URETERO-RENO FIBERSCOPE Reprocessing Manual

Contents

Contents Chapter 1 General Policy ... 1 1.1

Instructions ... 1

1.2

Importance of reprocessing ... 2

1.3

Signal words ... 2

1.4

Precautions ... 3

1.5

Reprocessing before the first use ... 6

1.6

Reprocessing and storage after use ... 7

1.7

Reprocessing before patient procedure ... 8

Chapter 2 Function and Inspection of the Accessories for Reprocessing ... 9 2.1

ETO cap (MB-156) ... 9

2.2

Single use single-ended cleaning brush (BW-400B) ... 11

2.3

Single use combination cleaning brush (BW-411B) ... 12

Chapter 3 Compatible Reprocessing Methods ... 15 3.1

Compatibility summary ... 15

3.2

List of compatible methods ... 16

3.3

Detergent solution for manual cleaning ... 18

3.4

Disinfectant solution for manual disinfection ... 19

3.5

Water ... 20

3.6

Rinse water ... 20

3.7

Alcohol ... 20

3.8

ETD (EndoThermo Disinfectors) ... 21

3.9

OER-AW (Olympus Endoscope Reprocessor) ... 22

3.10 Washer-Disinfector ... 23 3.11 Hydrogen peroxide sterilization ... 26 3.12 Steam sterilization (autoclaving) ... 28 3.13 Signs of degradation from reprocessing and its number of times ... 29

Chapter 4 Reprocessing Workflow for Endoscopes and Accessories ... 33 4.1

Summary of reprocessing workflow ... 33

4.2

Workflow for reprocessing endoscopes and accessories using an AER/WD .. 34

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Chapter 5 Reprocessing the Endoscope ... 35 5.1

Summary of reprocessing the endoscope ... 35

5.2

Preparing the equipment for reprocessing ... 36 Equipment needed ... 36

5.3

Precleaning the endoscope ... 38 Equipment needed ... 38 Preparation ... 39 Wipe the insertion section ... 40 Flush the instrument channel with water ... 41 Detach the endoscope and accessories from the light source ... 42 Transport the endoscope and accessories ... 43

5.4

Leakage testing of the endoscope ... 44 Equipment needed ... 44 Inspection before the leakage test ... 45 Perform the leakage test ... 46

5.5

Manually cleaning the endoscope ... 52 Equipment needed ... 52 Clean the external surfaces ... 53 Brush the channel ... 56 Flush the instrument channel with detergent solution ... 62 Immerse the endoscope in detergent solution ... 62 Remove detergent solution from the channel ... 63 (Optional) Alcohol flush ... 64 Dry the endoscope ... 65

5.6

Manually disinfecting the endoscope ... 66 Equipment needed ... 66 Preparation ... 66 Immerse the endoscope in disinfectant solution ... 67 Remove the endoscope from disinfectant solution ... 68

5.7

Rinsing the endoscope following disinfection ... 68 Equipment needed ... 69 Rinse the endoscope ... 69 (Optional) Alcohol flush ... 70 Dry the endoscope ... 70

5.8

Sterilizing the endoscope and accessories ... 71 Equipment needed ... 71 STERRAD® 100S/NX®/100NX® sterilization of the endoscope and accessories ... 71 V-PRO® maX sterilization of the endoscope and accessories ... 72

5.9

Presoaking the endoscope ... 74 Equipment needed ... 74 Presoak the endoscope ... 75

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Chapter 6 Reprocessing the Accessories ... 77 6.1

Summary of reprocessing the accessories ... 77 Reprocessing the forceps/irrigation plug (isolated type) (MAJ-891) ... 77 Reprocessing the Luer-split (MAJ-2092) ... 77 Equipment needed ... 78

6.2

Manually cleaning the accessories ... 79 Manually cleaning the accessories ... 79 Dry the accessories ... 80

6.3

Manually disinfecting the accessories ... 80

6.4

Rinsing the accessories following disinfection ... 81 Rinse the accessories ... 81 Dry the accessories ... 81

6.5

Sterilizing the accessories ... 82 Steam sterilization (autoclaving) ... 82 STERRAD® 100S/NX® sterilization ... 83 V-PRO® maX sterilization ... 84

Chapter 7 Reprocessing Endoscopes and Accessories Using an AER/WD ... 85 7.1

Reprocessing endoscopes and accessories using an AER ... 85

7.2

Reprocessing endoscopes and accessories using an ETD ... 86 ETD ... 86 (Optional) Alcohol flush ... 86 Dry the endoscope and accessories ... 86

7.3

Reprocessing endoscopes and accessories using an OER-AW ... 87 OER-AW ... 87 (Optional) Alcohol flush ... 87 Dry the endoscope and accessories ... 87

7.4

Reprocessing accessories using a WD ... 88 Washer-Disinfector ... 88 Dry the accessories ... 88

Chapter 8 Storage and Disposal ... 89 8.1

Precautions for storage and disposal ... 89

8.2

Storing the sterilized endoscope and accessories ... 90

8.3

Disposal ... 90

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1.1 Instructions

Chapter 1 1.1

General Policy

Ch.1

Instructions • This manual contains the reprocessing methods recommended by Olympus for the endoscopes and accessories listed on the front cover. • This instruction manual contains essential information on reprocessing endoscopes and accessories safely and effectively. • Before reprocessing, thoroughly review this manual and the manuals of the reprocessing equipment and chemicals that will be used for reprocessing. Reprocess all the devices as instructed. • Note that the complete instruction manual set for the endoscope and accessories consists of this manual and the “OPERATION MANUAL” with your endoscope model listed on the cover. Both manuals accompanied the endoscope at shipment. • Keep this manual and all related manuals in a safe and accessible location (e.g., in the reprocessing area). • If you have any questions or comments about any information in this manual, or if a problem that cannot be solved occurs while reprocessing, contact Olympus. • This manual is based on the requirement of ISO 17664: 2017.

 Terms used in this manual AER/EWD/WD: AER is the abbreviation for Automated Endoscope Reprocessor, which is used for reprocessing the endoscopes and accessories. EWD is the abbreviation for Endoscope Washer-Disinfector, which is used for reprocessing the endoscopes and accessories. EWD refers to AER and AER is used in this manual. WD is the abbreviation for Washer-Disinfector, which is used for reprocessing the heat-stable endoscopes and accessories employing alkaline cleaning and thermal disinfection.

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1.2 Importance of reprocessing

Ch.1

1.2

Importance of reprocessing

The medical literature reports incidents of cross-contamination resulting from improper reprocessing. It is strongly recommended that all individuals engaged in reprocessing closely observe all instructions given in this manual and the manuals of all ancillary equipment, and have a thorough understanding of the following items: • Professional health and safety policies of your healthcare facility • Instruction manuals for the endoscope, accessories, and all the other reprocessing equipment • Structure and handling of the endoscope and accessories • Handling of pertinent chemicals When selecting appropriate methods and conditions for reprocessing, follow the policies at your institution, applicable national laws and standards, and professional society guidelines and recommended practices, in addition to the instructions given in this manual.

1.3

Signal words

The following signal words are used throughout this manual:

WARNING

Indicates a potentially hazardous situation which, if not avoided, could result in death or serious injury.

CAUTION

Indicates a potentially hazardous situation which, if not avoided, may result in minor or moderate injury. It may also be used to alert against unsafe practices or potential equipment damage.

NOTE

2

Indicates additional helpful information.

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1.4 Precautions

1.4

Ch.1

Precautions WARNING • An insufficiently reprocessed endoscope and/or accessory may pose an infection control risk to the patients and/or operators who contact them. • The endoscope reprocessor, light source, and/or front panels of equipment may cause an infection control risk. Perform proper cleaning and disinfection as described in their respective instruction manuals. A tap or basin that medical personnel come in contact with may cause an infection control risk as well. Perform proper replacement, cleaning, and disinfection. • All disinfection methods (whether performed manually or by an AER/WD) and all sterilization methods (whether performed by steam or hydrogen peroxide) require thorough prior cleaning of the instruments being reprocessed. If the instruments are not adequately cleaned prior to disinfection/sterilization, these processes will be ineffective. Immediately after each patient procedure and before disinfection/sterilization, thoroughly clean the endoscope and the accessories used with the endoscope. • The channel of the endoscope and all accessories used with the endoscope during the patient procedure must be reprocessed after each patient procedure, even if the channel or accessories were not used during the patient procedure. Insufficient reprocessing of these components may pose an infection control risk to patients and/or operators. • Residual detergent solution and disinfectant solution may cause adverse reactions in patients. Therefore, rinse all external surfaces and the channel of the endoscope and accessories thoroughly with water to remove residual detergent solution following cleaning and residual disinfectant solution following disinfection. • The results of sterilization depend on various factors. These factors include how the equipment was packaged and the placing and loading of the package in the sterilization device. Verify the sterilization process using biological and/or chemical indicators. Follow the guidelines for sterilization issued by national authorities, professional organizations and infection control professionals, including the frequency of the above verification, as well as the instruction manual for the sterilization device. • Establish an internal system of identifying contaminated versus reprocessed endoscopes and accessories to prevent both mix-ups and cross-contamination. Some national or professional guidelines recommend separating dirty (contaminated) area, clean area, and storage area. Touching a reprocessed endoscope and/or accessories with contaminated gloves or placing them on a contaminated hanger or surface, including letting them touch the floor, will recontaminate them. URF-P7/P7R REPROCESSING MANUAL

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1.4 Precautions

Ch.1

WARNING • Prior to each patient procedure, confirm that the endoscope and accessories have been properly reprocessed and stored. If there are any doubts or questions, reprocess them again before the patient procedure, following the instructions given in this manual. • Perform a leakage test on the endoscope after each precleaning procedure. Do not use the endoscope if a leak is detected. Use of an endoscope with a leak may cause damage to the bending mechanism or other malfunctions. Use of a leaking endoscope may also pose an infection control risk. Leakage tester

Figure 1.1 • Store alcohol in an airtight container. Alcohol stored in an open container may cause a fire hazard and may result in a loss of efficacy due to evaporation. • The accessories listed on the front cover of this manual cannot be refurbished or repaired and are intended to be replaced once they show any signs of wear and tear. Should any irregularity be observed, use a replacement accessory instead. Using defective accessories may cause equipment malfunction, reduce the efficacy of reprocessing, present a risk to patients and/or operators, or damage the endoscope and/or accessories. • Single-use brushes, such as the single use single-ended cleaning brush (BW-400B) and the single use combination cleaning brush (BW-411B), are designed for cleaning only one endoscope and its related accessories. Dispose of the single-use brush immediately after use. Using a single-use brush to clean multiple endoscopes and/or accessories may reduce its cleaning efficacy and may damage the brush leading to brush breakage or the endoscope and/or accessory damage. • Patient debris and used reprocessing chemicals pose infection control risks. To guard against contact with dangerous chemicals and potentially infectious material, wear appropriate personal protective equipment during reprocessing. Such protective equipment should include appropriate eyewear, face mask, cap, moisture-resistant clothing, shoe covers, and chemical-resistant gloves that fit properly and are long enough to prevent skin exposure.

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1.4 Precautions

Ch.1

WARNING • The reprocessing room must be adequately ventilated to minimize the risks from chemical vapors. • Always remove contaminated personal protective equipment before leaving the reprocessing area to prevent contamination from spreading. • Only Olympus-recommended or Olympus-endorsed AERs have been validated by Olympus. When using an AER that is not recommended by Olympus, the manufacturer of the AER is responsible for validating compatibility of the AER with each Olympus endoscope, accessories, and medical instruments. • Only use the AER/WD that meets the requirements of the relevant parts of ISO 15883 series in the member states of the EU. • Before using an AER/WD, confirm that it is capable of reprocessing the endoscope including all channels, accessories, and medical instruments. Be sure to attach all required connectors/adapters. Otherwise, insufficient reprocessing may pose an infection control risk. If you are uncertain as to the ability of your AER/WD to reprocess the endoscope including all channels, accessories, and medical instruments, contact the manufacturer of the AER/WD for specific instructions and information on compatibility and the required connectors/adapters. • The instructions provided in this manual are not valid for Olympus devices repaired by a non-Olympus facility. The Olympus recommended reprocessing procedures have not been validated for reprocessing devices repaired by a non-Olympus facility. In the event that your device has been repaired by a non-Olympus facility, contact the repair facility for instructions regarding reprocessing. • Prions, which are the pathogenic agents of the Creutzfeldt-Jakob disease (CJD) cannot be destroyed or inactivated by the reprocessing methods stated in this instruction manual. When using the endoscope and accessories on patients with CJD or variant Creutzfeldt-Jakob disease (vCJD), be sure to use them for such patients only, or immediately dispose of them after use in an appropriate manner to prevent the usage of exposed devices on other patients. For methods to handle CJD/vCJD, follow the respective guidelines in your country. • The endoscope and accessories may be damaged by published methods for destroying or inactivating prions. For information on the durability of Olympus equipment against a particular reprocessing method, contact Olympus. In general, Olympus cannot guarantee the effectiveness, safety, and durability of reprocessing methods not described in this reprocessing manual. If you choose to use a reprocessing method not recommended in this manual, the local institution and/or physicians must assume responsibility for its safety and efficacy. Make sure to carefully inspect each piece of endoscopic equipment for irregularities (damage) prior to each patient procedure. Do not use the equipment if any irregularity is found.

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1.5 Reprocessing before the first use

Ch.1

WARNING • Good quality control practices typically require appropriate documentation. Items such as local SOPs (Standard Operating Procedures), confirmation of operator training, routine testing of the disinfectant’s MEC (Minimal Effective Concentration), confirmation of the disinfectant’s use-life, etc. should be documented as performed.

CAUTION • Before immersing the endoscope in reprocessing fluids, confirm that the ETO cap (MB-156) is not attached to the endoscope. If the ETO cap is attached, the reprocessing fluids will be able to penetrate the inside of the endoscope, and it can be damaged. • When aerating or irrigating the endoscope channel, the air or water pressure must not exceed 0.3 MPa (3 kgf/cm2, 43 psig). Higher pressures may cause damage to the endoscope. • Store spare accessories in their original packaging to prevent damage. • To prevent damage, do not apply excessive force to the endoscope and accessories during reprocessing. • Vapors from disinfectant solution and alcohol may damage electronic devices such as computers. Properly manage the quality and durability of the devices used in reprocessing rooms and the ventilation performance of the rooms.

1.5

Reprocessing before the first use

New endoscopes, repaired endoscopes, accessories, and the carrying case for endoscopes are not reprocessed prior to shipping from Olympus, regardless of whether those instruments are for new purchase, demo, or loaner purposes. Reprocess all such endoscopes and accessories received from Olympus according to the instructions given in this manual before storage and before using them in a patient procedure.

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1.6 Reprocessing and storage after use

1.6

Ch.1

Reprocessing and storage after use WARNING • Do not reuse detergent solution. • Do not reuse rinse water. • Detergent and disinfectant solution are only effective when used according to the detergent and disinfectant manufacturer’s instructions. Follow the manufacturer’s instructions regarding activation (if required), concentration, temperature, contact time, use life, and expiration date required to achieve successful cleaning and disinfection. • If the disinfectant solution is reused, check its efficacy by proper methods, such as using a test strip, according to the disinfectant manufacturer’s recommendations prior to use. • Do not reuse alcohol. • Alcohol is not a sterilant or high-level disinfectant. • To maintain sterility of equipment following sterilization, use sterile packaging and wraps according to national guidelines. • Store the endoscope and accessories in a proper storage cabinet, following the policies at your institution, applicable national laws and standards, and professional society guidelines and recommended practices. • Improper storage practices, such as not thoroughly drying external and internal surfaces (lumens) prior to storage, will lead to an infection control risk.

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1.7 Reprocessing before patient procedure

Ch.1

1.7

Reprocessing before patient procedure WARNING Improper handling, such as touching a reprocessed endoscope and/or accessories with contaminated gloves, placing a reprocessed device on a contaminated hanger or surface, allowing devices to touch the floor, etc. will recontaminate the device.

NOTE Some national or professional guidelines recommend reprocessing endoscopes prior to their first use of the day, when the certain time passes after disinfecting/sterilizing or in case the storage time recommended by the national authorities is exceeded. Confirm that the endoscope and accessories have undergone proper reprocessing following their last use and that they have been stored properly. Check the storage period of reprocessed endoscopes, and check for surface contamination (e.g., dust). Check the expiration date marked on all items and check for tears or breaches in the sterile packaging. If there are any doubts or questions concerning whether a device is contaminated, reprocess it again following the instructions given in this manual.

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2.1 ETO cap (MB-156)

Chapter 2

Function and Inspection of the Accessories for Reprocessing

Ch.2

Certain accessories are required for reprocessing the endoscope. This chapter describes the function of these accessories. It also describes how to inspect these accessories before using them to reprocess the endoscope.

2.1

ETO cap (MB-156)

Connector

CAUTION Caution is described that a miss attaching or removing this cap may cause a breakage of the endoscope.

Figure 2.1

CAUTION Failing to attach/remove the ETO cap may cause a damage to the endoscope.

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2.1 ETO cap (MB-156)

 Function • When performing gas sterilization (e.g., hydrogen peroxide low temperature plasma), the ETO cap must be attached to the venting connector on the control section.

Ch.2

Venting connector

ETO cap

Figure 2.2

CAUTION If the ETO cap is not attached to the endoscope during hydrogen peroxide sterilization, the air inside the endoscope will expand and could rupture the bending section cover and/or damage the angulation mechanism. • When performing manual or automated cleaning and disinfection including ETD, the ETO cap must be removed from the venting connector on the control section.

 Inspection Confirm that the ETO cap is free from scratches, flaws, and debris.

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2.2 Single use single-ended cleaning brush (BW-400B)

2.2

Single use single-ended cleaning brush (BW-400B)

Tip

Ch.2

Handle Bristles

Brush head

Shaft

Figure 2.3

 Function The single use single-ended cleaning brush is used to brush the inside of the instrument channel of the endoscope.

Instrument channel port Instrument channel

Figure 2.4

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2.3 Single use combination cleaning brush (BW-411B)

 Inspection 1 Remove the brush from its packaging just prior to use. 2 Confirm that the tip and brush head at the distal end are securely attached. Check the

Ch.2

brush head for loose or missing bristles.

3 Check the bristles for any damage. If the bristles are crushed, gently straighten them with your gloved fingertips.

4 Check for bends, scratches, and other damage to the shaft. CAUTION Do not reprocess the single use single-ended cleaning brush prior to use. The brush may be damaged.

2.3

Single use combination cleaning brush (BW-411B)

Tip

Bristles

Channel cleaning brush part

Handle

Shaft

Channel-opening cleaning brush part

Figure 2.5

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Bristles

2.3 Single use combination cleaning brush (BW-411B)

 Function The channel cleaning brush part of the single use combination cleaning brush is used to brush the instrument channel junction of the endoscope.

Instrument channel junction

Figure 2.6 The channel-opening cleaning brush part of the single use combination cleaning brush is used to brush the instrument channel port of the endoscope.

Instrument channel port

Figure 2.7

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Ch.2

2.3 Single use combination cleaning brush (BW-411B)

 Inspection CAUTION

Ch.2

Do not reprocess single use combination cleaning brush prior to use. The brush may be damaged.

1 Remove the brush from its packaging just prior to use. 2 Confirm that the channel cleaning brush part and tip at the distal end are securely attached.

3 Check the channel cleaning brush and channel-opening cleaning brush parts for loose or missing bristles.

4 Check the bristles of the channel cleaning brush and the channel-opening cleaning brush parts for any damage.

5 If the bristles are crushed, gently straighten them with your gloved fingertips. 6 Check for bends, scratches, and other damage to the shaft.

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3.1 Compatibility summary

Chapter 3

3.1

Compatible Reprocessing Methods Ch.3

Compatibility summary

The endoscope and accessories are compatible with several methods of reprocessing. The endoscope and accessories are compatible with several methods of reprocessing. For information concerning the applicable reprocessing methods and parameters, refer to Section 3.2, “List of compatible methods”. Additionally, some reprocessing methods may cause degradation of medical devices that shortens product life. For information concerning degradation of medical devices from reprocessing and its number of times, refer to Section 3.13, “Signs of degradation from reprocessing and its number of times”. Follow the policies at your local institution when choosing which methods to employ.

CAUTION • The methods listed as “compatible” in Table 3.1 is compatible for routine use only when used according to manufacturer’s instructions. Repeated use and reprocessing of endoscopes and accessories lead to gradual wear and tear. Furthermore, reprocessing methods that employ higher temperatures and more caustic/corrosive materials may lead to faster deterioration. In general, sterilization processes are harsher on equipment than disinfection processes. Before each patient procedure, inspect the endoscope and accessories for damage, according to the instructions described in this manual and its companion “OPERATION MANUAL”. • The instructions provided in this manual regarding compatible reprocessing methods are not valid for Olympus devices repaired by a non-Olympus facility. Olympus repairs devices to manufacturer’s specifications using original equipment manufacturer’s (OEM) materials. The use of non-OEM materials to repair an Olympus device may affect the material compatibility and reprocessing efficacy of the device with certain reprocessing chemicals or methods. In the event that your device has been repaired by a non-Olympus facility, contact the repair facility for instructions regarding compatible reprocessing methods.

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