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themselves or their employers.

Biopsy forceps which have a spiral construction and other accessories which are

difficult to clean by hand should be ultrasonically cleaned and rinsed prior to

autoclaving or disinfection. Other accessories requiring disinfection, including the

cleaning brushes themselves, should be cleaned in detergent using a soft brush

before disinfection.

Protection of Personnel

It is essential that endoscopy staff have the correct personal protective

equipment available at all times and are trained in its use (Table II). Each

endoscopy unit must have a policy for dealing with disinfectant spillage and all

staff must be trained in its implementation. There should always be sufficient

numbers of trained staff and items of equipment to allow enough time for

thorough cleaning and disinfection to take place. Training of staff in these

aspects of their work is vital.

Table 2

Personnel Protection in Endoscopy

1. Wear disposable waterproof aprons. These should be discarded if soiled

with disinfectant.

2. Use nitrile gloves which are long enough to protect the forearms from

splashes. These should be changed regularly because they absorb


3. Goggles prevent conjunctival irritation and protect the wearer from


4. Disposable charcoal-impregnated face masks may reduce inhalation of

vapour from disinfectants, but experience with them is not yet widespread.

5. An HSE-approved vapour respirator should be available in case of spillage

or other emergencies. It should be stored away from disinfectants as the

charcoal adsorbs fumes and respirators should be regularly replaced.

Staff Health

All staff using or coming into contact with glutaraldehyde should be included in a

health screening programme which comprises:

-Pre-employment enquiry regarding asthma, skin and mucosal symptoms, such

as rhinitis and conjunctivitis, and lung function testing by spirometry.

-Annual lung function tests by spirometry.

-Annual completion of a health questionnaire.

-Immediate notification of skin rashes, chest and sinus problems.

-Records must be kept for 30 years.

It is recommended that this policy is extended to include other disinfectants used

in endoscopy because hazards associated with the alternatives are largely

unknown. In addition, although endoscopy is not a designated 'exposure prone

procedure' (personal communication, Chief Medical Officer) it is strongly advised

that all staff involved in endoscopic practice should be vaccinated against

hepatitis B. Other recommendations relating to risk of needle stick injury and

hazards relating to open cuts, abrasions and other skin lesions, reported by the

previous Working Party, remain unchanged.

We wish to thank Mr Phil Gifford of the Health and Safety Executive for his

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