The Principles of Medical Device Decontamination

a sterile body cavity rather than a natural orifice. All stages are important for patient safety: bedside clean immediately after use; manual leak testing with full immersion and tip angulation in addition to that done by the EWD; effective irrigation of all lumens of every endoscope, detergent cleaning, chemical disinfection, rinsing with water of a quality compatible with that endoscope’s use and, if not for immediate use, drying. Some non-lumened endoscopes, typically nasendoscopes, will often be decontaminated by manual wiping with leak testing frequently omitted. There are also medical devices other than endoscopes which come into contact with mucous membranes that are not amenable to sterilisation such as intra-cavity ultrasound (US) probes, the most typical examples of which are intra-vaginal or transrectal US probes and transoesophageal echocardiography (TOE) probes. These are more problematic than endoscopes in that either decontamination (cleaning, chemical disinfection and rinsing) is entirely manual, or automated disinfection, always needs to be preceded by manual cleaning. These should be decontaminated by staff with specific training in dedicated facilities that support recommended decontamination procedures to be followed. Guidance on this has been produced by the Healthcare Infection Society working group published in August 2018 1 . Some medical devices have contact with intact skin, including devices such as pulse oximeters and blood pressure cuffs. These are typically low risk and poorly amenable to effective decontamination. If they are used with particularly susceptible patients, such as those in specialist burns units, they should be either single patient use or, where cost prohibits this, allocated to a single patient for the duration of that patient’s need, and then meticulously cleaned and disinfected as a terminal procedure. Always consult the manufacturers’ instructions for compatible decontamination processes and products.

Analysis of decontamination failures

In the initial phase where a decontamination failure is first suspected or identified, there is usually only sparsely established fact on which to base analysis. The main components that need to be established are the exact nature of the failure or failures, the duration over which they occurred and whether patients associated with the failed decontamination can be identified.

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