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glutaraldehyde.

Use of new disinfectants

The aldehyde disinfectants currently in use are irritant and sensitising but

alternatives that are safer to use may be less effective as disinfectants or may

damage endoscopes and processing equipment. If an alternative to

glutaraldehyde is to be tried, the Working Party endorses the advice given by

Babb and Bradley in 1995 (34). :

1. Inform the instrument and processing equipment manufacturers as use of

an alternative to glutaraldehyde may invalidate guarantees and/or service

contracts. (Most manufacturers are only too willing to assist and may

agree to check instruments and processing equipment periodically for

signs of damage.)

2. Carefully cost the change, bearing in mind the use life of the disinfectant.

3. Ensure that processed items are thoroughly cleaned and that the

manufacturers' stated contact times are achieved unless advice from

professional organisations is available.

4. Establish what is required in terms of COSSH regulations, ie ventilation,

personal protective clothing, and ensure that these are properly costed.

Keep the BSG, the Microbiology Advisory Committee to the Department of

Health, reference centres and disinfectant and instrument manufacturers

informed of your experience, be it favourable or not.

Sterilisation options

Unfortunately flexible endoscopes will not tolerate high processing temperatures

i.e. in excess of 60°C, and cannot therefore be autoclaved or disinfected using

hot water or subatmospheric steam. They may be sterilised, however, by other

means provided they are thoroughly clean and the manufactors' processing

criteria are met. Sterilisation options include :

Ethylene Oxide Low pressure or subatmospheric ethylene oxide sterilisers

operating at temperatures below 60°C are suitable for sterilising most flexible

endoscopes provided an EO venting cap is fitted in accordance with the

manufacturers' instructions and the instrument is suitably packaged or contained.

However, very few hospitals have an ethylene oxide steriliser. the gas is

dangerous and should only be used where suitable equipment, strict

environmental controls and specially trained staff are available. Biological

indicators are required for routine monitoring.

This process is unlikely to be suitable, if a quick turn around of instruments is

required, due to the lengthy periods (1-7 days) required for processing, the

incubation period for indicators and aeration to remove gaseous residuals.

Further advice on this method of sterilisation is contained within the Medical

Devices Agency Guidance on Decontamination of Endoscopes from the

Microbiology Advisory Committee (4).

Gas Plasma This is a highly excited body of gas produced by the application of

energy to a gas under vacuum, making ions and molecules within the plasma

collide to produce free radicles. These interact with microorganisms to disrupt

their function. The most well-known system is Sterrad TM which utilises a low

temperature <50°C) hydrogen peroxide gas plasma. The manufacturers

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