Physicians use endoscopes to diagnose and treat numerous medical disorders. Until simpler and effective alternatives are identified for device disinfection in clinical settings, following this guideline, other CDC guidelines 1, 22, 95, 96 and FDA-cleared instructions for the liquid chemical sterilants/high-level disinfectants would be prudent.
#DENTAL HAND INSTRUMENTS QUIZ WIT PICTURES PROFESSIONAL#
92-94 Infection with spore-forming bacteria has not been reported from appropriately high-level disinfected endoscopes.Īn additional problem with implementation of the Spaulding system is that the optimal contact time for high-level disinfection has not been defined or varies among professional organizations, resulting in different strategies for disinfecting different types of semicritical items (e.g., endoscopes, applanation tonometers, endocavitary transducers, cryosurgical instruments, and diaphragm fitting rings). For example, is an endoscope used for upper gastrointestinal tract investigation still a semicritical item when used with sterile biopsy forceps or in a patient who is bleeding heavily from esophageal varices? Provided that high-level disinfection is achieved, and all microorganisms except bacterial spores have been removed from the endoscope, the device should not represent an infection risk and should remain in the semicritical category. 29, 87-91 Many newer models of these instruments can withstand steam sterilization, which for critical items is the preferred method.Īnother problem with implementing the Spaulding scheme is processing of an instrument in the semicritical category (e.g., endoscope) that would be used in conjunction with a critical instrument that contacts sterile body tissues. However, evidence that sterilization of these items improves patient care by reducing the infection risk is lacking. Some of these items cannot be steam sterilized because they are heat-sensitive additionally, sterilization using ethylene oxide (EtO) can be too time-consuming for routine use between patients (new technologies, such as hydrogen peroxide gas plasma and peracetic acid reprocessor, provide faster cycle times). 28, 86 Heat-stable scopes (e.g., many rigid scopes) should be steam sterilized. This is true particularly for a few medical devices (e.g., arthroscopes, laparoscopes) in the critical category because of controversy about whether they should be sterilized or high-level disinfected. Thus, in some situations, choosing a method of disinfection remains difficult, even after consideration of the categories of risk to patients. For example, the scheme does not consider problems with reprocessing of complicated medical equipment that often is heat-sensitive or problems of inactivating certain types of infectious agents (e.g., prions, such as Creutzfeldt-Jakob disease agent). One problem with implementing the aforementioned scheme is oversimplification. Microbial Contamination of DisinfectantsĬoncerns about Implementing the Spaulding Scheme.Susceptibility of Antibiotic-Resistant Bacteria to Disinfectants.
Disinfection in Ambulatory Care, Home Care, and the Home.Toxicological, Environmental and Occupational Concerns.Disinfection of HBV-, HCV-, HIV- or TB-Contaminated Devices.Tonometers, Cervical Diaphragm Fitting Rings, Cryosurgical Instruments, and Endocavitary Probes.Concerns about Implementing the Spaulding Scheme.
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