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TJF-Q190V Duodenoscope Cleaning and Disinfection Checklist
TJF-Q190V Duodenoscope Cleaning and Disinfection Checklist This checklist is designed for use solely as a customer educational tool and is not intended to replace or in any way modify the Olympus instruction manual/reprocessing manual. Be sure to follow the detailed steps outlined in the reprocessing manual that was included with your Olympus equipment when purchased. While Olympus' training may be used in support of a facility's overall competency program, it shall not constitute certification of the facility's CDS protocol. Olympus shall in no event be held responsible for a facility's proper performance of CDS protocol nor for a facility staying current with ongoing CDS instructional changes and corresponding training updates. Facility owners of Olympus equipment are fully responsible for complying with industry CDS standards and manufacturer's proper use and CDS instructions.
Facility Name
Date
Endoscope Models: Check each model reviewed during this session. TJF TJF-Q190V
Instructor Name Title Signature
Staff Member Name Signature
Pre-Cleaning 1. 2. 3.
Wear appropriate Personal Protective Equipment. (PPE). Turn OFF the video processor and light source. Prepare a clean 2000 ml container of the water.
4.
Wipe the entire insertion section of the endoscope from the boot at the control section to the distal end with a water-soaked lint-free cloth.
5.
Detach the single use distal cover (MAJ-2315).
a. Lower the forceps elevator. b. Gently hold the distal end of the bending section. c. Tear and twist off the single use distal cover. d. Wipe the distal end of the endoscope with wet lint-free cloths or sponges.
6.
Turn ON the suction source and ensure the biopsy valve cap is closed.
7.
Immerse the distal tip in the water and aspirate the water for 30 seconds or more.
8.
While continuing the immersion and the aspiration, raise and lower the forceps elevator three times, by turning the elevator control lever.
9.
Remove distal tip from the water. Depress the suction valve, and aspirate air for 10 seconds or more.
10.
Turn OFF the suction source.
11.
Remove the air/water valve and attach the air/water cleaning adapter.
12. 13.
Turn ON the light source turn and set the air flow to HIGH.
14.
Depress the air/water channel cleaning adapter, and flush water for 30 seconds or more.
15.
Release the air/water channel cleaning adapter button to flush air for 10 seconds or more.
16. 17. 18.
Turn OFF the light source.
Immerse the distal tip in clean water.
Disconnect all removable and reusable parts from the endoscope. Transport to reprocessing area in a covered container.
Demonstrated
Comments:
Leakage Testing 1.
Fill a basin with clean water.
2.
Detach air/water channel cleaning adapter, suction valve, and biopsy valve from the endoscope.
3. 4. 5.
Connect the leakage tester to the MU-1. (Maintenance Unit).
6.
Confirm that the leakage tester's connector cap and venting connector are dry. If wet, dry with a lint free cloth.
7.
Connect the leakage tester to the endoscope. Ensure bending section has inflated.
8.
Completely immerse the endoscope in water.
9.
Observe for 30 seconds while angulating the bending section in all directions.
Turn ON the MU-1. Depress pin inside connector cap to confirm that air is being emitted.
and lower the elevator by moving the endoscope’s elevator 10. Raise lever 3 times, checking for a potential leak. If a continuous series of bubbles emerges from any location, remove
endoscope from the water, and contact Olympus for further 11. the instructions.
no leak is detected, remove the endoscope from the water and turn 12. IfOFF the MU-1.
13. Disconnect the leakage tester from the MU-1. 30 seconds or until the bending section contracts to its pre14. Wait expansion size. the leakage tester connector cap from the venting 15. Disconnect connector.
16. Thoroughly dry the leakage tester by using a clean, lint-free cloth. Comments:
Demonstrated
Manual Cleaning 1.
Fill a basin with fresh detergent solution prepared as recommended by the manufacturer.
2.
Completely immerse the endoscope in the detergent solution. Clean the external surfaces of the insertion section
a. Immerse the endoscope in detergent solution. b. Wipe the insertion tube using lint-free cloths, brushes or sponges. c. Take the insertion section out of the detergent solution and confirm that no debris remains on all external surfaces of the bending section and the insertion tube.
d. If any debris remains on the external surfaces of the bending section and the insertion tube, repeat Steps “b and c” until no debris is observed.
3.
Clean the external surfaces of the control section and its surrounding parts.
a. Immerse the endoscope in detergent solution. b. Thoroughly wipe or brush all external surfaces of the control section, the boot, and the universal cord’s boot, using clean lint-free cloths, sponges, or brushes.
c. Take the control section, the boot, and the universal cord’s boot out of the detergent solution and confirm that no debris remains on all their external surfaces.
d. If any debris remains, repeat Steps “b and c” until no debris is observed.
4.
Clean the external surfaces of the endoscope connector and the universal cord.
a. Immerse the endoscope in detergent solution. b. Thoroughly wipe or brush all external surfaces of the endoscope connector and the universal cord, using clean lint-free cloths, sponges, or brushes.
c. Take the endoscope connector and the universal cord out of the detergent solution and confirm that no debris remains on all their external surfaces.
d. If any debris remains, repeat Steps “b and c” until no debris is observed.
5.
Brush the forceps elevator and the forceps elevator recess.
a. Confirm the instrument channel outlet is opened.
Demonstrated
b. At the front side of the forceps elevator insert the channel-opening brush into the instrument channel along the forceps elevator until the brush handle touches the distal end. Completely pull the brush out of the instrument channel. Repeat this “push and pull” action 3 times.
c. Clean the brush bristles with your gloved fingertips. d. Insert the brush into the instrument channel along the forceps elevator until the brush handle touches the distal end. “Push, twist and pull” into the front of forceps elevator recess.
e. Clean the brush bristles with your gloved fingertips. f. Take the distal end out of the detergent solution and confirm that no debris remains on the forceps elevator. If any debris remains, repeat Steps “5a to 5f” until no debris is observed.
6.
Brush the back of the forceps elevator.
a. Raise the elevator control lever to close the forceps elevator. b. Insert the brush into the forceps elevator recess along the back of the forceps elevator until the brush handle touches the distal end. At the back of the elevator forceps, “push and pull” 1 time.
c. Clean the brush bristles with your gloved fingertips. d. Take the distal end out of the detergent solution and inspect for debris on the forceps elevator. If any debris remains repeat steps “6b6d”.
7.
a. Brush the bottom of the forceps elevator, the groove, the forceps elevator recess, and the back of the forceps elevator from the back side
b. Hold the distal end to see the back-side surface. c. Brush across the bottom of the forceps elevator in both directions 3 times.
d. Clean the brush bristles with your gloved fingertips. e. Insert the brush into the groove along the back of the forceps elevator until the brush handle touches the distal end. Completely pull the brush out of the groove. Repeat this “push and pull” action 3 times.
f. Clean the brush bristles with your gloved fingertips. g. Insert the brush into the top of forceps elevator recess until the brush handle touches the distal end of the endoscope. Completely pull the brush out of the forceps elevator recess. Undertake this “push and pull” action 1 time.
h. Clean the brush bristles with your gloved fingertips. i. Move the forceps elevator 3 times.
j. Take the distal end out of the detergent solution and confirm that no debris remains on the bottom of the forceps elevator, the groove, the forceps elevator recess, and the back of the forceps elevator. If any debris remains repeat steps “7c to 7j”.
k. When all debris removed Re-immerse the distal end in the detergent solution and lower the forceps elevator.
8.
Brush the distal end and the distal ring of the endoscope (5 sides).
a. Lens side surface: 1. Hold the distal end of the endoscope so that the lens is viewable. 2. While immersing the distal end completely in the detergent solution, brush the lens side surface of the distal end and the distal ring in both directions of the arrow as shown, using the channel opening cleaning brush.
3. Pay particular attention to the air/water nozzle opening, the objective lens, the edge, and around the hook as to not leave any debris. 4. Clean the bristles of the brush in the detergent solution using your gloved fingertips to remove any debris. 5. Take the distal end out of the detergent solution and confirm that no debris remains on the lens side surface of the distal end and the distal ring. If any debris remains, repeat Steps “2 through 5” until no debris is observed. 6. When all debris is removed, put the distal end in the detergent solution.
b. Distal Surface: 1. Hold the distal end so that the distal surface is viewable. 2. While immersing the distal end completely in the detergent solution, brush the distal surface of the distal end in both directions of the arrow as shown.
3. Clean the bristles of the brush in the detergent solution using your gloved fingertips to remove any debris. 4. Take the distal end out of the detergent solution and confirm that no debris remains on the distal surface of the distal end. 5. If any debris remains, repeat Steps “2 through 4” until no debris is observed.
6. When all debris is removed, put the distal end in the detergent solution.
c. Left side surface (top recess extra): 1. Hold the distal end with the lens facing right, so that the left side surface (highlighted in yellow) is viewable.
2
4
6
2. While immersing the distal end completely in the detergent solution, brush the left side surface (highlighted in yellow) of the distal end and the distal ring in both directions of the arrow as shown above. Pay particular attention to the edge of the distal ring as to not leave any debris. 3. Clean the bristles of the brush in the detergent solution using your gloved fingertips to remove any debris. 4. While immersing the distal end completely in the detergent solution, brush the two grooves (highlighted in yellow) of the left side surface in both directions of the arrow as shown above 5. Clean the bristles of the brush in the detergent solution using your gloved fingertips to remove any debris. 6. While immersing the distal end completely in the detergent solution, brush the left side surface of the distal end and the distal ring in both directions of the arrow as shown above. 7. Clean the bristles of the brush in the detergent solution using your gloved fingertips to remove any debris. 8. Take the distal end out of the detergent solution and confirm that no debris remains on the left side surface of the distal end and the distal ring. 9. If any debris remains, repeat Steps “2 through 8” until no debris is observed. 10. When all debris is removed, put the distal end in the detergent solution.
d. Right side surface (top recess extra): 1. Hold the distal end with the lens facing left, so that the right side surface (highlighted in yellow) is viewable.
2
4
6
2. While immersing the distal end completely in the detergent solution, brush the right side surface (highlighted in yellow) of the distal end and the distal ring in both directions of the arrow as shown above. Pay particular attention to the edge of the distal ring as to not leave any debris. 3. Clean the bristles of the brush in the detergent solution using your gloved fingertips to remove any debris. 4. While immersing the distal end completely in the detergent solution, brush the two grooves (highlighted in yellow) of the right side surface in both directions of the arrow as shown above. 5. Clean the bristles of the brush in the detergent solution using your gloved fingertips to remove any debris. 6. While immersing the distal end completely in the detergent solution, brush the right side surface of the distal end and the distal ring in both directions of the arrow as shown above. 7. Clean the bristles of the brush in the detergent solution using your gloved fingertips to remove any debris. 8. Take the distal end out of the detergent solution and confirm that no debris remains on the right side surface of the distal end and the distal ring. 9. If any debris remains, repeat Steps “2 through 8” until no debris is observed. 10. When all debris is removed, put the distal end in the detergent solution.
e. Back side surface: 1. Hold the distal end so that the back side surface (opposite surface of the lens side surface) is viewable. 2. While immersing the distal end completely in the detergent solution, brush the back side surface (highlighted in yellow) of the distal end and the distal ring in both directions of the arrow as shown below. Pay particular attention to the edge of the distal ring as to not leave any debris.
3. Clean the bristles of the brush in the detergent solution using your gloved fingertips to remove any debris. 4. While immersing the distal end completely in the detergent solution, brush the back side surface of the distal end and the distal ring in both directions of the arrow as shown above 5. Clean the bristles of the brush in the detergent solution using your gloved fingertips to remove any debris. 6. Take the distal end out of the detergent solution and confirm that no debris remains on the back side surface of the distal end and the distal ring.
7. If any debris remains, repeat Steps “2 through 6” until no debris is observed. When all debris is removed, put the distal end in the detergent solution.
9.
Use endoscope model-specific brushes to brush channels/cylinders/ports until no visible debris remains.
a. Brush the instrument/suction channel in the insertion tube: 1. Insert the channel-cleaning brush at 45 angle into the opening located at the side wall of the suction cylinder. 2. Using short strokes, feed the brush through the suction channel until it emerges from the distal end of the endoscope. 3. Remove any debris from the bristles with your fingertips and carefully pull the brush back through the suction channel. 4. Clean the brush bristles with your fingertips to remove any debris. 5. Repeat until no debris is observed on the brush.
b. Brush the suction channel in the universal cord: 1. Insert the channel-cleaning brush straight into the suction cylinder. 2. Using short strokes, feed the brush through the suction channel until it emerges from the suction connector on the endoscope connector. 3. Remove any debris from the bristles with your fingertips and carefully pull the brush back through the suction channel. 4. Clean the brush bristles with your fingertips to remove any debris. 5. Repeat until no debris is observed on the brush.
c. Brush the suction cylinder. 1. Insert the channel-opening cleaning brush into the suction cylinder until half the brush section is inserted. 2. Rotate the brush one full revolution and pull the brush out of the suction cylinder. 3. Remove any debris on the brush bristles with your fingertips and clean the brush in the detergent solution. 4. Repeat until no debris is observed on the brush.
d. Brush the instrument channel port. 1. Insert the channel-opening cleaning brush into the instrument channel port fully until the brush handles touches the channel opening. 2. Rotate the brush one full revolution and pull the brush out of the instrument channel port. 3. Remove any debris on the brush bristles with your fingertips and clean the brush in the detergent solution.
4. Repeat until no debris is observed on the brush.
Comments:
Manual Cleaning Manual Flushing of Endoscope Channels 1.
Connect the distal-end flushing adapter (MAJ-2319).
a. Confirm the instrument channel outlet is opened (elevator is laying down).
b. Fill a 30ml syringe with detergent solution, attach to the white port and forcefully flush into white port.
c. Flush 5 more times for total of 180 mls. d. Fill a 30ml syringe with detergent solution, attach to the green port and forcefully flush into green port.
e. Flush 5 more times for total of 180 mls. f. Separate the distal-end flushing adapter. g. Move the forceps elevator 3 times.
2.
Connect the suction cleaning adapter (MH-856) to the instrument channel port.
a. Cover the suction cylinder and aspirate for 30 seconds. b. While aspirate, move the forceps elevator 3 times. c. Turn OFF suction pump. d. Detach the suction cleaning adapter.
3.
Flush the air/water channel with detergent solution.
a. Attach the channel plug (MH-944) and injection tube (MH-946) accordingly.
b. Using 30mL syringe to flush 90 mL of detergent in the air/water channel (right side port).
Demonstrated
c. Wipe all external surfaces of the endoscope and all accessories including the distal end flushing adapter.
d. Leave attached endoscope in the detergent solution according to the manufacturer time.
e. Observe distal end above water If any debris remains, repeat the Manual Cleaning and Manual Flushing steps until all debris is removed.
4.
Remove detergent solution from the distal end and all channels. Immerse endoscope and accessories in clean rinsing water and gently agitate to rinse.
a. Attach the distal-end flushing adapter. b. Draw water into syringe initially 30 mL, flush into white port. c. Flush 2 more times for total of 90 mL. d. Draw water into syringe initially 30 mL, flush into green port. e. Flush 2 more times for total of 90 mL. f. Separate the distal-end flushing adapter. g. Attach the injection tube and channel pug to the endoscope. Using 30-mL syringe to flush 90 mL of water in each port of the injection tube.
h. Move attached scope to dry clean basin, cover its openings with lint-free cloths to prevent splashing.
i. Using 30-mL syringe to flush 90 mL of air in each port of the injection tube
j. Detach the channel plug and injection tube. k. Flush 30 mL of air into each port of the empty distal-end flushing adapter.
l. Wipe dry the external surfaces. Comments:
Automated Endoscope Reprocessor (AER)
Demonstrated
High-Level Disinfection AER Type: High Level Disinfectant Type:
**Note: Prior to disinfection in the AER, raise the forceps elevator to the intermediate position.
1.
Test the disinfectant concentration (i.e., MRC) according to the manufacturer's instructions.
2.
Inspect the connections according to the AER manufacturer's instructions.
3.
Attach the endoscope connectors/adapters to the AER and endoscope as per the AER manufacturer's instructions.
4.
Operate the AER according to the AER manufacturer's instructions.
5.
Ensure the endoscope is soaked in disinfectant solution according to the disinfectant manufacturer's recommendations for time and temperature.
6.
Remove the endoscope promptly after the AER cycle is completed.
7.
Perform the terminal steps that the AER does not perform (e.g., alcohol and air purge).
FOR FACILITY INTERNAL USE ONLY! Olympus personnel are unable to demonstrate use of individual manufacturer's AER.
Comments:
Manual High-Level Disinfection 1.
Fill a clean, large basin with disinfectant solution.
2.
Test the disinfectant concentration (i.ei Minimal Required Concentration- MR) according to the manufactures instructions.
3.
Completely immerse the endoscope and equipment in disinfectant solution, ensure the elevator is lowered.
4. 5. 6.
Attach the channel plug and injection tube to the endoscope. Attach the distal-end flushing adapter. Draw disinfectant into syringe initially 30 mL, flush into white port.
Demonstrated
7.
Flush 5 more times for total of 180 mL.
8. Draw disinfectant into syringe initially 30 mL, flush into green port. 9. Flush 5 more times for total of 180 mL. 10. Detach and separate the distal-end flushing adapter. 11. Move the forceps elevator 3 times. 30-mL syringe to flush 180 mL of disinfectant in each port of 12. Using the injection tube. there is bubble formation, keep flushing until no bubbles can be 13. Ifseen. only the biopsy valve cap of the channel plug (MH-944) from 14. Remove the instrument channel port of the endoscope. flush 180 mL of disinfectant into the instrument channel 15. Forcefully port.
16. Move the forceps elevator 3 times. flush 180 mL of disinfectant into the instrument channel 17. Forcefully port.
18.
Detach all accessories and leave in disinfectant solution for manufacturer’s specified time. Wipe surf ace to remove any surface bubbles.
19. Remove the endoscope and accessories from disinfectant solution. 20. Attach the channel plug and injection tube. 30-mL syringe to flush 90 mL of air in each port of the injection 21. Using tube.
22. Keep flushing until bubbles come. the endoscope from the disinfectant solution with 23. Remove accessories attached. 30 mL of air into each port of the empty distal-end flushing 24. Flush adapter.
25. Remove the distal end flushing adapter from the disinfectant solution. Comments:
Rinsing after Manual High-Level
Demonstrated
Disinfection 1. 2. 3. 4.
Move the attached endoscope into basin of sterile water for rinsing.
5.
Using 30-mL syringe to flush 90 mL of water in each port of the injection tube.
6. 7. 8.
Move the forceps elevator 3 times.
9.
Using 30-mL syringe to flush 90 mL of air in each port of the injection tube.
Detach the channel plug and the injection tube from the endoscope. Wipe external surfaces with lint-free cloth. Attach the channel plug and the injection tube to the endoscope.
Move the attached endoscope onto dry sterile basin. Cover its opening with lint-free cloths to prevent splashing.
10. Detach only the injection tube from the endoscope. a sterile suction tube to the suction connect on the endoscope 11. Attach and on the suction pump. Turn ON the suction pump. air for 15 seconds or more while move elevator forceps 3 12. Aspirate times.
13. Turn OFF suction pump. 14. Detach the remaining accessories. 15. Thoroughly dry with lint-free cloth and cotton swab. Comments:
Alcohol Flush 1.
Attach a reprocessed channel plug and injection tube to the endoscope.
2.
Using 30-mL syringe to flush 90 mL of alcohol in each port of the injection tube, (30 mL air/water channel is sufficient).
3.
Move the forceps elevator 3 times.
4.
Using 30-mL syringe to flush 90 mL of air in each port of the injection tube.
Demonstrated
5.
Detach only the injection tube from the endoscope.
6.
Attach a sterile suction tube from the suction pump to the suction connector on the endoscope connector and turn ON the suction pump. Aspirate air for 30 seconds or more.
7.
Turn OFF suction and detach suction tubing and the channel plug from the endoscope.
8.
Thoroughly dry external surfaces with a lint-free and cotton swab.
Comments:
Drying the Endoscope with compressed air 1.
Cover the distal end, the control section, and the endoscope connector of the endoscope in sterile lint-free cloths to prevent splashing alcohol from the channel openings.
2.
Feed compressed filtered air of less than 0.5 MPa from the opening of the suction cylinder until no alcohol exits from the distal end, the instrument channel port, and the suction connector of the endoscope.
3.
Feed compressed filtered air of less than 0.5 MPa from the instrument channel port until no alcohol exits from the distal end of the endoscope.
4.
Feed compressed filtered air of less than 0.5 MPa from the large opening of the air/water cylinder until no alcohol exits from the distal end and the water supply connector of the endoscope.
5.
Feed compressed filtered air of less than 0.5 MPa from the two small openings of the air/water cylinder until no alcohol exists from the air supply connector and the air pipe of the endoscope.
6.
Thoroughly dry the inside of the suction cylinder, the air/water cylinder, and the instrument channel port of the endoscope, using sterile cotton swabs.
7.
Thoroughly dry the external surfaces of the endoscope by wiping with sterile lint-free cloths.
Demonstrated
Comments:
Sterilisation with Ethylene Oxide Gas
Demonstrated
1.
Flush and dry all channels of the endoscope, the channel plug, and the injection tube, according to the “Alcohol Flush” and “Drying the endoscope” instructions. (Refer to pgs 146-148 of the Reprocessing Manual).
2.
Attach the ETO cap (MB-156) to the venting connector on the endoscope connector.
3.
Confirm the elevator is lowered at the distal end.
4.
Seal the endoscope and accessories in individual packaging appropriate for ethylene oxide gas sterilisation, according to your institution’s protocol.
5.
Sterilise and aerate the packaged endoscope and accessories according to the parameters described in the reprocessing manual. In addition, always comply with the instructions of the steriliser manufacturer.
Comments:
Endoscope Storage 1.
Detach all accessories as applicable following manual alcohol flushing of endoscopes.
a. Detach all valves.
2. 3.
Ensure all angulation locks are in the free position. Confirm that all surfaces of the endoscope and accessories are dry.
4.
Move elevator control lever in the opposite direction of the down arrow i.e. Confirm that the elevator is lowered and the instrument channel outlet at the distal end is open.
5.
Hang the endoscope so that the universal cord and insertion tube are hanging vertically.
6.
Store the endoscope in a well-ventilated cabinet, according to National and Professional guidelines.
Comments:
Demonstrated