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MIS instruments and rigid endoscopes

MIS instruments and rigid endoscopes

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If I am using sterile sheaths, can I dispense with dipping the instruments and carry out a wipe disinfection? Alternatively, what are the written sources describing the hygienic procedures to be adopted when using camera heads as accessories for endoscopy
Our view is that camera heads should be cleaned and disinfected after use even if they are being used with a sterile covering. Unfortunately, there are no concrete sources describing this procedure. This means it is extremely important to comply with the manufacturer’s instructions. This process is also described in ISO17664.
Regarding the processing, how do you classify a conical amnioscope of a length of 20 cm length and a diameter of about 14.5 cm at the wide end?
According to the Robert Koch Institute, an amnioscope is a hollow space and thus classified B. The diameter is of secondary relevance. The classification semi critical or critical depends on its use. Semi critical are all instruments in contact with mucous membrane or pathologically mutated skin. Critical instruments are those, that are in contact with blood or penetrance of mucous membrane. As the amnioscope is used during birthing, there is definitely contact with blood. That is why this instrument should be classified as critical. Being a hollow space instrument, processing by means of a class B steam sterilizer according to DIN EN 13060 is recommended
Is it o.k. to process laproscopic MIS instruments mechanically (washer- disinfector) about 24 to 48 hours after manual pre-cleaining in the operating theatre? What are the official regulations and conditions?
The situation described should be an exception which may occur for example on a weekend. In this case, particularly hollow space instruments should be thoroughly rinsed by fully demineralized water until clear water comes off the outlet openings. If treated in such a way, the laproscopic set may be passed on to the CSSD for later processing in a washer-disinfector. This procedure must be previously discussed with the CSSD.

If necessary, such instrument sets are additionally treated in the CSSD, for example by means of ultrasound, before machine cleaning. Appropriate cleaning must be assured and should be verified randomly by means of a protein test. Under such precautionary measures, such a procedure could be tolerated in exceptional cases.
Is it possible to process MIS-instruments that cannot be disassembled?
There is no general answer to this question. Forceps and scissors equipped with a connection for washing cannot be disassembled but they can be sufficiently cleaned and sterilized. Make sure, that the processing agent has access to all surfaces that have direct or indirect contact with the patient.
How can you treat and autoclave irrigating cannulas (lumen<1mm) ?
Cannulas of less than 1 mm in diameter are difficult to reprocess. Cannulas of less than 0.5 mm should not be reprocessed, as perfect cleaning cannot be assured. However, the possibility to reprocess a cannula does not only depend on the diameter, its length is also important. To assure the safe processing of such filigree instruments, the following aspects must necessarily be taken into account: The cannula must be rinsed with sterile water immediately after application, to prevent any obstruction. If is possible to use a non physiological salt solution. Check with the appropriate guide wire if the cannula is not obstructed. Make sure that the interior is carefully dried after processing; if necessary blow through it with a dry syringe until no more humidity emerges. Steam sterilisation by a fractionated pre-vacuum method according to EN285. Manufacturers have proved in a sterilisation study (part 1 published in Zentralsterilisation 2001; 9(6) 425 - 437 and part 2 published in Zentralsterilisation 2002; 10 (2) 100 - 109), that cannulas of an inner diameter of 0.5 mm and a length of 500 mm can be sterilised with a fractionated pre-vacuum method according to EN285.

Key words: rigid endoscopes, treatment of autoclave irrigating cannulas