ABSTRACT
PURPOSE: Numerous federal bodies and professional societies have produced guidelines and standards for the reprocessing of endoscopes, but few specifically address the reprocessing of cystoscopes. MATERIALS AND METHODS: This document presents a summary of the current recommendations for reprocessing flexible cystoscopes, and highlights particular aspects of instrument reprocessing that are unique to cystoscopy. RESULTS: Cystoscopes are classified as "semi-critical" devices. Such devices require high-level disinfection or sterilization between patients. High-level disinfection differs from sterilization in that high-level disinfection does not kill large numbers of bacterial spores, while sterilization involves the complete destruction of all microbial life. In the office setting, high-level disinfection (using glutaraldehyde or another chemical disinfectant) is commonly employed for the reprocessing of flexible cystoscopes. During high-level disinfection, standard reprocessing steps should be followed to prevent contamination of the cystoscope between uses. These include precleaning, leak testing, cleaning, disinfection, rinsing, and drying. Recommended "soak times" for glutaraldehyde vary from 20 to 45 minutes, depending upon the degree to which these steps are followed. If no precleaning is performed, a 45-minute glutaraldehyde soak is required to achieve high-level disinfection. Conversely, a 20-minute soak is adequate to achieve high-level disinfection if recommended reprocessing steps are followed prior to immersion in the glutaraldehyde. One chemical disinfectant (ortho-phthalaldehyde) has been associated with anaphylaxis in bladder cancer patients, and should be avoided in these patients. CONCLUSIONS: This white paper provides a concise reference document for the reprocessing of flexible cystoscopes. In addition, references and links to more comprehensive resources are provided. This document may be useful for clinicians and others who are in search of guidance in this area.
Subject(s)
Cystoscopes , Disinfection/standards , Equipment Reuse/standards , Sterilization/standardsABSTRACT
Technological advances have changed how traditional surgical procedures are performed. New knowledge and surgical skills are required to effectively monitor the patient and manage fluids administered perioperatively. Today, selective fluids are used in a variety of surgical specialties. Complications of fluid therapy can occur that are intrinsic to each procedure within a specialty. This article provides perioperative nurses with the information needed to evaluate different fluid media and their applications and identify patient care considerations. Possible complications and important postanesthesia care concerns also are discussed.
Subject(s)
Fluid Therapy/methods , Minimally Invasive Surgical Procedures/nursing , Operating Room Nursing/methods , Perioperative Care/methods , Preoperative Care/methods , Arthroscopy/adverse effects , Arthroscopy/nursing , Fluid Therapy/adverse effects , Fluid Therapy/nursing , Gynecologic Surgical Procedures/adverse effects , Gynecologic Surgical Procedures/nursing , Health Services Needs and Demand , Humans , Lipectomy/adverse effects , Lipectomy/nursing , Minimally Invasive Surgical Procedures/adverse effects , Monitoring, Physiologic/methods , Monitoring, Physiologic/nursing , Nursing Assessment/methods , Osmolar Concentration , Patient Discharge , Patient Education as Topic , Patient Selection , Perioperative Care/adverse effects , Perioperative Care/nursing , Practice Guidelines as Topic , Preoperative Care/adverse effects , Preoperative Care/nursing , Urologic Surgical Procedures/adverse effects , Urologic Surgical Procedures/nursingABSTRACT
Reprocessing of endoscopic instrumentation reduces the risk of transmitting infectious organisms to patients and health care workers. Health care workers should use the Bloodborne Pathogen Standard and Standard Precautions to determine the best method to reduce and/or eliminate bioburden.