The Difficulty of Reprocessing Reusable Rigid Endoscopic Instruments: Are Disposables the Solution?

Abstract

instruments used during minimally invasive surgery. These reports often request guidance on how to reprocess reusable rigid endoscopie instruments and when disposables are more appropriate to use during an endoscopie procedure, such as laparoscopy or arthroscopy. Determining whether disposable or reusable instruments are more appropriate for your health care institution is often difficult, requiring an analysis of, in particular, three issues: the infection risk to the patient and the health care worker, reliability in performance, and the costs associated with their use. 'Reusable rigid endoscopie instruments have in the past been difficult to clean adequately. However, ECRI recently has examined reusable laparoscopic forceps from several manufacturers. Many of these forceps have been newly designed specifically to facilitate cleaning. These design improvements include a cleaning port for the instrument's shaft, the ability to disassemble the instrument for more thorough cleaning of its shaft with a brush, internal seals to prevent debris and fluids from collecting inside the instrument's shaft, and combining single-or multiple-use disposable jaws (e.g., scissors) with a reusable shaft and handle. The following practices for reprocessing reusable laparoscopic forceps or any other reusable endoscopie instrument after each use should, when performed in accordance with the manufacturer's instructions, minimize the likelihood of patient infection. ' '2 • Place the soiled instrument in warm water or a cleaning solution immediately after use to moisten the soil and prevent blood, mucus, and other debris from drying on the instrument. • When possible, disassemble the instrument as recommended in the operator's manual. • Wash each of the instrument's components in a cleaning solution. If an enzymatic detergent is used, ensure that the detergent is used in accordance with its label. Also, brush each of the instrument's accessible surfaces to remove remaining debris. • Rinse all of the instrument's components thoroughly with water to remove dislodged debris and the detergent solution. • Use an ultrasonic cleaning device containing a detergent solution formulated for use with ultrasonic cleaners to remove particles of debris from areas of the instrument inaccessible to the brush. Ensure that the instrument will not be damaged by the ultrasonic cleaner. • Rinse all of the instrument's components thoroughly with water to remove any remaining debris or detergent residues. • Visually inspect the instrument's components for cleanliness. • Lubricate all of the instrument's moving parts with a lubricant, as recommended by the instrument's manufacturer.*ECRI, formerly known as the Emergency Care Research Institute, in Plymouth Meeting, Pennsylvania, is a nonprofit agency that, among other functions, evaluates medical devices and provides guidance on their safe use.

High-Level Disinfection or “Sterilization” of Endoscopes?

“…12-20,58 Whenever it is impossible to ensure that all of a reused instrument's internal surfaces are cleaned and contacted by the sterilizing agent, disposables should be considered. 26,59,60 The documented safety of HLD notwithstanding, some healthcare facilities still may elect to "sterilize" their endoscopes. Before deciding on a particular sterilization method, several issues should be addressed.…”

Are All Sterilization Processes Alike?

“…Low‐temperature sterilizing processes provide a popular alternative for processing reusable instruments damaged by heat (Figure 1). Disposable instruments should be considered whenever the designs of the reusable instrument preclude assurances that all of their surfaces can be thoroughly precleaned 45 …”