2. Objectives:
As a result of successfully completing this chapter,
students will be able to:
Provide an overview of and discuss procedures to care for
and effectively process powered surgical instruments.
Explain basic concerns important when handling and
processing endoscopic instruments.
Discuss detailed information about flexible endoscopes.
Review general processing and inspection requirements for
rigid and semi-rigid endoscopes and laparoscopic
instruments.
Identify basic protocols important at each step in the
loaner instrumentation process.
6. Electrically Powered
Instruments
Cable attached to a
motorized hand piece
Require a cable that
can be sterilized
(One end attached to
the instrument
handpiece and the
other to a motor or
adapter that is
connected to a 110
volt outlet)
7. Pneumatic Powered
Instruments
Powered by Compressed
Gas
Powered by compressed
gas. They require a hose
that can be sterilized
(One end attaches to the
instrument handpiece and
the other to a stand alone
cylinder tank or a wall or
column mounted
regulator panel)
8. Battery Powered Instruments
Least cumbersome because
there is no cord or cable
Requires batteries and a battery
charger
9. Example of a Battery Powered
PSI and Two Styles of Batteries
10. PSI Processing Concerns
PSIs are complex instruments that
are difficult to clean and easy to
damage
Central Service Technicians should
follow manufacturer’s processing
instructions carefully
11. Fluid Invasion
Occurs when water
or cleaning
solution is allowed
to enter PSIs
Fluid invasion can
severely damage a
PSI
15. Common PSIs
Dermatomes/Dermabraiders – used to harvest skin
grafts or reshape skin surfaces
Cebatomes – used to remove cement
Sternal Saws – used to split the sternum for open
heart surgery
Dental Drills – used for teeth and jawbones
Micro Drills – used for middle ear bones and to drive
very small wires
Wire Drivers, Drills and Saws – come in various
sizes and are used to work on small to large bones.
Saws - designed to perform specific cutting actions
such as reciprocating or oscillating
17. Basic PSI Processing Procedure
(You MUST Follow Manufacturer’s Specific Instructions)
Remove all bits, burrs and blades from the unit, disconnect from the power source
Disassemble and remove debris at point of use, keep the instrument moist
Separate devices with internal mechanisms from simple devices. Generally, simple
components can be soaked
Attach handpiece to a hose of specialized cleaning attachment to reduce the risk of
fluid invasion during cleaning
Clean the exterior with an approved germicidal detergent
Pay special attention to recessed areas, moving levers, switches, etc.
Clean recessions and cannulas using a stiff bristle brush
Clean, rinse and inspect the hose, cable or battery pack. Look for signs of damage or
excessive wear
Lubricate and test as required by the manufacturer
Dry all components
Package and sterilize as recommended by the manufacturer
20. Rigid Endoscopes
Provide an optical
view and in some
cases minimal
access through a
rigid instrument.
The scope is
inserted through a
sheath inserted via
a small incision.
21. Flexible Fiberoptic Endoscope
Provides optical
access using a
flexible,
maneuverable scope
most commonly
inserted through a
mucous membrane
opening.
22. Regulations and Guidelines
Several regulatory agencies and
professional associations provide
input into proper scope handling and
processing practices.
For a list, please refer to pages 207-
209 in the text.
23. Infection Control Concerns
Flexible endoscopes pose significant
infection control challenges. Their
configuration makes them difficult to
clean and dry and they can harbor
bacteria.
24. Infection Control Issues
Inadequate training of employees who clean and handle
scopes
Adequate time for thorough processing
Commitment of employees (and policy writers) to safely
reprocess scopes
Failure to adequate inspect scopes prior to processing
Failure to follow manufacturer’s instructions for
reprocessing
Failure to follow label direction on processing chemicals
Using the scope without a leak test
Poor manual cleaning habits
Failure to use automatic endoscope reprocessors in
accordance with manufacturer’s instructions
Improper drying and storing procedures
25. Additional Concerns:
Failure to leak test correctly
Failure to manually clean all channels
Failure to flush all channels with disinfectant solution
Failure to fully immerse
Failure to adequately time the length of disinfectant contact
Use of disinfectant solutions after their expiration date
Failure to process all scopes in the same manner (Standard
Precautions)
Failure to sterilize biopsy forceps
Inaccessible manufacturer’s instructions
Variations in staff training
Improper reprocessing of reusable cleaning supplies.
26. Additional Concerns:
Inadequately trained personnel
Lack of competence reviews for scope processing and
procedures
Improper storage and transport
Pressure from physicians to process scopes more quickly
so they can perform more procedures on more patients
Difficulties processing these complex instruments
Space constraints
Absence of, or an inadequate quality control program.
Poor water quality
Facility processing equipment
In order for endoscope processing to be successful, each
of these concerns must be addressed
28. Glutaraldehyde
High Level Disinfectant
Can be used manually or in automatic
processors
Must be tested
Takes Time
Employee Safety Concerns (ventilation a must!)
31. Advantages of AERs
Process consistency
Reduced staff exposure to
chemicals
Timed cleaning
Consistent exposure to the
cleaning agent
Timed contact with liquid
disinfectants
An air flush cycle to remove
excess moisture
Use of copious and
consistent amounts of rinse
water
32. When using AERs:
Follow manufacturer’s instructions to
connect the scope to the AER
Place removable parts in the AER if
possible
Attach channel cleaning connectors to all
channels
Follow manufacturer’s instructions for
using disinfectants
Set the machine for the recommended
time
33. Staff Education
All staff must be
thoroughly educated in
the proper cleaning,
processing, and handling
of endoscopes
Page 215 in the text
contains a sample
competency checklist for
endoscope training
34. A Closer Look at
Endoscopes
Although they look similar,
endoscopes vary greatly in
configuration
Some scopes are only used to
visualize and do not have
channels, while others have
internal channels
41. Gastroscope
Esophagoscope
Used for the visual inspection of the
upper GI tract (gastroscope) and for
the direct visualization of the
esophagus and the cardia of the
stomach (esophagoscope)
42. Colonoscope
Sigmoidoscope
Used for the visual inspection of the
entire large intestine (colonoscope)
and the visual inspection of the lower
part of the large intestine
(sigmoidoscope)
48. Endoscope Accessories
Diagnostic Accessories
Therapeutic Accessories
Follow manufacturer’s
instructions for the
proper processing of
each type of accessory
50. An Important Note:
The term “Rigid” is
misleading! Rigid
Endoscopes are
VERY DELICATE
and can be easily
damaged
51. Rigid Endoscope Guidelines
Always follow manufacturers’ recommendations
Never soak instruments for cleaning or high level disinfection in
a metal soak pan
Instruments may need to be soaked in a vertical position
Utilize flush ports when available to circulate (under pressure)
enzymatic detergent through the channels
Lenses must never be placed in an ultrasonic cleaner
Gently brush clean the exterior and accessible lumens with the
appropriate brush
Thoroughly rinse with distilled water and rough dry
Inspect instruments for cleanliness, missing parts, and damage.
Thoroughly air-dry instruments
Remember that these instruments are fragile and must be
handled carefully
53. Inspection
Check surfaces of the telescope for
visible damage
Inspect for clarity using white paper
with writing on it
Check the eyepiece seal for visible
damage
57. Loaner Instrumentation
Owned by the
vendor and
brought in for a
specific case
Can have a
significant impact
on Central Service
workload
58. Loaner Instrument Processes
Log Receipt of Loaner Instruments and Implants.
Include the following information:
Date
Time
Signature of delivery person
Initials of receiving person
Doctor’s name
Patient’s last name
Number of trays
Inventory check of tray(s) for completeness
Inventory check of tray(s) for damaged items.
59. Loaner Instrument Processes
ALL Loaner instruments
must be decontaminated by
the receiving facility before
use
After cleaning and
decontamination, inspect
and assemble instruments
for sterilization. Defective
instruments should be
documented
Sterilize according to
manufacturer’s instructions
After sterilization, place in a
low traffic area and handle
as little as possible before
use
60. As technology advances, instruments
(and the Central Service Technician’s
job) become more complex...