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automated cleaning and disinfection.

d. If no provision is made to contain or extract irritant vapour, atmospheric

levels may be increased due to displacement of disinfectant laden air

when fluids are pumped or drained from compartments of the machine.

e. The machines, exhaust ventilation and water treatment systems are

expensive to purchase, install and maintain.

f. Excessive dilution of the disinfectant with a subsequent reduction in

potency, may occur due to the carry over of cleansing solution or rinse

wate (44,45).

g. A build-up of disinfectant will occur if the rinse water is reused. This may

transfer toxic residues to the endoscope and cause irritation of the

patient's mucosa or endoscopist's eyes. It is preferable that the rinse

water is not reused.

Some special features or performance characteristics are optional but all

machines should clean, disinfect and rinse all internal channels and external

surfaces of the range of endoscopes used in accordance with local Hospital

Infection Control Committee protocols and/or national guidelines. Instructions

and training should be given by the machine manufacturers on how to connect

the instrument to the washer/disinfector to ensure all channel irrigation. The

machine should be programmable to accommodate the disinfectant contact times

recommended by the disinfectant manufacturers, the Department of Health and

the professional societies such as the BSG. They should have also a cycle time

compatible with the workload of the unit. Other features to consider when

purchasing a machine are:

a. the number of endoscopes which can be processed simultaneously.

b. a cycle counter and fault indicator.

c. a control system for use when the disinfectant produces an irritating or

sensitising vapour. Machines are available which are able to contain

and/or condense irritant vapours or will exhaust them either directly to the

outside or adsorb them onto a carbon filter.

d. a water treatment system which prevents recontamination of processed

instruments during rinsing. Filtration using bacteria retaining filters with a

pore size of 0.2 to 0.45u is satisfactory. The use of filters can create

additional problems and users should be aware of the need for

decontamination of the filtration and water delivery system. Bacteria free

water is preferable but not essential for rinsing of gastrointestinal

endoscopes except when the endoscope is to be used for ERCP.

Bronchoscopes and invasive surgical endoscopes also require bacteria

free water. To prevent the build up of disinfectant residues it is preferable

that the rinse water is dumped at the end of each cycle.

e. a reliable, effective and simple machine disinfection cycle.

f. an air drying facility to expel fluids and dry the channels of the endoscope

at the end of a cycle.

g. a facility to irrigate the channels of the endoscope with alcohol before


h. a leak test facility.

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