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3 Questions About Autoclavable Endoscopes
What you need to know before you switch from chemical sterilization or upgrade your old scopes.
Stephanie Wasek
Publish Date: October 10, 2007   |  Tags:   Infection Prevention

Today's surgical imaging devices are truly autoclavable - light cords, telescopes, videoscopes and cameras. The benefits of using autoclavable endoscopes for general, colorectal, bariatric, orthopedic, ENT, GYN, cosmetic and urological procedures are many: faster room turnover, reduced inventory and a method of reprocessing that's more reliable, inexpensive and environmentally safe. Here are three questions you should ask the manufacturer before you buy an autoclavable scope - whether you're buying your first or upgrading your old one - to set your mind at ease that you're getting what you want.

1. Is the entire optical chain autoclavable?
The scope, camera and light cable are the components of the optical chain. However, if one of the optical chain's components is not autoclavable, you need to maintain two reprocessing systems anyway - typically an autoclave and a peracetic acid or hydrogen gas plasma system - notes Alex Seifert, the director of surgery center systems for Arthrex.

"Each component needs to be autoclavable, or you're still paying and waiting for the chemical cycle," says Matt Fahy, the director of marketing for Olympus surgical products. "If you have to do even one piece in something other than an autoclave, you're not saving yourself time or money."

Autoclaving is reasonably fast (about 20 minutes) and costs pennies a cycle, compared with chemical reprocessing, which can be over $10 per cycle, says Mr. Fahy. Besides, if the entire optical chain is autoclavable, you'll be following the Association for periOperative Registered Nurses' (AORN's) preferred method for sterilization, and you'll be using an environmentally friendly - both inside and outside the workplace - method of sterilization, Mr. Fahy points out.

There's no real reason you couldn't reprocess one part of the optical chain differently than the others; they will still work together, according to Mr. Seifert. However, he says, the scopes, cameras and light cords should not be autoclaved one day and chemically sterilized the next, because the chemicals could affect the way the device's seals withstand the heat and pressure of the autoclave.

Is Your Water Good for Your Scopes?

The beauty of autoclaving is that the high temperatures will kill any bacteria and viruses on your autoclavable scopes. However, any dirt or debris on your autoclavable scopes will not be eradicated; in fact, it'll be even more difficult to get rid of. That's why it's very important to consider your facility's water quality when reprocessing autoclavable scopes.

"If you have hard water, or if your water comes from a desalination facility, some of what's in that water can end up on the scopes as deposits," says Fred Newey, a market manager for Smith and Nephew. "It's like a lasagna pan: If you don't do a good job of cleaning it, then you put it in the oven again, you'd just be baking everything on there. And just as that debris wouldn't allow you to see through the glass pan well, it wouldn't allow you to see through the scope's lens well, either."

Especially if you're in the process of building a facility, it's important to have the water quality tested and to install filters and water softeners, if necessary.

"You have to take the care to clean the scopes properly, too," says Mr. Newey. "If you're switching to autoclavable scopes, you have to make some commitment to the new cleaning steps and cleaning processes."

- Stephanie Wasek

2. Is the scope really autoclavable?
"The word autoclavable is often misused or overused," says Mr. Fahy. "In reality, everything is autoclavable once. You can put your phone, for instance, through an autoclave once. But it's not fair to say it will work the second time.

"Being able to autoclave something over the long-term is different than its simply being autoclavable."

He recommends you check the fine print or ask your equipment sales representative whether the autoclavable scope you're looking into carries a limit on the number of cycles, or whether chemical reprocessing is recommended over autoclaving. In addition, says Mr. Fahy, you can't always count on being able to put an autoclavable telescope or videoscope through a flash cycle, so you should get the details on that, too, before you decide on a scope.

"It's great for metal instruments, like scalpels. That's easy," says Mr. Fahy. "The challenge is with multi-component products like imaging devices that are composed of a variety of materials like glass and metal."

3. Can it be flashed?
Any claim that a scope is autoclavable needs to be further defined so that the user knows if flash autoclaving, as opposed to the longer pre-vacuum cycle, has been validated by the manufacturer.

Flash cycles are more stressful on instruments because the temperature is raised rapidly, the steam is exhausted out, and the temperature then comes down quickly, says Melissa Waldroup, the product manager for reprocessing at Richard Wolf. The harsh cycle causes the metal and glass to expand and contract, which the materials do at different rates, and which therefore can lead to damage to the scope, says Mr. Fahy.

So if a scope is approved only for pre-vacuum autoclaving - which itself involves very high temperatures, but during which the temperature comes down much more slowly - not only will you have to be prepared for potentially longer turnaround times, but you could damage the scope if it is flashed after you find yourself down a scope with little turnaround time available.

"Pretty much any scope can be pre-vacuum-approved for a lifetime," says Ms. Waldroup. "And AORN and AAMI (Association for the Advancement of Medical Instrumentation) standards state that flash is for emergency use only, so we don't recommend that you use it regularly. But many scopes do hold up for long-term flashing."

And AORN recommends you flash in emergency situations if you don't have time to put an instrument through a regular cycle in the autoclave, says Mr. Fahy. "Chemical reprocessing is further down the list," he says.

Therefore, when buying an autoclavable scope, you should "take into consideration how often you use flash, whether you have flash trays and how you are going to transport those scopes," says Ms. Waldroup. "Trays are essential for autoclaving and flash for a scope's protection."

Check with the manufacturer for its recommendations if you plan to flash your scopes or just want that option. The AORN recommends three minutes at 270'F after proper, thorough manual cleaning and decontamination.

Safeguarding your autoclavable scopes
When you have an autoclavable scope, you must be vigilant about protecting it from damage, as even the smallest defect could lead to water's getting inside the scope, which would require thousands of dollars worth of repairs.

"Theoretically, the way the steel and lenses are joined together, they should last for a very long time," says Fred Newey, a market manager for Smith and Nephew. "When scopes come in for repair, it's related to some kind of damage, usually from handling, and not due to anything solely as a result of autoclaving. For example, in arthroscopy, you're using a lot of drills and shavers, and the scope will be damaged by those."

Careful scope inspection and handling, then, will help make your investment in autoclavable technology more worthwhile.

"Using autoclavable telescopes and videoscopes translates to better patient safety and durability and cost-efficiency," says Mr. Fahy. "You can perform more procedures more effectively. It's bewildering to me that there are people who don't do autoclave."

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