Question: I have not performed rhinoscopies for a number of years. My current Welch Allen rhinoscope is no longer manufactured. Can you provide me with detailed instructions on how to clean a flexible non-channel rhinolarynoscope?
Dr. Dana V. Wallace, Associate Professor, Nova Southeastern Allopathic Medical School, Davie Florida
Answer: Most rhinolarynoscope manufacturers will have their own set of cleaning AKA "reprocessing" instructions and it would be best to review their recommended method, when this is available. While non-channel rhinolarynoscopes are easier to reprocess than those with a channel, similar cleaning/disinfecting procedures are recommended for both. New products continue to be developed, e.g., Aldahol 1.8 high-level disinfectant and FlexClean 895 detergent, as featured on the Olympus website.
When one looks at published studies on reprocessing of flexible laryngoscopes, simple pre-cleaning with soap and water, use of alcohol wipes, and brief submersion in a high-level disinfectant all seem to be effective. However, the authors do suggest using two or more steps in the disinfectant process. (ARCH Otolaryngol Head Neck Surg/Vol 138 (NO.2), Feb 2012 "Disinfection of Flexible Fiberoptic Laryngoscopes..." article attached.)
Cidex OPA is recommended over glutaraldehyde which is more of an irritant, thereby introducing increased risk for staff performing the disinfectant process. Cidex OPA has excellent stability over a wide pH range (pH 3-9), is not a known irritant to the eyes and nasal passages, does not require exposure monitoring, has a barely perceptible odor, and requires no activation. (For more details see https://www.cdc.gov/infectioncontrol/guidelines/disinfection/disinfection-methods/chemical.html)
In 2004, the manufacturers of Cidex OPA reported anaphylaxis-like reaction after cystoscopy with a scope that had been reprocessed using Cidex OPA. Of approximately 1 million urologic procedures performed using instruments reprocessed using OPA, 24 cases have been reported. Most of these reactions were in patients with bladder cancer who had had multiple urological procedures. The author is not aware of any published reports of anaphylaxis following the use of a rhinolaryngoscope reprocessed using Cidex OPA. However, there have been isolated reports of contact dermatitis and asthma in healthcare workers when exposed to Cidex OPA.
A tertiary amine compound (TAC), e.g., Sencron2®, manufactured in Turkey and commonly used in Europe, seems to be a good alternative disinfectant requiring a relatively short disinfectant exposure time and is more cost effective than Cidex OPA. However, this product is not widely used in the United States.
The following protocol is one that the author has used for reprocessing but there are certainly others that could be adopted.
Reprocessing of scope uses cleaning, followed by soaking in a high-level disinfectant, e.g., Cidex OPA Solution (Johnson & Johnson product) or equivalent product. Cidex OPA Solution contains 0.55% ortho-phthalaldehyde
The personnel performing the cleaning of the instrument should wear personal protective equipment, e.g., gloves, eye protection, mouth protection, and fluid-repellent gown. Cidex OPA can stain clothing, countertops, and floors. Cidex OPA may discolor skin. If there is accidental skin contact, wash with soap and water. Skin discoloration will usually resolve after 1-2 days.
- Scrub instrument with anti-bacterial soap and water for 30 seconds.
- Complete a 30 second scrub with 70% isopropyl alcohol.
- Thoroughly rinse scope with water and dry instrument
- Pour Cidex OPA (full-strength) into an appropriate disinfectant tray and fully immerse non-channel endoscope in tray. It is recommended to use a Cidex Solution Test strip each time an instrument is cleaned to confirm that the solution has the Minimal Effective Concentration (MEC) for proper disinfecting. Cover tray with secure lid.
- Soak for 12 minutes at 68 degrees F (per US labeling instructions)
- Rinse thoroughly in disinfectant tray with water for 3 rinses, with each rinse lasting one minute and using a minimum of 2 gallons of water/rinse
- Dry instrument and return to storage case
Note: Unopened, Cidex OPA Solution has a shelf life of 2 years. Once opened, it must be discarded in 75 days. When present in the disinfecting tray, it may be reused for 14 days and then should be discarded.
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