The Project: To ensure the safe transfer of chemical disinfectants within an endoscope reprocessing unit.

The Solution: Use custom fabricated couplings that provide a leak-free fluid pathway.

By Sean Fenske, Editor-in-Chief
Today's medical practitioners rely on flexible endoscopes for a variety of diagnoses ranging from those involving colon-related illnesses to sinus ailments. While the use of these high-cost devices has become more routine, the cleaning and high-level disinfection procedures involved with equipment reprocessing can be challenging.

The WD440 AdaptaScope endoscope washer uses quick disconnect couplings that provide a leak-free connection between internal endoscope channels and endoscope washing devices during the cleaning and disinfection process.
Endoscopes are generally difficult to clean and the harsh chemicals used for reprocessing need to be handled with care. For this reason, many hospitals and medical centers are now utilizing automated cleaning systems. Advanced reprocessing systems are helping medical organizations reduce nurses' exposure to chemicals during disinfection procedures, while at the same time, minimizing patient health risks that can result from improperly cleaned equipment. Furthermore, they expedite the endoscope reprocessing effort and allow practitioners to avoid exam backlogs.

The increased reliance on automated equipment has, in turn, led to a greater urgency among suppliers of these washing and disinfecting systems to differentiate their product designs. For Wassenburg Medical Devices of Dodewaard, Netherlands–a supplier of reprocessing systems to Europe, Middle East, and Africa–one secret to its success is the use of high-quality, reliable components such as quick disconnect couplings from Colder Products Co. (St. Paul, MN), a provider of fluid connection solutions. These coupling products provide a leak-free connection between internal endoscope channels and endoscope washing devices during the cleaning and disinfection process.

"Proper disinfection of endoscope devices requires the use of aggressive, liquid chemicals. We needed a durable, easy-to-use coupling that could minimize the exposure of gastroenterology nurses to these potentially harmful cleaners during the disinfection procedure," says Ronald Wassenburg, owner of Wassenburg Medical Devices. "Colder designed a leak-free, user-friendly connection that provides safety benefits while also helping to expedite the reprocessing effort."
Endoscope Usage on the Rise
Endoscopes are heat-sensitive, electronic instruments used in internal body cavity examinations. An endoscope's internal channels (or lumens) are used to shine light in the specific body cavity that is being analyzed. Typical endoscopic procedures include colonoscopies, bronchial, sinus, and abdominal exams.

One reason the use of the flexible endoscope has become increasingly common is because endoscopic tests represent a favorable alternative to surgical diagnostic methods. For practitioners, the endoscopic procedure eliminates the need to make medical incisions to determine ailments. For patients, this means they can avoid the stress of surgery and accelerate the individual healing process.

However, to ensure endoscopes are available without delay, practitioners need an effective and efficient reprocessing method. Endoscopes are high-cost devices, so they are reused by hospitals and medical centers. Before reuse, the equipment must be safely reprocessed to eliminate the risk of transmitting infectious diseases among patients. This involves a complex cleaning and disinfection effort. The procedure is particularly challenging because the internal channels of the endoscope can become exposed to microorganisms that are often difficult to reach, especially during manual cleaning activities.

Since manual washing methods are often tedious and time-consuming, medical organizations have begun seeking out more effective alternatives. One solution increasingly being adopted worldwide is the use of automated cleaning systems.
Automated Cleaning Solution

Quick disconnect couplings like this valved version are custom-made and tested in advance to ensure compatibility with the harsh chemicals used during reprocessing.
Automated cleaning systems are efficient and relatively simple to use. For example, Wassenburg's WD440 AdaptaScope endoscope washers are top-loading devices that open in a similar fashion to household washing machines. Once the top door is opened, an endoscope is inserted for cleaning. Each internal channel of the endoscope is connected to separate fluid lines in the washing apparatus, ensuring that they are rinsed independently. Separate pumps assist with potential blockage of fluid paths, while keyed, color-coded cleaning lines transmit aldehyde-based disinfectants and oxidants. A touch-screen display guides users through the internal cleaning steps at the same time that a powerful washing process cleans the outside of the endoscope.

"Transmittable illnesses such as NvCJD (New Variant Creuzveld Jacobs Disease), commonly known as mad cow disease, have alerted health officials to the risks that are involved if endoscope devices are not properly processed," says Wassenburg. "Our machines are characterized by precise measuring systems and process control so an alarm is sounded if for some reason an internal channel is blocked and prevents proper processing from occurring."

A further benefit of Wassenburg systems is traceability. Process data such as the endoscope code, user code, and patient code can be saved in the machine's memory and downloaded to a computer. It can then be easily accessed in the event of a medical emergency to track the source of a problem.
Ensuring Safety and Effectiveness
While traceability features provide peace of mind for customers, Wassenburg relies on specialized, high-quality components to ensure optimum machine operation. The system's couplings, for instance, were custom-made by Colder and tested in advance to ensure they were compatible with the harsh chemicals used during reprocessing. Colder couplings also include important safeguards against misconnections.

"Colder worked with us from the beginning to find a solution that met our material requirements," says Wassenburg. "In addition, the couplings produce an audible "click" that alerts our technicians when the connection has been made and they are keyed to match corresponding fluid lines. These features offer added assurance that the coupling will not become disconnected during the cleaning process and that nurses are connecting the right lines."

While the number of couplings used in endoscope washers varies from one model to the next, endoscope reprocessing equipment generally requires several connections on the machine's inside as well as to the supply and drain lines. Wassenburg uses a variety of Colder couplings with 1/8 in. and 1/4 in. flow path. It is the keying feature, however, that is a big hit with gastroenterology nurses.

"Nurses appreciate color-coded fluid lines, since they match the required connections and ensure the machines are properly hooked up in advance of cleaning. They also frequently comment on how easy the couplings are to use," says Wassenburg.

This ability to offer practical couplings that make its systems more appealing to nurses is important for Wassenburg. Yet, patient safety remains paramount.

"Having a reliable coupling is just one aspect of a safe, overall system–albeit an important one. Knowing that our systems can be depended on for fast and efficient cleaning during medical emergencies certainly makes the investment worthwhile," says Wassenburg.
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