Published Dec 13, 2000
Can anyone give me more information regarding the normal standards concerning how a bronchoscope should be sterilised. Is it enough sterilising it with Gluteraldehyde in a basin or should a proper machine be used and for how long should it be left in the solution.
That used to be my job as a ED technician. There should be instructions that come with the scope on how to clean it- but from experience, NO soaking the thing for 20 min will not clean it. Eventually the scope will get clogged with STUFF that wasn't gotten out and then you will be in trouble when the MD can't visualize it. We have two bronchoscopes on a difficutl airway cart. The short one is soaked, the long one we send to the Bronch Lab for disinfection- they take it apart,and get it clean- I don't know how though, every few weeks, if we are using it a lot, we send the short one to the lab as well.
Our bronchoscopes are sterilized in the Olympus DSD same as our colon/gastroscopes. The attachments are a little different. Prior to having the DSD we used the Steris. It's prewashed/brushed just like the scopes.
our bronchoscopes are leak test, brushed, washed externally then flushed serveral times with the cleaning solutions. Then placed in a scope processor where it is wash,disinfected for 45 min.,then rinsed and alcoholed and dried.
We use no cidex!!!!!! If you read, the time necessary to sterilize, it is prohibitive. We are a small OR. We average 25 cases a day. We have 2 video and 2 nonvideo scopes. They are always sterilized before use. Either by ETO or in Steris. By the way the reason that we went with sterilization was that we were using Cidex and had some odd cultures come back from patients. (3 or 4 patients showing the same unusual bacterial infection). We cultured the scopes after cleaning and soaking (In a scope disinfector) and wonder of wonders, the scope was contaminated.
The bottom line is this: All of our patients get a sterile scope(cysto, bronch, gastroscope, colon etc.)
Our hospital put their money where our mouths were. We all have said "If I'm going to have this done, the scope is going to be sterile."
Ours are the same and ENDORNs we use the olympus scope washer for all our endoscopes. The Colon and EGD scopes are on one setting and the bronch is a different setting about a 70 minute cycle (bronch)vs a 40 min cycle (endoscopes). The scopes are leak tested under water then hand cleaned in a sink with kleenzyme and brushes that go down the channels then hooked up in the washer and processed on the cycle that is set for each scope. The washer uses a detergent cycle, metracide cycle ,alcohol cycle and then water cycle. They are then dried and hung in the scope closets that house all of our endoscopes. Bronchoscopes are processed on a longer cycle due to the difficulty with AFB and other Lung bugs that are difficult to kill and since it goes into the lung a higher level of processing is used. Steris is fine as well and I have heard of many places that use steris processing of their scopes.
we have medivators and use gluteralderhyde to disinfect bronchoscopes
the current standard in my state requires a 20 minute wash time in gluteraldehyde. we also heat the gluteralderhyde at around 40 degrees celius which speeds up the cleaning time a little.
i might also add from reading the label on the gluteraldehyde bottle it says that it takes around 7 hours 40 mins to steriles scopes in gluteraldehyde.
there is also the problem of scope material breaking down due to regular steriliation using gas sterilisation, after 2 years scopes that are gased tend to start losing the black rubber off them due to the gasing. :)
teeituptom, BSN, RN
I just send it back to OR and let them clean it
aint life grand
all of our scopes are cleaned per manufacturer standards and then sterilized in the steris system1.
if it were me having a bronchoscopy, i would want a sterile scope. if i ever have a bronchoscopy or if anybody in my family ever does, you can bet i'll be asking how the scope is processed between cases.
the alternative to steris system1 would be gas sterilization in a central supply or spd area.
Isn't it interesting that so many places have so many different ways of doing things. It just says to me that standards are so general and varied there is such a wide interpretation that no really knows what is the best and safest way to do anything! I am constantly floored by our varied practices. Why are there so many different recommendations and practices? Shouldn't it be the same everywhere? How are we to know when we go to a different hospital, outpatient service provider, Dr office or what ever if what they are doing is really an accepted way to do things? No one intentionally provides poor service ( well maybe ) but with that in mind everywhere I have ever worked someone in charge has made the decision about how something is to be done and most of those decisions are made with reccomendations from some other supposidly knowledgable source.(Questioning those decisions in very unpopular and will make your life miserable most of the time so many just don't, and go on to do what everyone else is doing.) We cannot know everything. We have to have some faith in those who have set up the policies that we function under. So many times though we find out that those policies are woefully inadaquate and sometimes dangerous. Why cant we have national standards that directly spell out what is to be done and how it is to be done so everyone who comes to us for help will be getting the same level of safety and care from Maine to California Ie.. this bronchoscope is processed tha same way every bronchoscope is processed throughout the U.S. Then it wouldn't matter where you go the process would be the same and there would be less room for interpretation and a decrease in the level of care. You work someplace and do things the way you are taught to do them and feel that you know what is to be done and how it is to be done. Then you go someplace else and find they do things very differently and it is confusing, who is right, and what is the best way to do something? Sometimes this doesnt matter and the level of care is not in jepordy but other times you find out that the way you were doing things was wrong or you find out the way things are being done now are wrong. How are we to know when there is so much ambiguity and wide latitude for instituting institutional policy and procedure. We all know there is a watering down of standards as they are translated from place to place and person to person. So many of us look down on and scoff at them that they become a joke or a just a pain in our @##. What about the people who are placing their faith in us as professionals to take the very best care of them or their loved one. Sorry to go on. Thanks for letting me vent!
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