Re: When is a sheath not a sheath??

[Wishart, Michael]

[Posted on behalf of Jenny McCarthy – Moderator]

Hi Michael
If this is the same product we use in the OR here (a video laryngoscope)
the sheath is actually the laryngoscope blade. It is made of hard
plastic and I would imagine almost impossible to perforate during use.
The company recommend washing the reusable handle in detergent and than
wiping over with 70% alcohol. As the OR manager and the infection
control coordinator I was happy with this.
Jenny McCarthy
OR Manager/IC Coordinator
Maryvale Private Hospital
Morwell

—–Original Message—–
Of Wilson, Fiona L (Infection Control)

Dear Michael, it sounds like a sheath to me (main definition of sheath
is a protective covering) and the national guidelines do make it clear
that sheaths are not a substitute for high level disinfection or
sterilisation of semi-critical items (bit like gloves and hand hygiene
really). I would be recommending that the scope is
disinfected/sterilised between patients (whether a sheath was in place
or not).
I am really not sure why sheaths are used at all – if the scopes are
reprocessed between patients, why put a sheath on them?
I would be interested in what the ‘hard plastic disposable cover’ is for
and why it is not considered to be a ‘sheath’.
Also – it may be approved for use by TGA but they would not be saying it
was s substitute for appropriate reprocessing – just that it is
approved for use to cover the scope.

Fiona Wilson
Manager, Infection Control
Western Health
email: fiona.wilson@wh.org.au

—–Original Message—–
Of Wishart, Michael

I am perplexed by a product I have just looked at. It is a video
laryngoscope which has a sterile, disposable hard plastic cover which is
placed over a flexible fibreoptic component and then placed into the
oral cavity for tracheal intubation. Once used on a patient, the hard
plastic cover is disposed of and the manufacturer’s instructions state
the flexible fibreoptic component can be wiped over with 70% alcohol to
decontaminate it.

My understanding of the current national infection control guidelines is
that fibreoptic endoscopes which are covered by sheaths still require
high level disinfection of the non-disposable component that enters a
body cavity. The supplier debated with me that this hard plastic
disposable cover is not a sheath, as it is not likely to be perforated
during normal use. TGA must agree with them as the product is fully
approved for clinical use by TGA. Most users must agree as apparently
this product has been well accepted, mainly in emergency centres and
emergency vehicles.

This made me ask the question: what is a sheath? I do agree that the
hard plastic cover of this product does look like it would resist
perforation in normal use, but at what point does a sheath not become a
sheath? Does this mean that if an ENT endoscope manufacturer comes up
with a hard wearing disposable cover it would not be considered a sheath
for the purpose of our national infection control guidelines?

I would welcome some discussion on this topic to help settle my
perplexion.

Thanks
Michael

Michael Wishart | GPH – Infection Control Coordinator

GPH – Quality & Safety Unit (Infection Control) | Greenslopes Private
Hospital
Newdegate Street, Greenslopes QLD 4120
t: 07 3394 7919 | f: 07 3394 7985
e: WishartM@ramsayhealth.com.au | w: http://www.ramsayhealth.com.au

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[Lisa Ryan]

The hard plastic cover is still regarded as a sheath. This entire device
( once the sheath is discarded )requires high level disinfection as a
minimum as per the national guidelines/ Spalding device classifications.
The actual device manufacturers reprocessing instructions must be
reviewed during the product trial phase by infection/ risk management
input to ensure they are appropriate prior to use.
At my hospital this or a similar devices go through CSD and are
reprocessed using Sterrad as per the manufacturers instructions.

Regards

Lisa Ryan
Infection Control / RTW Coordinator
Calvary North Adelaide Hospital
89 Strangways tce
North Adelaide, 5006
ph;08 82399276
pager; 08 82399100 no 476
email; lryan@calvarysa.com.au

—–Original Message—–
Behalf Of Wishart, Michael

[Posted on behalf of Jenny McCarthy – Moderator]

Hi Michael
If this is the same product we use in the OR here (a video laryngoscope)
the sheath is actually the laryngoscope blade. It is made of hard
plastic and I would imagine almost impossible to perforate during use.
The company recommend washing the reusable handle in detergent and than
wiping over with 70% alcohol. As the OR manager and the infection
control coordinator I was happy with this.
Jenny McCarthy
OR Manager/IC Coordinator
Maryvale Private Hospital
Morwell

—–Original Message—–
Of Wilson, Fiona L (Infection Control)

Dear Michael, it sounds like a sheath to me (main definition of sheath
is a protective covering) and the national guidelines do make it clear
that sheaths are not a substitute for high level disinfection or
sterilisation of semi-critical items (bit like gloves and hand hygiene
really). I would be recommending that the scope is
disinfected/sterilised between patients (whether a sheath was in place
or not).
I am really not sure why sheaths are used at all – if the scopes are
reprocessed between patients, why put a sheath on them?
I would be interested in what the ‘hard plastic disposable cover’ is for
and why it is not considered to be a ‘sheath’.
Also – it may be approved for use by TGA but they would not be saying it
was s substitute for appropriate reprocessing – just that it is
approved for use to cover the scope.

Fiona Wilson
Manager, Infection Control
Western Health
email: fiona.wilson@wh.org.au

—–Original Message—–
Of Wishart, Michael

I am perplexed by a product I have just looked at. It is a video
laryngoscope which has a sterile, disposable hard plastic cover which is
placed over a flexible fibreoptic component and then placed into the
oral cavity for tracheal intubation. Once used on a patient, the hard
plastic cover is disposed of and the manufacturer’s instructions state
the flexible fibreoptic component can be wiped over with 70% alcohol to
decontaminate it.

My understanding of the current national infection control guidelines is
that fibreoptic endoscopes which are covered by sheaths still require
high level disinfection of the non-disposable component that enters a
body cavity. The supplier debated with me that this hard plastic
disposable cover is not a sheath, as it is not likely to be perforated
during normal use. TGA must agree with them as the product is fully
approved for clinical use by TGA. Most users must agree as apparently
this product has been well accepted, mainly in emergency centres and
emergency vehicles.

This made me ask the question: what is a sheath? I do agree that the
hard plastic cover of this product does look like it would resist
perforation in normal use, but at what point does a sheath not become a
sheath? Does this mean that if an ENT endoscope manufacturer comes up
with a hard wearing disposable cover it would not be considered a sheath
for the purpose of our national infection control guidelines?

I would welcome some discussion on this topic to help settle my
perplexion.

Thanks
Michael

Michael Wishart | GPH – Infection Control Coordinator

GPH – Quality & Safety Unit (Infection Control) | Greenslopes Private
Hospital
Newdegate Street, Greenslopes QLD 4120
t: 07 3394 7919 | f: 07 3394 7985
e: WishartM@ramsayhealth.com.au | w: http://www.ramsayhealth.com.au

This e-mail message and any accompanying files may contain
information that is confidential and subject to privilege. If you
are not the intended recipient, and have received the e-mail
in error, you are notified that any use, dissemination,
distribution, forwarding, printing or copying of the message
and any attached files is strictly prohibited. If you have
received this e-mail message in error please immediately
advise the sender by return e-mail, or telephone 1800 243 903.
You must destroy the original transmission and its contents.
Any views expressed within this communication are those of
the individual sender, except where the sender specifically
states them to be the views of Ramsay Health Care.
This communication should not be copied or disseminated
without permission.
————————————————————————

Messages posted to this list are solely the opinion of the authors, and
do not represent the opinion of AICA.
Archive of all messages are available at http://aicalist.org.au/archives
– registration and login required.
Replies to this message will be directed back to the list. To create a
new message send an email to aicalist@aicalist.org.au
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Northern/Melbourne/Western Health e-mail network. The sender cannot be
validated. Caution is advised. Contact IT Services (+61 3 ) 9342 8888
for more information.

Messages posted to this list are solely the opinion of the authors, and
do not represent the opinion of AICA.
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Replies to this message will be directed back to the list. To create a
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This email and any attachments transmitted with it are confidential and
may be subject to legal professional privilege. If you are not the
intended recipient, you are prohibited from using, disclosing, or
copying the information (including any personal information) contained
in it unless lawfully authorised to do so by the intended recipient. Any
misuse may contravene Australian privacy and other laws where personal
information is included.
If you have received this email in error, please inform us by return
email and
then delete the all copies of the email and any attachments from your
mailbox and computer storage.

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do not represent the opinion of AICA.
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