65--Endoscope Cabinets

Salient Characteristics for Endoscopic Drying and Storage Cabinets 1). Cabinets must be made out of material that can be cleaned and disinfected. 2). Must be VA approved for drying and storage in accordance with VHA Directive 1116-2 3). Endoscopic cabinets must allow scopes to hang freely without touching the sides or bottoms of cabinets. Scopes must not touch when hung or placed vertically. 4). Cabinets should be closed to allow for vented circulation of air to dry endoscopes to eliminate microbial growth. This is a requirement for lumened scopes. 5). These cabinets are currently in use in other VA facilities in VISN 7. VHA Directive 1116-2 VHA Directive 1116 (2), Section 21, p.37 (8) Storage. A closed, vented cabinet that allows air circulation around the endoscopes is required when storing an endoscope with lumens. (a) Endoscopes that have been high-level disinfected are to be hung vertically with the distal tip hanging freely in a clean, well-ventilated, dust-free area. They are to be hung so that no part of the scope touches the bottom of the cabinet and in sufficient space for storage of multiple endoscopes without touching. (b) Endoscope storage cabinets must be cleaned and disinfected on a weekly schedule with a hospital-approved disinfectant. (c) If absorbent material is placed in the bottom of the scope cabinet, it must be changed daily (or more often if needed) on the days scopes are reprocessed. (9) Flexible endoscopes that have been reprocessed in accordance with the manufacturer s IFU, properly dried, and stored by hanging in a clean, closed, and vented cabinet can be used for up to 12 days after reprocessing and storage. Flexible endoscopes that are seldom used and are not reprocessed after 12 days can be segregated in a separate storage cabinet. The cabinet should be labeled to indicate reprocessing is required prior to use of the segregated endoscopes. Any flexible endoscope not used within 12 days must undergo full reprocessing before the next patient use. (10) Each VA medical facility must have a procedure in place that delineates how each flexible endoscope will be tracked through the decontamination, cleaning, and storage phase and then to each patient use ANSI/AAMI ST91 (American National Standard) p.32-33 10 Storage of reprocessed endoscopes 10.1 General Considerations The endoscope should be hung vertically with the distal tip hanging freely in a well-ventilated, clean area, following the endoscope manufacturer s written IFU for storage. For example, make sure that the insertion tube hangs vertically and is as straight as possible (no bends). If the scope has an angulation lock, it should be in the open position while in storage. There should be sufficient space between and around scopes to prevent them hitting into one another, which can cause damage to the scopes. All removable parts (e.g., valves and caps) should be detached from the endoscope. To keep the parts together with the scope, a small bag or similar device can be used to attach the parts to the scope. Rationale: When flexible and semi-rigid endoscopes are hung in the vertical position, coiling or kinking is prevented, allowing any remaining moisture to drain out of the endoscope and decreasing the potential development of an environment conducive to microbial growth in the endoscope. Following recommended storage practices facilitates drying and decreases potential for contamination. All valves and other accessories should be removed in preparation for drying. The scope protector may create an environment favorable for microbial growth if the endoscope is not dry and cannot hang straight (Thomas, 2005; Goldstine, 2005; Bisset et al., 2006). Storing endoscopes with valves or caps on the scope will trap residual moisture in the internal channels and provide optimal conditions for microbial growth. AORN (2015e) recommends that flexible and semi-rigid endoscopes should be stored in a closed cabinet with venting that allows air circulation around the endoscopes, internal surfaces composed of cleanable material, adequate height to allow endoscopes to hang without touching the bottom of the cabinet, and sufficient space for storage of multiple endoscopes without touching. Rationale: A storage area with good ventilation encourages continued air-drying of the surfaces and prevents excessive moisture buildup, thus discouraging microbial contamination. Correct storage of the endoscope will also prevent damage to the exterior of the instrument by protecting it from physical impact. NOTE Some flexible fiberoptic endoscopes require storage with the venting cap (for ethylene oxide) applied. Some models of videoscopes also have venting caps. The manufacturer s instructions for storage of the specific scope in use should be followed. The CDC recommends that a policy and procedure be developed to ensure that end-users know whether a particular endoscope has been cleaned and high-level disinfected or sterilized, because when a user leaves an endoscope on a cart or other surface, the status of the scope (used or unused) might not be clear (CDC, 2008). Develop protocols to ensure that users can readily identify an endoscope that has been processed and is ready for patient use. Attach a tag or label (or other method) to document that the scope has been cleaned or high-level disinfected. The tag or label is affixed to the endoscope after it has been processed and before it is placed in the storage cabinet. For quality assurance, the tag should be labeled with the following information: a) Date of processing b) Name(s) of person(s) who performed the processing c) Date of high-level disinfection Store endoscopes in a manner that will protect them from damage or contamination. Some endoscope storage cabinets feature HEPA-filtered air that is used to provide positive pressure in the cabinet and reduce the incidence of possible bacterial contamination. Some cabinets provide HEPA-filtered air through each endoscope channel, as well as the air in the cabinet itself. The endoscopic personnel need to understand the role moisture plays in contributing to microbial growth after the high-level disinfection process. To help ensure that no moisture is left on or in any part of the endoscope all channels should be flushed with 70 80% alcohol to facilitate drying (see Section 6). All channels should be purged with filtered medical grade air at the correct psi (outlined in the manufacturer s written IFU for that specific scope) (see Section 6). Special storage cupboards or cabinets designed for endoscopes are commercially available that assist the drying process by means of special ventilation methods, using filtered air or container systems. Regardless of whether a special cabinet is used, the temperature and humidity in the area where the scopes are stored should be monitored. 10.2 Storage of high-level disinfected endoscopes Before storage, the channel of the high-level disinfected endoscope should be dry to help prevent bacterial growth and the formation of biofilm. The endoscope should hang in a way to prevent damage to the scope and prevent the formation of moisture. Special care should be taken to avoid coiling of any part of the endoscope to reduce chances of any droplets forming within the channels. Endoscopes should be stored suspended vertically in a way to allow circulation of air. Endoscopes should hang freely. Caps, valves and other detachable components should not be installed on the endoscope during storage. Detachable parts that are to be reused (e.g., air/water and suction valves/pistons) should be processed together and stored with the specific endoscope as a unique set in order to allow traceability. Valves should be dried and lubricated according to the manufacturer s written IFU. Each scope should be identified with a tag or other means so that when it is pulled from storage, the user is able to verify that the scope has been processed and is ready for use.