COVID-19 Infection Control Policy

  • Overnight Storage of Equipment:

    • Cleaned endoscope and associated equipment shall be stored in a locked, climate-controlled, clean space overnight.

    • The cleaned endoscope shall remain within a transport sleeve in the storage case.

    • OR

    • The cleaned endoscope shall be contained within a humidity, temperature and environmentally controlled locked upright cabinet.

    • If at any time the endoscope has not been cleaned for more than 5 days it will be immediately re-processed prior to its next use.

 

  • Transport of Equipment to Facility:

    • Cleaning procedures for the equipment transport vehicle.

      • All FEES equipment shall be stored within a specified, cleaned space within the vehicle

      • The storage space within the vehicle shall be cleaned with a bleach solution (1/3 cup bleach to 1 gallon of water).

        • Spray the non-porous surface of the endoscope storage area with the bleach solution.

        • Allow the solution to sit for 5 minutes.

        • Wipe the excess solution with a clean, dry paper towel.

      • (Previously cleaned) Cart, tote, and endoscope case shall be placed on a clean, dry surface in the storage area of the vehicle for transport to the facility.

      • OR

      • (Previously cleaned) Tote and endoscope case shall be placed on a clean, dry surface in the storage area of the vehicle for transport to the facility.

 

  • Unloading vehicle/entering the facility:

    • Entry into the facility shall be through the authorized location and compliance with all entry requirements will be ensured (i.e.: temperature checks, questionnaires, provision of this policy in writing, etc).

    • No items made of fabric (other than personal clothing) shall be brought into the facility.

      • All items related to the performance of the FEES procedure shall be either single-use and disposable or able to be wiped down with a SaniCloth or bleach solution.

 

  • Pre-FEES preparation:

  • Prior to use with first patient, and away from patient’s room (or patient if exam being done in a dedicated therapy room), use test strip to test Resert Revital-Ox solution, according to manufacturer’s instructions (full dip, lay flat, read at 90 seconds, purple=pass). If it does not pass, re-test. If fails, discard Resert Revital-Ox obtain fresh Resert Revital-Ox and re-test. Record testing in log. 

  • With gloves on, dry leak test (30 seconds) with scope remaining in protective sleeve. Return scope to carrying case and transport scope to patient room (or bring patient to therapy room). 

  • With gloves on, place thermometer into Resert Revital-Ox to verify temperature (between 68 and 86 degrees)

 

  • Completion of the FEES procedure:

    • Don personal protective garments as appropriate and indicated by the facility for each patient. 

    • Discard protective sleeve from endoscope. 

    • With fresh gloves on, complete FEES exam. 

 

  • Pre-Cleaning of Endoscope:

    • Immediately after study, perform pre-cleaning with Enzymatic sponge (Ruhof Corp, Endozime Sponge) or enzymatic wipe (RTU Enzymatic wipe, Zutron).

    • Using gloved hands, remove the Enzymatic Sponge or wipe from the package holding over a sink or dirty container to catch the enzymatic solution. 

    • Place the endoscope insertion tube into the sponge/wipe and gently squeeze around the tube. 

    • In a downward motion, gently pull sponge/wipe past the end of the scope. Take care not to tug on the scope as this will pull the it away from the proximal scope housing. Repeat the cleaning slowing and gently 3 to 5 times. 

    • Next, use the sponge/wipe to clean the distal tip of the endoscope. Care should be taken in handling the tip to prevent damage to its mechanical movement properties. Gently brush the sponge/wipe on the lens of the endoscope several times and in several different directions to dislodge and clear any debris. 

    • Discard the sponge or wipe into an appropriate trash receptacle. 

    • Rinse scope in running tap water. 

 

  • Wet Leak Testing:

    • Attach leak tester to scope

    • Inflate to 160-180 mm Hg

    • Perform dry test, 10 seconds

    • Holding pressure from dry test, move scope into Resert Revital-Ox tube and perform wet test with appropriate scope movement, 10 seconds

    • Remove from liquid, release pressure, disconnect leak tester. 

    • Record results in log

    • If tests fail, scope cannot be used until repair is completed by scope manufacturer.

 

  • Isolation Patients: 

    • Thorough cleaning of equipment after assessing a patient on isolation precautions is mandatory, done just inside the FEES exam room, or outside the exam room if logistics do not allow for adequate cleaning while in room. Appropriate wipe is used (SaniCloth or bleach as indicated). Resert Revital-Ox is discarded after use with patients with highly infectious conditions (VRE, MRSA, c diff., etc) and replaced with new solution.

 

  • High Level Disinfection:

    • Replace rubber cap on the distal end of the cord. 

    • Insertion portion of the endoscope is soaked in Resert Revital-Ox for 8 minutes.

    • Completely rinse insertion portion of scope in tap water.

    • Wipe scope with alcohol pad (70% isopropyl).

    • Allow to dry while hanging for minimum of 15 minutes.

    • Place in clean protective sleeve and place scope into travel carrying case for transport. 

 

  • Cleaning of FEES computer and other equipment:

    • Components are wiped down with SaniCloth (or bleach cloth for patients with c.diff) with attention given to “high frequency touch” surfaces.

    • If SaniCloths are unavailable, all hard surfaces shall be sprayed with a solution consisting of a mixture of 1/3 cup bleach mixed with 1 gallon of water, per CDC guidelines. This shall remain on the hard surfaces for a minimum of 5 minutes, then the remainder wiped off with a clean, dry paper towel. 

 

  • Storage of Clean Endoscope between procedures:

    • Scope is placed in plastic sleeve and returned to hard case

    • If clean scope is not used for 5 days, it must be completely re-processed with HLD before next use.

 

  • Procedure for loading equipment into vehicle:

    • Outside of the vehicle, spray the entire cart, scope case, and equipment tote with Lysol or bleach solution (including cart wheels) as well as non-porous liner of cargo area of the vehicle prior to placement of the equipment into the storage area of the vehicle. 

    • OR

    • Outside of the vehicle, spray the scope case and equipment tote with Lysol or bleach solution (including endoscope case wheels) as well as non-porous liner of cargo area of the vehicle prior to placement of the equipment into the storage area of the vehicle. 

 

References:

  • Alfa, M.J. & Howie, R. (2009). Modeling microbial survival in buildup biofilm for complex medical devices. BMC Infectious Diseases, 9, 56-69. 

  • Center for Disease Control (2009). Guideline for disinfection and sterilization in Healthcare Facilities, 2008. CDC Healthcare Infection Control Practices 

  • Advisory Committee (HICPAC), November 2008; rev. December 2009. www.cdc.gov/hicpac/pdf/guidelines/Disinfection_Nov_2008.pdf. 

  • Centers for Disease Control. (2017). Cleaning and Sanitizing with Bleach – Natural Disasters and Severe Weather. Retrieved from www.cdc.gov/disasters/bleach.html.

  • Center for Disease Control (September, 2015). Immediate need for healthcare facilities to review procedures for cleaning, disinfecting, and sterilizing reusable medical devices. CDC Health Advisory, CDCHAN-00382. 

  • Collins, W.O. (2009). A review of reprocessing techniques of flexible nasopharyngoscopes. Otolarynogology, Head and Neck Surgery, 141, 307-310. 

  • FDA (2009). Preventing cross-contamination of endoscope processing: Safety communication from FDA, CDC, and the VA. Retrieved November 8, 2012, from http://www.fda.gov/MedicalDevices/Safety/Alertsand Notices/ucm190273.htm. 

  • Rutala, W.A. & Weber, D.J. (2004). Reprocessing endoscopes: United States perspective. Journal of Hospital Infection, 56,Suppl 2, S27-39 

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Email: Danni@mobilefeesnwa.com

Phone: 479-222-1425

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Danni Welch, M.S.CCC-SLP

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