Standard Operating Procedure for Cystoscope and Telescope Cleaning

Dr Rohan Batra, Dr Ankush Goyal

This SOP is for trained personnel involved in reprocessing reusable rigid cystoscopes and their accessories in urology, operating theatres and central sterile services departments (CSSD).

It includes:

  • Telescope
  • Cystoscope sheath
  • Bridge
  • Obturator

General principles

  • Every reusable cystoscope set must undergo appropriate cleaning and sterilization before reuse, in accordance with the device and applicable institutional policy.
  • Cleaning must precede sterilization. Inadequate cleaning can compromise the effectiveness of subsequent processing.
  • Steam sterilization is the preferred method for components compatible with heat and moisture.
  • Low-temperature hydrogen peroxide sterilization, including STERRAD or ETO may be used for devices like telescopes and configurations approved for the specific system and cycle.

Procedure

Step 1. Point-of-use care and transport

  • Remove gross soil promptly after use. This can be done by rinsing the instruments thoroughly under running water.
  • Prevent blood and debris from drying on the instrument.
  • Transport instruments in a closed, labelled, leak-resistant container to the designated reprocessing area.

Step 2. Disassembly and cleaning

  • Wear appropriate personal protective equipment like gloves.
  • Disassemble the telescope, sheath, bridge, obturator and detachable components.
  • Use a compatible detergent or enzymatic cleaner. Alternatively, the instruments can be cleaned with hypochorite solution.
  • Clean external surfaces, joints and accessible channels using appropriate brushes and flushing tools.
  • If the soiling is more, enzymatic solutions with ultrasonic cleaners should be done so that all the contamination and organic products are removed before sterilization.

Step 3. Drying and inspection

  • Dry external surfaces using a clean, lint-free cloth.
  • Dry channels using regulated clean air (air gun can be used here).
  • Inspect the telescope’s optics, sheath, bridge, obturator, connections, seals and channels for residual soil, damage or corrosion.
  • Repeat cleaning if soil remains.

Step 4. Packaging

  • Disassemble the components as required for the selected validated cycle of ETO or H2O2 cycle.
  • Ensure the components meet the process-specific dryness requirements.
  • Apply the required external process indicator and place an internal chemical indicator as specified by the packaging and sterilizer instructions.
  • Label the pack for traceability.

Step 5:  Selection of sterilization method

  1. Steam sterilization (autoclave)
    Confirm that the sheath, bridge and obturator are compatible with the selected steam cycle. In general, the steam cycle is at 121 degrees Celsius with 15 psi for a minimum of 30 minutes. After the cycle, adequate time has to be given for cooling.
  2. Low-temperature hydrogen peroxide sterilization (STERRAD) or ETO
    Confirm that telescope is compatible with the specific STERRAD model or ETO model and cycle. Ensure that instruments are dried properly as any moisture can cancel the cycle midway.

Monitoring of sterilization

  • Mechanical monitoring: Review the cycle record and confirm that the required parameters are achieved.
  • Biological monitoring: Use a biological indicator appropriate for the sterilization technology and follow the prescribed monitoring frequency.

Storage and traceability

  • Store released instruments in a clean, dry and protected area.
  • Inspect packaging integrity and labelling before use.
  • Maintain records linking the sterilization load to the instrument set and patient/procedure, according to institutional policy.
  • Reprocess instruments if the package is compromised or sterility is in doubt.

Troubleshooting

  • Stuck light post / light-cable connector: Remove the light cable if it disconnects normally. If the connector is stuck, inspect for dried soil or residue. Remove visible soil using a soft cloth, sponge or cotton applicator with a compatible, neutral-pH enzymatic cleaning solution. For residual film on the fibre-optic inlet post, if it is still stuck, clean with a 70% alcohol wipe or sterile cotton-tip applicator with 70% alcohol and wait for some time. Special lubricants from authorised instrument providers like Storz, Olympus and Wolff are available like Do not use pliers, hammering, excessive twisting, metal tools, unapproved lubricants or solvents.
  • Soiling of Telescope lens: Complete the routine cleaning process first. Confirm that the residual deposit is on an optical glass surface. Apply a small amount of the specified cleaning paste to a clean, moistened cotton applicator. Thoroughly rinse away all paste residues. Complete the required cleaning and reprocessing steps again, including drying, inspection and the validated sterilisation process before reuse.

Responsibilities

  • Urology/operating theatre staff: Point-of-use care and safe transport.
  • CSSD staff: Cleaning, inspection, packaging, sterilization, monitoring and documentation.
  • Institutional authority: Approval and periodic review of the SOP.

Related Posts