Duodenoscope Cleaning and Disinfection Checklist

Pre-Cleaning 1. 2. 3.

Demonstrated

Wear appropriate Personal Protective Equipment (PPE). Turn OFF the Video processor and light source. Prepare a clean 1,000 ml container of water.

4.

Wipe down the insertion tube with a water-soaked lint-free cloth or sponge. Wipe from the boot at the control section toward the distal end.

5.

Lower the forceps elevator by turning the elevator control lever.

6.

Turn ON the suction source and ensure the biopsy valve cap is closed.

7.

Immerse the distal tip in water and depress the suction valve to aspirate the water for 30 seconds.

8.

While continuing the immersion and the aspiration, raise and lower the forceps elevator three times, by turning the elevator control lever.

9.

Remove distal tip from the water. Depress the suction valve, and aspirate air for 10 seconds.

10.

Turn OFF the suction source.

11.

Remove the air/water valve and attach the air/water cleaning adapter.

12. 13.

Turn ON the light source turn and set the air flow to HIGH.

14.

Depress the air/water channel cleaning adapter, and flush water for 30 seconds.

15.

Release the air/water channel cleaning adapter button to flush air for 10 seconds.

16. 17.

Turn OFF the light source.

18.

Confirm that the water-resistant cap is dry and free of debris, and attach the water-resistant cap.

19.

Transport to reprocessing area in a covered container.

Immerse the distal tip in clean water.

Disconnect all removable and reusable parts from the endoscope.

Comments:

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Leakage Testing

Demonstrated

1.

Fill a basin with clean water.

2.

Detach air/water channel cleaning adapter, suction valve and biopsy valve from the endoscope.

3. 4. 5.

Connect the leakage tester to the MU-1. (Maintenance Unit).

6.

Confirm that the leakage tester’s connector cap and venting connector are dry. If wet, dry with a lint free cloth.

7.

Connect the leakage tester to the endoscope. Ensure the bending section has inflated.

8.

Completely immerse the endoscope in water.

9

Observe for 30 seconds while angulating the bending section in all directions.

Turn ON the MU-1. Depress the pin inside connector cap to confirm air is being emitted.

and Lower the forceps elevator by moving the endoscope’s 10. Raise elevator lever 3 times, checking for a potential leak.

11.

If a continuous series of bubbles emerges from any location, remove the endoscope from the water, and contact Olympus for further instructions.

no leak is detected, remove the endoscope from the water and turn 12. IfOFF the MU-1.

13. Disconnect the leakage tester from the MU-1. 30 seconds, or until the bending section contracts to its pre14. Wait expansion size. the leakage tester connector cap from the venting 15. Disconnect connector.

16. Thoroughly dry the leakage tester by using a clean, lint-free cloth. Comments:

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Manual Cleaning

Demonstrated

1.

Fill a basin with fresh detergent solution prepared as recommended by the manufacturer.

2.

Completely immerse the endoscope in the detergent solution.

3.

Use a soft brush, lint-free cloth, or sponge to thoroughly clean all external surfaces, paying attention to the air/water nozzle opening and the objective lens on the distal end of the insertion section, and ensure that all surfaces of the distal end are thoroughly cleaned

4.

Lower the forceps elevator by turning the elevator control lever in the opposite direction of the “◄U” direction until the forceps elevator stops.

5.

Straighten the bending section of the endoscope. Brush the forceps elevator, including the guide wire-locking groove and the forceps elevator recess, with the single-use channel-opening cleaning brush (e.g. BW-412T) as follows:

a. Insert the brush into the forceps elevator recess along the forceps elevator until the brush handle touches the distal end of the endoscope and pull the brush out the forceps elevator recess. Repeat the insertion and pulling out three times.

b. Brush the guide wire-locking groove.

6.

Raise the forceps elevator by turning the elevator control lever in the “◄U” direction until the forceps elevator stops.

7.

While holding the distal end, brush the forceps elevator and the forceps elevator recess with the single-use channel-opening cleaning brush (e.g. BW-412T) as follows:

a. Insert the brush into the forceps elevator recess along the back of the forceps elevator until the distal end of the brush touches the bottom of the forceps elevator recess and pull the brush out of the forceps elevator recess.

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b. Insert the brush into the forceps elevator recess, rotate the brush one full revolution.

c. Pull the brush out of the forceps elevator recess.

8.

Operate the elevator control lever to raise and lower the forceps elevator in the detergent solution three times.

9.

Clean the bristles of the brush in detergent solution by using your gloved fingertips to remove any debris.

the forceps elevator by turning the elevator control lever in the 10. Lower opposite direction of the “◄U” direction until it stops.

11.

Brush the distal end of the endoscope, except the forceps elevator and the forceps elevator recess, by using the single use channelopening cleaning brush (BW-412T) until no debris is observed upon inspection of the endoscope.

endoscope model-specific brushes to brush 12. Use channels/cylinders/ports until no visible debris remains.

a. Brush the instrument/suction channel in the insertion tube: 1. Insert the channel-cleaning brush at 45 angle into the opening located at the side wall of the suction cylinder. 2. Using short strokes, feed the brush through the suction channel until it emerges from the distal end of the endoscope. 3. Remove any debris from the bristles with your fingertips and carefully pull the brush back through the sution channel. 4. Clean the brush bristles with your fingertips to remove any debris. 5. Repeat until no debris is observed on the brush.

b. Brush the suction channel in the universal cord: 1. Insert the channel-cleaning brush straight into the suction cylinder. 3 Acacia Place, Notting Hill. VIC 3168 PO Box 985 Mt Waverley. VIC 3149 Phone: 1300 132 992 Fax: 03 9543 1350 Web: www.olympusaustralia.com.au ABN 90 078 493 295

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2. Using short strokes, feed the brush through the suction channel until it emerges from the suction connector on the endoscope connector. 3. Remove any debris from the bristles with your fingertips and carefully pull the brush back through the suction channel. 4. Clean the brush bristles with your fingertips to remove any debris. 5. Repeat until no debris is observed on the brush.

c. Brush the suction cylinder. 1. Insert the channel-opening cleaning brush into the suction cylinder until half the brush section is inserted. 2. Rotate the brush one full revolution and pull the brush out of the suction cylinder. 3. Remove any debris on the brush bristles with your fingertips and clean the brush in the detergent solution. 4. Repeat until no debris is observed on the brush.

d. Brush the instrument channel port. 1. Insert the channel-opening cleaning brush into the channel port fully until the brush handles touches the channel opening. 2. Rotate the brush one full revolution and pull the brush out of the instrument channel port. 3. Remove any debris on the brush bristles with your fingertips and clean the brush in the detergent solution. 4. Repeat until no debris is observed on the brush.

13. Remove the endoscope from the detergent solution. 14. Attach the suction cleaning adapter to the instrument channel port. the suction tube from the suction source to the suction 15. Connect connector on the endoscope.

16. Turn ON the suction source. 17. Confirm that the forceps elevator is lowered. the distal end and weighted end of suction cleaning adapter 18. Immerse in detergent. distal end of endoscope and distal end of suction cleaning 19. Ensure adapter remain in detergent solution. the suction cylinder with your gloved finger, and aspirate 20. Cover detergent solution for approximately 30 seconds. continuing the immersion and aspiration, raise and lower 21. While forceps elevator at least 3 times by turning the elevator control lever.

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22. Turn OFF the suction source. 23. Detach the suction tube and the suction cleaning adapter. 24. Brush the forceps elevator recess. a. Confirm that the forceps elevator is lowered and straighten the bending section of the endoscope.

b. Brush the forceps elevator and the forceps elevator recess with the single-use soft brush (MAJ-1888), keeping the distal end of the endoscope immersed in the detergent solution.

c. Brush the guidewire locking grove with 3 strokes. d. Brush both groves with 3 strokes. e. Clean the bristles of the brush gently with your fingertips in the detergent solution.

f. Raise the forceps elevator by turning the elevator control lever in the “◄U” direction until the forceps elevator stops.

g. Brush the whole back side of the forceps elevator with the brush (MAJ-1888) three times, keeping the distal end of the endoscope immersed in the detergent solution.

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h. Clean the bristles of the brush gently with your fingertips in the detergent solution.

i. Insert the brush head slowly into the groove under the forceps elevator until the end of the brush touches the wall behind the elevator.

j. While keeping the distal end of the endoscope immersed in the detergent solution, rotate the inserted brush three revolutions while ensuring that the end of the brush contacts the wall behind the forceps elevator.

k. Pull the brush out slowly and gently clean the bristles in the detergent solution with your fingertips.

l. While immersing the distal end in detergent solution, operate the elevator control lever to raise and lower the forceps elevator three times. With forceps elevator raised, use the tip of the syringe to flush interior of forceps elevator with 30mls of detergent solution.

25.

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Lower the forceps elevator by turning the elevator control lever. Insert the tip of the 30ml syringe into the interior the forceps elevator recess in the detergent solution, flush the interior recess with 30mls of the detergent solution

26. **Note: When you use a luer-lock type syringe, the tip of the

syringe may not fit into the interior of the forceps elevator recess. In this case, hold the tip of the syringe over the interior of the recess while the syringe contacts the surface of the endoscope. steps 24i through 26 (note steps 24a through 24h do not need 27. Repeat to be repeated).

28.

While raising and lowering the forceps elevator, inspect the forceps elevator and the forceps elevator recess for any debris. Repeat brushing and/or flushing the elevator and the elevator recess all debris is gone.

29. Dispose of the brush in an appropriate manner. Comments:

Manual Cleaning Manual Flushing of Endoscope Channels 1.

Attach the channel plug to the air/water ad suction cylinders, and the biopsy valve cap to the instrument channel port.

2.

Attach the injection tube to the endoscopic connector.

3.

Immerse the suction port of the injection tube into the detergent solution.

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Demonstrated

4. 5.

Attach a 30 ml syringe to the air/water port of the injection tube.

6.

While the endoscope is immersed in detergent solution, wipe external surfaces of the endoscope/accessories with a lint-free cloth.

7.

Soak the endoscope and accessories in detergent solution for the time specified by the detergent manufacturer.

8.

Remove the endoscope and accessories from the detergent solution.

9.

Immerse the endoscope and accessories in clean water, and gently agitate to thoroughly rinse.

Flush the air/water channel with 90 mls detergent.

10. Immerse the suction port of the injection tube in the water. 90mls of water through each side of the injection tube with a 11. Flush clean 30ml syringe.

12. Remove the endoscope and equipment from the water. the endoscope in a clean basin and cover the distal end and 13. Place control section with a clean, lint- free cloth to prevent splashing. a 30ml syringe, flush each side of the injection tube with 90mls 14. Using of air.

15. Remove the cloth from the distal end. 16. Disconnect the channel plug and injection tube from the endoscope. a clean, lint-free cloth to dry all external surfaces, channel plug, 17. Use and injection tube. all items for residual debris. If any debris remains, repeat the 18. Inspect entire cleaning process until it is removed. the accessories as described in the Olympus 19. Reprocess Reprocessing Manual, Chapter 6, Reprocessing the Accessories.

Comments:

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Automated Endoscope Reprocessor (AER) High-Level Disinfection

Demonstrated

**Note: Prior to disinfection in the AER, raise the forceps elevator to the intermediate position.

1.

Test the disinfectant concentration (i.e., MRC) according to the manufacturer's instructions.

2.

Inspect the connections according to the AER manufacturer's instructions.

3.

Attach the endoscope connectors/adapters to the AER and endoscope as per the AER manufacturer's instructions.

4.

Operate the AER according to the AER manufacturer's instructions.

5.

Ensure the endoscope is soaked in disinfectant solution according to the disinfectant manufacturer's recommendations for time and temperature.

6.

Remove the endoscope promptly after the AER cycle is completed.

7.

Perform the terminal steps that the AER does not perform (e.g., alcohol and air purge).

FOR FACILITY INTERNAL USE ONLY! Olympus personnel are unable to demonstrate use of individual manufacturer's AER.

Comments:

Manual High-Level Disinfection **Note: Prior to manual disinfection, raise the forceps elevator to the intermediate position.

1.

Fill a basin with disinfectant solution.

2.

Test the disinfectant concentration (i.e. MRC) according to the manufacturer's instructions.

3.

Attach the channel plug and injection tube to the endoscope.

4.

Completely immerse the endoscope and equipment in disinfectant solution.

5.

Confirm that the suction port of the injection tube is immersed in the disinfectant solution.

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Demonstrated

6.

Use a 30 ml syringe to forcefully inject 180mls of the disinfectant into each side of the injection tube and confirm that no air bubbles exit the distal tip.

7.

Remove the biopsy valve cap of the channel plug from the instrument channel port of endoscope (leaving the channel plug attached to the air/water and suction cylinders of the endoscope).

8.

Use a 30ml syringe to forcefully inject 180mls of the disinfectant solution by using the 30 ml syringe.

9.

Confirm that no air bubbles exit the distal end of the endoscope’s insertion section during the sixth flush.

air bubbles still exit, flush the channel with the disinfectant solution 10. Ifuntil no air bubbles exit. the forceps elevator raised, insert the tip of the 30ml syringe into 11. With the interior of the forceps elevator recess in the disinfectant solution.

12. Flush the interior of the recess with 60 mls of the disinfectant solution. 13.

Lower the forceps elevator by turning the elevator control lever. Insert the tip of the 30ml syringe into the interior the forceps elevator recess in the disinfectant solution.

14. Flush the interior of the recess with 60mls of the disinfectant solution. 15.

Turn the elevator control lever to raise and lower the forceps elevator three times, keeping the distal end of the endoscope immersed in the disinfectant solution.

a 30ml syringe to forcefully inject 90mls of the disinfectant 16. Use solution into the instrument channel. flush at least three times, minimizing disinfectant solution 17. Forcefully leakage from the port. that no air bubbles exit the distal end of the endoscope's 18. Confirm insertion section during the third flush. air bubbles still exit, flush the channel with the disinfectant solution 19. Ifuntil no air bubbles exit.

20. Repeat Steps 11 through 19. the equipment and endoscope are immersed in disinfectant, 21. While disconnect all equipment from the endoscope. any bubbles that adhere to the surfaces with a gloved finger 22. Remove or a clean lint-free cloth. the basin of disinfectant solution. with a tight-fitting lid to 23. Cover minimise the diffusion of disinfection vapors endoscope and equipment for the time and at the temperature 24. Soak recommended by the disinfectant manufacturer.

25. Reconnect the channel plug and injection tube to the endoscope. the suction port of the injection tube from the disinfectant 26. Remove solution. a 30 ml syringe to each port on the injection tube, and flush 27. Attach with 90 ml of air. 3 Acacia Place, Notting Hill. VIC 3168 PO Box 985 Mt Waverley. VIC 3149 Phone: 1300 132 992 Fax: 03 9543 1350 Web: www.olympusaustralia.com.au ABN 90 078 493 295

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the endoscope with attached accessories from the 28. Remove disinfection solution.

Comments:

Rinsing after Manual High-Level Disinfection 1. 2. 3. 4. 5. 6.

Fill a basin with sterile water, filtered water, or tap water.

7.

Use a 30 ml sterile syringe to inject 90mls of water through each side of the injection

8.

Raise the forceps elevator by turning the elevator control lever. Insert the tip of the 30ml syringe into the interior of the forceps elevator recess in the rinse water and flush the interior of the recess with 30mls of the rinse water.

9.

Lower the forceps elevator by turning the elevator control lever. Insert the tip of the 30ml syringe into the interior the forceps elevator recess in the rinse water and flush the interior of the recess with 30mls of the rinse water.

10.

Turn the elevator control lever to raise and lower the forceps elevator three times, keeping the distal end of the endoscope immersed in the rinse water.

11.

Repeat Steps 7 through 10 above for the necessary number of times, following the rinsing method described in the disinfectant solution manual.

Completely immerse the endoscope and equipment in the water. Detach the channel plug and injection tube from the endoscope. Wipe all external surfaces with a lint-free cloth. Attach the channel plug and injection tube to the endoscope. Immerse the suction port of the injection tube in the rinse water.

turning the elevator control lever, put the forceps elevator in 12. By intermediate position of the range of movement. the endoscope and equipment from the rinse water and 13. Remove place them in a sterile basin.

14. Cover the distal tip with a sterile, lint-free cloth. a 30 ml syringe to inject 90mls of air through each side of the 15. Use injection tube.

16. Remove the cloth from the endoscope. 3 Acacia Place, Notting Hill. VIC 3168 PO Box 985 Mt Waverley. VIC 3149 Phone: 1300 132 992 Fax: 03 9543 1350 Web: www.olympusaustralia.com.au ABN 90 078 493 295

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Demonstrated

17. Detach only the injection tube from the endoscope. a sterile suction tube from the suction pump to the suction 18. Attach connector on the endoscope connector.

19. Turn ON the suction source. 20. Aspirate air for at least 15 seconds. continuing the aspiration, raise and lower the forceps elevator 21. While three times, by turning the elevator control lever.

22. Turn OFF the suction pump. 23. Detach the suction tube and the channel plug from the endoscope all external surfaces with a sterile, lint-free cloth to thoroughly 24. Wipe dry the endoscope. Using sterile cotton swabs, dry the inside of the suction cylinder, air

cylinder, the instrument channel port, and the forceps 25. air/water elevator recess.

Comments:

Alcohol Flush

Demonstrated

1.

Fill a small sterile basin with the alcohol.

2.

Attach a reprocessed channel plug and injection tube to the endoscope.

3.

Immerse suction port of injection tube in 70% isopropyl or ethyl alcohol.

4.

Cover the distal end and control section with a sterile lint-free cloth to prevent splashing.

5.

Attach a sterile 30 ml syringe to the suction channel port of the injection tube and flush the suction channel with 90mls of the alcohol, i.e., pump the syringe at least three times.

6.

Move the syringe to the air/water channel port of the injection tube and flush the air/water channel with 30ml of the alcohol.

7.

Raise the forceps elevator by turning the elevator control lever. Insert the tip of the 30mls syringe under the covering cloths and into the interior of the forceps elevator recess and flush the interior of the recess with 30mls of alcohol.

8.

Lower the forceps elevator by turning the elevator control lever. Insert the tip of the 30 ml syringe under the covering cloths and into the interior of the forceps elevator recess and flush the interior of the recess with 30mls of the alcohol.

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9.

Turn the elevator control lever to raise and lower the forceps elevator three times.

10. Remove the suction port from the alcohol. a 30 ml syringe to inject 90mls of air through each side of the 11. Use injection tube.

12. Remove the cloth(s) from the endoscope. 13. Disconnect all equipment from the endoscope. dry the external surfaces of the endoscope, the channel 14. Thoroughly plug, and the injection tube, by wiping with a sterile, lint-free cloth. sterile cotton swabs to dry the inside of the air/water and suction 15. Use cylinders, forceps recess, and instrument channel port.

Comments:

Sterilisation

Demonstrated

1.

Flush and dry all channels of the endoscope, the channel plug, and the injection tube, according to the “Alcohol Flush” instructions.

2.

Wipe and dry all external surfaces of the endoscope and accessories by using a sterile, lint-free cloth(s) moistened with alcohol.

3.

Thoroughly dry the inside of the suction cylinder, the air/water cylinder, the forceps elevator recess, and the instrument channel port of the endoscope by using a sterile cotton swab(s).

4.

Detach the water-resistant cap from the electrical connector.

5.

Seal the endoscope and accessories in individual packaging appropriate for ethylene oxide gas sterilisation, according to your institution’s protocol.

6.

Sterilise and aerate the packaged endoscope and accessories according to the parameters described in the reprocessing manual. In addition, always comply with the instructions of the steriliser manufacturer.

Comments:

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Endoscope Storage 1.

Demonstrated

Detach all Accessories as applicable following manual alcohol flushing of endoscopes.

a. Detach all valves. b. Detach the water-resistant cap from the electrical connector.

2. 3.

Ensure all angulation locks are in the free position. Confirm that all surfaces of the endoscope are completely dry.

4.

Move elevator control lever in the opposite direction of the down arrow i.e. Confirm that the elevator is lowered and the instrument channel outlet at the distal end is open.

5.

Hang the endoscope so that the universal cord and insertion tube are hanging vertically.

6.

Store the endoscope in a well-ventilated cabinet, according to National and Professional guidelines.

Comments:

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