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endoscope can be disinfected in an automated washer/disinfector. If this

process is done manually, steps 3 and 4, described previously under 'At

the start of the day', should be followed. Once completed all channels

must be rinsed with bacteria-free water in the same manner. Air may be

blown through the channels at this stage to expel excess fluids which

might otherwise dilute the disinfectant (44,45).

9. The endoscope is now ready for disinfection. The instrument must be fully

immersed in disinfectant for the correct contact time, ensuring that all

channels are filled with disinfectant. A timer will ensure immersion times

are correct.

10. The instrument is rinsed as in steps 7 and 8 'At the start of the day'.

11. The relevant work surfaces, such as the top of the endoscopy trolley,

should be wiped clean between patients, usually with an alcohol wipe, in

accordance with local hospital policy. Once the endoscope has been

disinfected, rinsed and dried, fresh valves should be inserted and the

instrument placed on the clean surface ready for use.

Cleaning and Disinfection of endoscopes: after the last case

1. Endoscopes used during the list should be leak-tested, cleaned and

disinfected. When 2% glutaraldehyde is used the contact time should be

20 minutes, while for peracetic acid and chlorine dioxide this should be for

5 minutes.

2. Endoscopes should be dried before storage. Seventy per cent alcohol

may be aspirated through the channels to assist drying. Thorough drying

reduces the risk of subsequent microbial proliferation.

3. Endoscopes should then be stored hanging vertically in a designated

ventilated cupboard, not in their transit cases.

4. All valves used during the list should, after disinfection and rinsing, be

dried with a cotton wool bud and lubricated with silicone oil as instructed

by the manufacturer. They should not be replaced in the endoscope case

for storage

Cleaning and Disinfection of Accessories

Accessories require the same attention to detail. Some accessories are single

use and, where access for cleaning is difficult or the item is heat sensitive, their

use should be encouraged. Cytology brushes, polypectomy snares, injection

needles and some ERCP accessories may be purchased as single use The risk

of transfer of infection by re-using possibly contaminated items must be weighed

against the cost of single-use accessories Many accessories are autoclavable

and their use should be encouraged; these include water bottles, biopsy forceps,

dilators and guidewires. During ERCP, disposable accessories should be used

whenever possible or if reusable there should be sufficient autoclavable

accessories to allow one per case with no requirement to disinfect during a list.

The Medical Devices Agency Bulletin DB 9501 advises on potential hazards,

both clinical and legal, associated with reprocessing and reusing medical devices

intended for single use (46). Users who disregard this information, and prepare

single use items for re-use without due precautions, may be transferring legal

liability for the safe performance of the product from the manufacturer to

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