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While the debate over sterilization vs. high-level disinfection of surgical instruments, specifically flexible scopes such as those used in endoscopy, same-day surgery managers still face the day-to-day question of which product to choose for their program’s high-level disinfection. (For more information, see "Controversy erupts over whether to disinfect or sterilize endoscopes," Same-Day Surgery, February 2000.)
"Obviously, steam sterilization is the ideal method for surgical instruments, but this is not an appropriate method for flexible scopes, and not all freestanding same-day surgery programs have access to a sterilizer," says Lawrence F. Muscarella, PhD, director of research and development for Customer Ultrasonics, an Ivyland, PA-based company that manufacturers automatic washers and disinfectors.
"When looking at high-level disinfection, no one germicide is better than another," says Muscarella. "But different germicides are better for some programs because they meet needs that are specific to that surgery program."
Muscarella describes three scenarios that show how same-day surgery managers might determine which product meets their needs.
• Manager wants low-cost product with a proven track record.
If low cost, instrument compatibility, and a proven track record are the most important features for a same-day surgery manager, 2% glutaraldehyde is the most logical choice, says Muscarella. This product does require a well-ventilated area and does take a minimum of 20 minutes for high-level disinfection, he adds. A well-ventilated room is defined as one in which the air in the room is exchanged 10 times every hour, he explains.
The benefit is its compatibility with instruments, he explains; in other words, used properly, it does not cause rubber components to bend or lenses to fog, he says.
The same-day surgery staff at Strong Memorial Hospital in Rochester, NY, uses 2% glutaraldehyde and soaks flexible scopes for 22 minutes, says Deborah G. Spratt, RN, MPA, CNAA, CNOR, nurse manager of the operating room. "We’ve had no problems with this method, and we check with the manufacturers to make sure we follow their recommendations," she adds.
• Busy SDS program needs soaking times of less than 15 minutes.
High-volume programs that need to disinfect equipment more quickly might opt for a product such as Cidex OPA (Advanced Sterilization Products, Irvine, CA), says Muscarella. (See "Vendors" at the end of this article.) Soaking time for this product is generally 12 minutes, he adds.
Another option for programs that already own an automated reprocessor and want to cut soaking time even more could be Rapicide, Muscarella says. The product was approved by the Federal Drug Administration in August 2000 for distribution. "We plan to market Rapicide early in 2001," says R.C. Kippenhan, director of discovery and development for MediVators in Eagan, MN. The product requires a five-minute soak time at 35 degrees Celsius, he adds.
• Facility with poor ventilation has concerns about glutaraldehyde fumes.
Although all germicides release vapors, some same-day surgery staff members with poorly ventilated areas are especially concerned about glutaraldehyde fumes, says Muscarella. If poor ventilation is a concern, there are a number of non-aldehyde germicides, he says.
"Sporox [Sultan Chemists, Englewood, NJ] and the Steris System 1 [Steris, Mentor, OH] are non-oxidizing methods of disinfection," Muscarella says. He does warn that there might be equipment compatibility issues with these products. "I recommend that you check with the manufacturer of both the equipment and the germicide to verify that this process will not damage the instrument." Written confirmation is important to keep any equipment warranties from being voided if there are problems, Muscarella adds.
No matter which method you choose to disinfect, manual cleaning of the instrument before disinfection is still an absolute must, says Spratt. There are a number of organizations that offer guidelines on cleaning endoscopes. (See "Resources" at the end of this article.)
"You get into trouble when you don’t clean the instrument according to the manufacturer’s recommendations prior to disinfection," Spratt says. "An enzymatic cleaner and friction with a brush is essential to reduce the bio-burden."
For more information about specific products used for high-level disinfection, contact:
• Cidex OPA, Advanced Sterilization Products, 33 Technology Drive, Irvine, CA 92618. Telephone: (877) 672-6699. Fax: (949) 453-6353. Web site: www.cidex.com.
• Sporox, Sultan Chemists, 85 W. Forest Ave., Englewood, NJ 07631. Telephone: (800) 637-8582 or (201) 871-1232. Fax: (201) 871-0321. Web site: www.sultanintl.com.
• Rapicide, MediVators, 2995 Lone Oak Circle, No. 10, Eagan, MN 55121. Telephone: (800) 537-7324 or (651) 405-1661. Fax: (651) 405-1881. Web site: www.medivators.com.
• Steris System 1, Steris Corp., 9260 Progress Parkway, Mentor, OH 44060-1834. Telephone: (800) 548-4873 or (440) 354-2600. Fax: (440) 639-4450. Web site: www.steris.com.
For more information about high-level disinfection, contact:
• Lawrence F. Muscarella, PhD, Director of Research and Development, Custom Ultrasonics, 144 Railroad Drive, Ivyland, PA 18974. Telephone: (215) 364-8577. E-mail: email@example.com.
• Deborah G. Spratt, RN, MPA, CNAA, CNOR, Nurse Manager, Operating Room, Strong Memorial Hospital, University of Rochester Medical Center, 601 Elmwood St., Box 624, Rochester, NY 14642. Telephone: (716) 275-9618. E-mail: firstname.lastname@example.org.
For guidelines on cleaning endoscopes, contact:
• American Society of Testing and Materials, 100 Barr Harbor Drive, West Conshohocken, PA 19428-2959. Telephone: (610) 832-9585. Fax: (610) 832-9555. Web site: www.astm.org. Standard Practice for Cleaning and Disinfection of Flexible Fiberoptic and Video Endoscopes is available for download on the Web site, by fax, or by mail. The cost is $30, and credit cards only are accepted.
• American Society for Gastrointestinal Endoscopy, 13 Elm St., Manchester, MA 01944-1313. Telephone: (978) 526-8330. Fax: (978) 526-4018. Web site: www.asge.org. Infection control practice for endoscopes is available at no charge on the Web site.
• Society of Gastroenterology Nurses and Associates, 401 N. Michigan Ave., Chicago, IL 60611-4267. Telephone: (800) 245-SGNA or in Illinois (312) 321-5165. E-mail: email@example.com. Web site: www.sgna.org. Guidelines for the Use of High Level Disinfectants and Sterilants for Reprocessing of Flexible Gastrointestinal Endoscopes is available for $5 for members of the society and $10 for nonmembers. Shipping and handling is $4.95.