As discussed in the previous section the presence of organic material such as blood, faeces and respiratory secretions can result in the failure of disinfection. This may be because either the organic material protects the microorganisms from exposure to the biocide or because the biocide may be inactivated by contact with organic material.
Consequently, rigorous cleaning of flexible endoscopes is required to remove such material before disinfection or sterilisation. This should occur immediately after use to prevent the drying of secretions.
See the section about pre-cleaning in the reprocessing module
Check the scope manufacturer's recommendations when selecting a cleaning product. Use the product in accordance with the manufacturer's recommendations.
The cleaning process is discussed in detail in the reprocessing module
Sensitisation may occur as a result of handling and contact with some cleaning agents. See the Hazardous Substances section of the Workplace Health and Safety module for a discussion of safety requirements.
Enzymatic detergents are the preferred detergents for use in cleaning flexible endoscopes and their accessories. The enzymes promote protein lysis and enhance the efficacy of brushing and flushing.
Manufacturers of enzymatic solutions report optimum efficacy when used in warm water but enzymes will continue to be active in water that has cooled to room temperature however, the use of hot water will destroy the enzyme activity. Heavy contamination by biological material may exceed the enzyme capacity. It is important to adhere to the manufacturers instructions when using these products.
Cleaning agents are used to remove soil and organic matter from endoscopes and accessories following use. There is a plethora of products available; the following principles will help in selection of a product suitable to individual units.
Where an enzyme product is not immediately available, a neutral instrument detergent can be used.
Household detergent is NOT suitable.
Chlorhexidine based detergents have been reported to damage instruments when followed by glutaraldehyde disinfection and should NOT be used.
Ultrasonic cleaners do not disinfect instruments. They are used to assist with the cleaning of instruments that cannot be adequately cleaned manually such as spiral wound instruments like biopsy forceps.
Ultrasonic vibration at the frequency used for cleaning does not kill microorganisms and infective aerosols may be produced. It is for this reason that the lid of the tank must be tightly closed during operation.
Ultrasonic cleaners work by subjecting instruments to high frequency, high-energy sound waves. This causes the soil to be dislodged from instruments and drop to the bottom of the tank, or be sufficiently loosened that it will be removed during the rinsing process.
The detergent used in the ultrasonic tank must be carefully selected in accordance with advice from the tank's manufacturer. Optimally it will be a neutral, low-foaming product and enzymatic cleaners will have enhanced benefits in this process.
| The use of ultrasonic cleaners in relation to cleaning is discussed in the ultrasonic cleaners section of the Quality Assurance module. |
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