Editor’sNote:
Questions can be e-mailed to jakridge@hpnonline.com, called in to Jeannie Akridge at HPN, (941)927-9345 ext.202, or mailed to: HPN CS Questions, 7650 So. Tamiami, Ste.10, Sarasota, FL 34231. Names and hospital identification will be withheld upon request.

Question:When cleaning endoscopes, is it a requirement to utilize a germicidal cleaning agent or disinfectant if the scopes are going to be sterilized?

Answer: Effective and thorough cleaning is always a prerequisite to disinfection or sterilization. The cleaning process is generally focused on the physical removal of soil and bioburden as opposed to the destruction of microbes. Therefore a germicidal cleaning agent may be used but it is not required. All guidelines associated with the reprocessing of endoscopes do require high-level disinfection or sterilization following thorough cleaning. High-level disinfection is the standard and minimum requirement. The pre-cleaning process should begin immediately after use. At the point of use all channels must be thoroughly flushed, insertion tubes and other endoscopic instruments should be wiped of gross soil and maintained moist. If bio soil is allowed to dry it will pose a great challenge to the cleaning process. The use of an appropriate enzymatic detergent as a presoak will facilitate the breakdown and loosening of soils especially any dried organic matter.

Question: I am a medical assistant in a physician owned outpatient clinic. Due to our increased volume and expansion the local hospital is no longer able to process our instruments. I have been relegated this responsibility; most of our procedures are non-invasive and do not require sterilization. I plan to disinfect our instruments and equipment following each use. Some of our instruments will require high-level disinfection. Is it possible to use one chemical for all levels of disinfection or will I require several products? Also how long can chemical disinfectants be used?

Answer: It is first imperative that you utilize chemical disinfectants that have been cleared by the Food and Drug Administration (FDA). Obtain all FDA documentation, technical data and instructions for use from the manufacturer. This information will clearly state how the chemical is to be used, and will state its efficacy, as a low level, intermediate, or high level disinfectant. In all likelihood you may be able to find and use one chemical for all desired levels of disinfection. It is essential that you follow the manufacturer’s instructions for use, which will include the chemical exposure times required to achieve the desired level of disinfection required. Be cautious and mindful that most chemical agents do have limitations and may not be compatible with all the materials and medical devices you are attempting to disinfect. All chemical agents and disinfectants do have expiration dates established by the manufacturer. Some manufacturers will provide two expiration dates – one general shelf life date for inactivated chemicals and another expiration date once the chemical has been activated or following first use. It is important to note that the expiration date of an activated chemical is based on its stability and minimum effective concentration (MEC) required to achieve the expected disinfection outcome. Once activated, liquid chemicals/disinfectants begin to degrade which can affect the chemical’s concentration and efficacy. The addition of any microbial soil, excess water and evaporation will adversely affect the chemicals concentration and effectiveness. It is therefore imperative that medical devices be thoroughly cleaned and dried prior to being placed in the chemical bath. Soaking bins should be kept covered to minimize evaporation and deposits of airborne contaminants. It is recommended that the MEC be tested prior to each use in accordance with manufacturer’s instructions. Under no circumstances should fresh chemicals be added to an already activated disinfectant soak or container. Regardless of the outcome results of a MEC test, a disinfectant must never be used beyond the expiration date. Appropriate records and logs should be maintained upon the activation of a chemical disinfectant, including activation date, MEC test dates and results, goods processed, exposure times, and identification of processing staff performing these functions. HPN