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Lumen based medical devices such as catheters, scopes, etc are toughest to clean due to complicated shape and lack of access to surface. Presently, hospitals manually clean catheters by flushing it with chemical & water using syringe. But this method has several drawbacks such as: • No Patient Safety: According to International Journal of Current Microbiology and Applied Sciences study, 72% of manually cleaned catheters are found contaminated with blood, clots or debris and during ETO sterilisation, the left blood components absorbs ETO gas which later causes toxicity in patient. [1,2]• Staff Safety: Long term/daily exposure to Multi-enzyme solutions used for cleaning catheters had adverse effects on labour/staff health such as vision problem, respiratory defects and may lead to cancer as well. This information is also mentioned on multi enzyme solution MSDS (Material Safety Data Sheet) provided by multi-enzyme solution manufacturer.• No quality assurance and non-standard process: Manual cleaning is a non-standard activity. Cleaning parameters such as pressure, time, etc cannot be regulated. Hence, Quality Assurance is not possible. Even accrediting agencies such as JCI, NABH etc do not recommend manual processing. The success rate of hand cleaned catheters is only 28% whereas the success rate of automated cleaned catheter is 99.3% (p<0.004) [1]. Hence, the clinically proven safe way of reprocessing catheter is to get it cleaned using Automatic Catheter Reprocessing System. You can use any commercially available Catheter Reprocessing System (CRS). Select the CRS which had inbuilt self-testing & calibration to ensures precise & effective cleaning of all types of catheters. The following are the steps for effective cleaning of catheters using automated systems (CRS):
== Steps ==
=== Wear Personal Protective Equipment (PPE) ===
# Wear following PPE to ensure work place safety:
#* Gloves
#* Eye protection
#* Apron
#* Shoe Covers
#* Hair cap and mask
=== Immediate washing of soiled catheter ===
#* Within Cath Lab, Nursing staff immediately rinse and flush the catheter once it is taken out of patient body with saline or RO water. This is a very crucial step.
#* The soiled catheters need to immersed in water or saline till further reprocessing to avoid clotting of blood.
#* After patient procedure is finished, take the soiled catheters to clean utility area.
#* Rinse the catheters surface and flush the lumen thoroughly with RO water.
#* Check catheters for any kink or damage. Discard physically damaged catheters.
=== Soak catheters in Multi Enzyme Solution ===
# It is recommended to immediately clean the catheters using automated reprocessing system.
# Incase, immediate cleaning is not possible. Prepare diluted solution of multi enzyme cleaner and dip the catheters in it. Ensure catheters are fully submerged. Any multi enzyme solution can be used such as 3M, Johnson & Johnson, Schuelke etc.
=== Clean Catheters using Automated CRS ===
# Automated CRS are very easy to use. As name suggest, they are fully automatic in operation and very less human intervention is required.The steps are as follows:
#* Turn on the system and wait for self test completion. self test checks the sub unit of CRS for any failure and alerts the user in case of part failure. Contact service or hospital biomedical team for in case of support.
#* Wait for "CRS Ready" message on display.
#* Open lid or cover.
#* Connect soiled catheters with cleaning port in the top tray. Maximum 12 catheters can be connected simultaneously.
#* Close lid or cover
#* Press Start Button
#* CRS will automatically take RO water, Chemical solution and dry air. it flushes the catheter using different pressure techniques and at regulated temperature. Generation os such high pressure is not possible with hands or in manual flushing.
#* CRS takes around 18-22 minutes to clean 12 catheters. (1.5 - 2 minutes per catheter).
#* Wait till cycle completes and meantime you can attend some other office work
#* CRS in last stage also dries the catheter lumen as well.
#* Once cycle is complete, A message is displayed on screen and catheters can be removed safely now.
#* Wipe off the catheters surface with clean lint free adsorbent material or fabric or cloth.
#* Check catheter for any physical damage or defect and discard any defective catheters
=== Packaging and sterilization. ===
#* Pack and label the catheters, marking number of use or size or other details
#* Use any cold sterilization techniques such as ETO, Hydrogen Peroxide etc.
#* Catheters are now ready to reuse.
== Tips ==
* In case of any error, restart the cleaning process again.
== Warnings ==
* Discard physical damaged or kinked catheters.
* Do not reprocess Positive Patient Catheters
* In case of any error, restart the cleaning process again.
* Advised Quality Test includes: AAMI TIR 30 or Physical inspection, pH, HIV, Hepatitis A, B & C, Microbial Culture & Protein Detection.
== Sources and Citations ==
* 1. Cardiac Catheters Reprocessing for Limited Resources Hospitals: An Experimental Study, International Journal of Current Microbiology and Applied Sciences. ISSN: 2319-7706 Volume 4 Number 11 (2015) pp. 640-6492. Cardiac Catheter Reuse in An Era of Reform: Cost-Efficiency and Regulatory Policy in the Face of Scientific Uncertainty, Harvard Library, Harvard Community, Dash.harvard.edu
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== Steps ==
=== Wear Personal Protective Equipment (PPE) ===
# Wear following PPE to ensure work place safety:
#* Gloves
#* Eye protection
#* Apron
#* Shoe Covers
#* Hair cap and mask
=== Immediate washing of soiled catheter ===
#* Within Cath Lab, Nursing staff immediately rinse and flush the catheter once it is taken out of patient body with saline or RO water. This is a very crucial step.
#* The soiled catheters need to immersed in water or saline till further reprocessing to avoid clotting of blood.
#* After patient procedure is finished, take the soiled catheters to clean utility area.
#* Rinse the catheters surface and flush the lumen thoroughly with RO water.
#* Check catheters for any kink or damage. Discard physically damaged catheters.
=== Soak catheters in Multi Enzyme Solution ===
# It is recommended to immediately clean the catheters using automated reprocessing system.
# Incase, immediate cleaning is not possible. Prepare diluted solution of multi enzyme cleaner and dip the catheters in it. Ensure catheters are fully submerged. Any multi enzyme solution can be used such as 3M, Johnson & Johnson, Schuelke etc.
=== Clean Catheters using Automated CRS ===
# Automated CRS are very easy to use. As name suggest, they are fully automatic in operation and very less human intervention is required.The steps are as follows:
#* Turn on the system and wait for self test completion. self test checks the sub unit of CRS for any failure and alerts the user in case of part failure. Contact service or hospital biomedical team for in case of support.
#* Wait for "CRS Ready" message on display.
#* Open lid or cover.
#* Connect soiled catheters with cleaning port in the top tray. Maximum 12 catheters can be connected simultaneously.
#* Close lid or cover
#* Press Start Button
#* CRS will automatically take RO water, Chemical solution and dry air. it flushes the catheter using different pressure techniques and at regulated temperature. Generation os such high pressure is not possible with hands or in manual flushing.
#* CRS takes around 18-22 minutes to clean 12 catheters. (1.5 - 2 minutes per catheter).
#* Wait till cycle completes and meantime you can attend some other office work
#* CRS in last stage also dries the catheter lumen as well.
#* Once cycle is complete, A message is displayed on screen and catheters can be removed safely now.
#* Wipe off the catheters surface with clean lint free adsorbent material or fabric or cloth.
#* Check catheter for any physical damage or defect and discard any defective catheters
=== Packaging and sterilization. ===
#* Pack and label the catheters, marking number of use or size or other details
#* Use any cold sterilization techniques such as ETO, Hydrogen Peroxide etc.
#* Catheters are now ready to reuse.
== Tips ==
* In case of any error, restart the cleaning process again.
== Warnings ==
* Discard physical damaged or kinked catheters.
* Do not reprocess Positive Patient Catheters
* In case of any error, restart the cleaning process again.
* Advised Quality Test includes: AAMI TIR 30 or Physical inspection, pH, HIV, Hepatitis A, B & C, Microbial Culture & Protein Detection.
== Sources and Citations ==
* 1. Cardiac Catheters Reprocessing for Limited Resources Hospitals: An Experimental Study, International Journal of Current Microbiology and Applied Sciences. ISSN: 2319-7706 Volume 4 Number 11 (2015) pp. 640-6492. Cardiac Catheter Reuse in An Era of Reform: Cost-Efficiency and Regulatory Policy in the Face of Scientific Uncertainty, Harvard Library, Harvard Community, Dash.harvard.edu
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