable personal protective equipment to prevent any biological contamination and/or chemical burns. A study undertaken in endoscopy units working with Soluscope equipment confirmed that exposure to peracetic acid remained far below the maximum recommended levels thanks to the enclosed process.41


Neo-Care Scope Vault 88 l WWW.CLINICALSERVICESJOURNAL.COM l Patient safety: The automated washer- SEPTEMBER 2020


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