REPROCESSING URETERORENOSCOPE

1. REPROCESSING OF UPPER TRACT ENDOSCOPIC INSTRUMENTS Dr Mayank Mohan Agarwal MS, MRCS(Ed), DNB, MCh (PGI, Chd) VMMF and IAUA Fellowships Uro-Oncology, Pelvic Floor Reconstruction (MSKCC, NY; UCLA, LA; WFUBMC, NC) Formerly, Associate Professor of Urology (PGI, Chd) Formerly, Consultant & Head of Urology (NMCSH, Abu Dhabi) Senior Consultant and Head of Urology Aster Ramesh Hospitals Guntur (AP), India <mayank.mohan@rameshhospitals.com>

2. Introduction • Control of environment • Control of personnel – patient & HCW • Control of equipment • Disinfection / sterilization • Instrument reprocessing – principles

3. Sterilization and disinfection Enveloped viruses Vegetative Bacteria Fungi Mycobacteria Nonenveloped viruses spores Sterilizant + + + + + + HL Disinfectant + + + + + +/- IL Disinfectant + + + + - - LL disinfectant + + +/- - - - Rutala et al. CDC Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008

4. Spaulding Classification

5. Spaulding Classification

6. STEAM STERILIZATION • The best form of sterilization whenever permissible • 1210C 15min • 1340C 5min • Open instruments • Laparoscopic instruments • Modern telescopes • Long channels Flash sterilization – • Not a replacement • Do not pack instruments

7. ETHYLENE OXIDE (ETO) • Sterilizant for moisture and heat sensitive instruments • Gas concentration (450 to 1200 mg/l) • Temperature (37 to 63°C) • Relative humidity (40 to 80%) • Exposure time (1 to 6 hours) • Plastic wrapped stuff • Long channels • Problem – • Flammable • Environmental pollution • Neurotoxic and carcinogenic

8. ETHYLENE OXIDE (ETO) • Sterilizant for moisture and heat sensitive instruments • Gas concentration (450 to 1200 mg/l) • Temperature (37 to 63°C) • Relative humidity (40 to 80%) • Exposure time (1 to 6 hours) • Plastic wrapped stuff • Long channels • Problem – • Flammable • Environmental pollution • Neurotoxic and carcinogenic 125cm length, 3mm diameter – NOT EFFECTIVE 40cm lengh, 1mm diameter - EFFECTIVE

9. STERRAD® : H2O2 plasma • Sterilization of heat sensitive instruments • Temperature <55°C • Exposure time <60 min • Advantage – • Short cycle • Non-toxic effluent • Efficacy against PRION • Disadvantage – • Luminal instruments

12. CHEMICAL IMMERSION Gluteraldehyde O-pthalaldehyde Peracetic acid Level of disinfection HLD HLD HLD / Sterilizant Contact time for HLD 20 - 45 min 10 – 12 min 5 min Contact time for sterilization 10 hours 24 hours 10 min Specialized ventilation Required Required Not required Toxic to environment +++ + - Neutralization 25g/g GLYCINE 25g/g GLYCINE NA Rutala et al. CDC Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008

13. FORMALIN CHAMBER • No standardization • How many pills? May be 10-15 tabs • How frequent changes? May be 7-10 days • How much time? At least 24hrs for disinfection, 96hrs for sterilization • Penetration into lumens – uniformly poor • Pulmonary toxicity • carcinogenicity Suzuki A, Namba Y. Nagoya J Med Sci 1982

14. FORMALIN CHAMBER • No standardization • How many pills? May be 10-15 tabs • How frequent changes? May be 7-10 days • How much time? At least 24hrs for disinfection, 96hrs for sterilization • Penetration into lumens – uniformly poor • Pulmonary toxicity • carcinogenicity Suzuki A, Namba Y. Nagoya J Med Sci 1982

15. INSTRUMENT RE-PROCESSING

16. INSTRUMENT RE-PROCESSING

17. INSTRUMENT RE-PROCESSING • DISMANTLING • PRECLEANING • LEAK TESTING • MANUAL CLEANING • RINSING AND DRYING • DISINFECTION • RINSING AND DRYING • ALCOHOL FLUSH • STORAGE / USAGE

18. • DISMANTLING • PRECLEANING • LEAK TESTING • MANUAL CLEANING • RINSING AND DRYING • DISINFECTION • RINSING AND DRYING • ALCOHOL FLUSH • STORAGE / USAGE INSTRUMENT RE-PROCESSING

22. • DISMANTLING • PRECLEANING • LEAK TESTING • MANUAL CLEANING • RINSING AND DRYING • DISINFECTION • RINSING AND DRYING • ALCOHOL FLUSH • STORAGE / USAGE INSTRUMENT RE-PROCESSING ENZYME SOLUTION

23. • DISMANTLING • PRECLEANING • LEAK TESTING • MANUAL CLEANING • RINSING AND DRYING • DISINFECTION • RINSING AND DRYING • ALCOHOL FLUSH • STORAGE / USAGE INSTRUMENT RE-PROCESSING FLUSH BRUSH

24. • DISMANTLING • PRECLEANING • LEAK TESTING • MANUAL CLEANING • RINSING AND DRYING • DISINFECTION • RINSING AND DRYING • ALCOHOL FLUSH • STORAGE / USAGE INSTRUMENT RE-PROCESSING BRUSH BRUSH

27. • DISMANTLING • PRECLEANING • LEAK TESTING • MANUAL CLEANING • RINSING AND DRYING • DISINFECTION : LIQUID • RINSING AND DRYING • ALCOHOL FLUSH • STORAGE / USAGE INSTRUMENT RE-PROCESSING

28. • DISMANTLING • PRECLEANING • LEAK TESTING • MANUAL CLEANING • RINSING AND DRYING • DISINFECTION : LIQUID • RINSING AND DRYING • ALCOHOL FLUSH • STORAGE / USAGE INSTRUMENT RE-PROCESSING

29. • DISMANTLING • PRECLEANING • LEAK TESTING • MANUAL CLEANING • RINSING AND DRYING • DISINFECTION : GAS • RINSING AND DRYING • ALCOHOL FLUSH • STORAGE / USAGE INSTRUMENT RE-PROCESSING

31. • DISMANTLING • PRECLEANING • LEAK TESTING • MANUAL CLEANING • RINSING AND DRYING • DISINFECTION • RINSING AND DRYING • ALCOHOL FLUSH • STORAGE / USAGE INSTRUMENT RE-PROCESSING AIR FLUSH

33. Conclusion • Instrument mechanical cleaning is A MUST (not an option) • Never forget to FLUSH and BRUSH the channel • Sterilization and HLD is not a substitute of mechanical cleaning • Do not cut corners in immersion time

34. Conclusion • Instrument mechanical cleaning is A MUST (not an option) • Never forget to FLUSH and BRUSH the channel • Sterilization and HLD is not a substitute of mechanical cleaning • Do not cut corners in immersion time

35. Thank you

REPROCESSING URETERORENOSCOPE

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