Guideline for Use of High Level Disinfectants & Sterilants ...

1 Guideline for Use of High Level Disinfectants & Sterilants for reprocessing flexible gastrointestinal endoscopes Guideline for Use of High Level Disinfectants & Sterilants for reprocessing Flex. gastrointestinal endoscopes Acknowledgements Copyright 2013. Society of Gastroenterology Nurses and Associates, Inc. (SGNA). First published 1998, 2003, 2006, 2007, 2010 & 2013. This document was prepared and written by the SGNA Practice Committee and adopted by the SGNA Board of Directors. It is published as a service to SGNA members. SGNA Practice Committee 2013-14 Michelle R.

2 Juan, MSN, RN, CGRN - Chair Ann Herrin, BSN, RN, CGRN - Co-chair Catherine Concert, DNP, RN, FNP-BC, CGRN Judy Lindsay, MA, BSN, RN, CGRN Midolie Loyola, MSN, RN, CGRN Beja Mlinarich, BSN, RN, CAPA Marilee Schmelzer, PhD, RN Sharon Yorde, BSN, RN, CGRN Kristine Barman, BSN, RN, CGRN Cynthia M. Friis, Med, BSN, RN-BC Reprints are available for purchase from SGNA Headquarters. To order, contact: Department of Membership Services Society of Gastroenterology Nurses and Associates, Inc. 330 North Wabash Chicago, IL 60611-4267 Tel: (800) 245-SGNA or (312) 321-5165 Fax: (312) 673-6694 Online: Email: Disclaimer The Society of Gastroenterology Nurses and Associates, Inc.

3 (SGNA) presents this Guideline for use in developing institutional policies, procedures, and/or protocols. Information contained in this Guideline is based on current published data and current practice at the time of publication. The Society of Gastroenterology Nurses and Associates, Inc. assumes no responsibility for the practices or recommendations of any member or other practitioner, or for the policies and practices of any practice setting. Nurses and associates function within the limits of state licensure, state nurse practice act, and/or institutional policy. Guideline for Use of High Level Disinfectants & Sterilants for reprocessing Flex.

4 gastrointestinal endoscopes Table of Contents Preface--------------------------------- ---------------------------------------- ---------------------------------------- ----4 Definition of Terms----------------------------------- ---------------------------------------- --------------------------4 I. General Principles Common to the use of all High- Level Disinfectants --------------------------- -----5 --------- A. Medical Device Classification system---------------------------------- ------------------------------5 ----------B. Product Safety---------------------------------- ---------------------------------------- --------------------6 ----------C.

5 General Characteristics------------------------- ---------------------------------------- -----------------6 ----------D. Biofilm--------------------------------- ---------------------------------------- ------------------------------6 ----------E. Susceptibility of Resistant Organisms------------------------------- ---------------------------------6 ----------F. Determining Minimum Effective Concentration (MEC) ---------------------------------------- 7 ----------G. Personal Protective Equipment ---------------------------------------- -------------------------------8 ----------H. Material Compatibility--------------------------- ---------------------------------------- ---------------8 ----------I.

6 Manual Cleaning ---------------------------------------- ---------------------------------------- ---------8 ----------J. Final Rinse/ Alcohol Purge / Storage--------------------------------- ------------------------------9 II. High- Level Disinfectant and sterilant Properties and Handling Recommendations-------------9 ---------- A. Glutaraldehyde-------------------------- ---------------------------------------- ------------------------9 ---------- B. Ortho-phthalaldehyde-------------------- ---------------------------------------- --------------------12 ---------- C. Peracetic Acid------------------------------------ ---------------------------------------- ---------------13 ---------- D.

7 Hydrogen Peroxide-------------------------------- ---------------------------------------- ------------15 ---------- E. Peracetic Acid /Hydrogen Peroxide-------------------------------- -------------------------------15 III. Summary--------------------------------- ---------------------------------------- ----------------------------------15 References------------------------------ ---------------------------------------- ---------------------------------------- 16 Recommended Reading--------------------------------- ---------------------------------------- --------------------17 Preface Professional associations and regulatory agencies recognize high- Level disinfection as the standard of care in reprocessing flexible endoscopes (American Society for gastrointestinal Endoscopy [ASGE])

8 Standards of Practice Committee et al., 2008). As of March 2009, the Food and Drug Administration has cleared thirty products as Sterilants and high- Level Disinfectants with general claims for reprocessing reusable medical and dental devices (United States Food & Drug Administration [FDA], 2009). Although several chemicals are cleared by the FDA as both Sterilants and high Level Disinfectants , this document will focus on the high Level disinfectant chemicals. All personnel using chemicals should be educated about biologic and chemical hazards present while performing procedures that use Disinfectants (Petersen et al.

9 , 2011). This Guideline provides information about the properties of the main ingredients of these solutions, their safe and effective use, and their compatibility with flexible endoscopes . The current FDA document has listed these products by brand name. It is beyond the scope of this document to review each individual product. A detailed cleaning protocol for endoscopes is found in the Society of Gastroenterology Nurses and Associates, Inc. (SGNA) Standards of Infection Control and reprocessing of flexible gastrointestinal endoscopes (2012). Refer to endoscope manufacturers guidelines for design features unique to a particular instrument and chemical compatibility.

10 Refer to the FDA for approved high Level Disinfectants / Sterilants for use. Definition of Terms For the purpose of this document, SGNA has adopted the following definitions: Automated endoscope reprocessor (AER) refers to machines designed for the purpose of cleaning and disinfecting endoscopes and accessories. Meticulous manual cleaning must precede the use of AERs (Petersen et al., 2011). Automated endoscope reprocessors limit exposure of personnel to the chemical Disinfectants (American Society for gastrointestinal Endoscopy Technology Committee et al., 2010; Rutala, Weber, & Healthcare Infection Control Practices Advisory Committee [HICPAC], 2008).