INTRODUCTION

Reprocessing the nasopharyngoscope in a community based Otolaryngology clinic

       For the reprocessing of a nasopharyngoscope currently there are four available techniques: Automatic Reprocessing Machines, High Level Disinfection, Sterile polyurethane sheath and Chlorine Di-Oxide Wipes (Tristel)1,2,3,4. The automatic reprocessing is performed with Peracetic acid or Ortho-phthalaldehyde vapors, it is the preferred method of disinfecting flexible scopes in the medical institutions. HLD is the method of choice in the community-based clinics. The polyurethane sheaths and chemical wipes either are not approved by Public Health Agencies (PGHA) or not available in most jurisdictions. The primary objective of the project of HLD-Station has been to improve the effectiveness, safety, and compliance with the PHA requirements.

        HLD protocol includes Air Leak Tests (Dry and Wet), Enzymatic whipping, Immersion of the scope in a disinfectant solution for a specified period and a thorough rinse in clean water before and after the usages on the patients. However, in practice the performance of these steps varies among the practitioners. The most significant variability involves the immersion of the scope in the disinfectant solution, Partial Immersion of the flexible fiber bundle alone or the Full immersion of the entire instrument.  Although, the full immersion procedure is the most desirable technique, but it requires the use of large volumes of the chemical disinfectant in a plastic tub predisposing for the damage to the flexible scope and the contamination of the office environment with the carcinogenic chemical vapors. 

        HLD-Station is designed to offer a modular solution to perform the dry/wet air leak tests, disinfection with full immersion or partial immersion, and the storage of the instrument in a well-ventilated vessel; all in one place. The materials used meet the microbiologic lab requirements and the design protects both the instrument as well as the personnel from harm. 

RFERRENCES

1. Sowerby LJ, Rudmik L. The cost of being clean: A cost analysis of nasopharyngoscope reprocessing techniques. Laryngoscope. 2018 Jan;128(1):64-71. doi: 10.1002/lary.26770. Epub 2017 Aug 16. PMID: 28815686

2. Rutala WA, Weber DJ. New developments in reprocessing semi critical items. Am J Infect Control. 2013 May;41(5 Suppl): S60-6. doi: 10.1016/j.ajic.2012.09.028. PMID: 23622752.

3. Alvarado CJ, Anderson AG, Maki DG. Microbiologic assessment of disposable sterile endoscopic sheaths to replace high-level disinfection in reprocessing: a prospective clinical trial with nasopharygoscopes. Am J Infect Control. 2009 Jun;37(5):408-413. doi: 10.1016/j.ajic.2009.04.276. PMID: 19482219.

4. Rutala WA, Weber DJ. Reprocessing semi critical items: Outbreaks and current issues. Am J Infect Control. 2019 Jun; 47S:A79-A89. doi: 10.1016/j.ajic.2019.01.015. PMID: 31146856.