Anonymous wrote:

Dr. Korman - 

My apologies for being vague.  I'm referring to the hyfrecator pen. I understand the blade is disposable.  Clearly, I have not done this procedure nor seen it done (yet) - so I am unfamiliar with the equipment.  Assuming there is a protective shield for these?  All of the rest, I understand.

Thank you,

Becky

So for the pen (handpiece): you can find the full instructions for use attached but you can either disinfect or sterilize, we only disinfect because it is not a sterile procedure and isn't in contact with the patient.  The pen is covered by a disposable sheath which conmed makes but also other brands- you can find it on the web if you search electrosurgical pencil sheath and hyfrecator.  In our office we disinfect only.  These are from the conmed instructions for use:

Pre-Cleaning/Disinfection:Pre-cleaning followed by disinfection may be used if:

• The handpiece is used with a Hyfrecator Sheath and sheath remains intact through procedure and subsequent handling; and

• The handpiece, not including the electrode, only contacts intact skin. Pre-cleaning:

1. Disconnect the handpiece from the generator and remove the electrode from the handpiece.

2. Using a CaviWipes™ or CaviWipes1™ disinfecting towelette, clean the surface of the handpiece including the section of cord at the proximal end of the handpiece and the distal tip of the handpiece of all gross debris.

3. Discard towelette.

Disinfection:

1. Using a CaviWipes™ or CaviWipes1™ disinfecting towelette, thoroughly wet the surface of the handpiece including the section of cord at the proximal end of the handpiece and the distal tip of the handpiece.

2. Ensure the surfaces are visibly wet and remain visibly wet for a minimum of 3 minutes for CaviWipes™ or 1 minute for CaviWipes1™

Cleaning followed by steam sterilization is required if the handpiece is used with a sterile sheath and the sheath is compromised during use or during handling post-use, or if the handpiece, not including the electrode, contacts non-intact skin or sterile tissue. Cleaning: 1. Disconnect the handpiece from the generator and remove the electrode from the handpiece. 2. Prepare a neutral or near-neutral pH detergent per manufacturer’s instructions. 3. Remove any obvious debris from all areas of the handpiece and cable using a soft, non-metallic brush and detergent for a minimum of one (1) minute and until visibly clean. Do not immerse the handpiece.4. Rinse all areas of the handpiece and cable thoroughly with purified water for a minimum of one (1) minute. Do not immerse the handpiece. Sterilization:Place the handpiece in a double muslin wrap or equivalent dual self-sealing peel pouch, and place single layer onto an open tray in a steam autoclave for sterilization. Process using either of the following methods:Steam, Pre-vacuum – Process at 132-135°C (270-275°F) for at least 3 minutes, not to exceed 4 minutes. Recommended drying time is at least 5 minutes at 132-135°C (270-275°F).Steam, Gravity Displacement – Process at 132-135°C (270-275°F) for at least 10 minutes, not to exceed 15 minutes. Recommended drying time is at least 5 minutes at 132-135°C (270-275°F

yes forceps and electrocautery

how do you clean your medical devices after making a procedure ? 
wich antiseptic is the best for killing HPV ? 

I work in a Ryan White clinic where the population is primarily MSM. I am trying to initiate DARE, rectal cytology and ultimately anoscopy to better care for our patients.

1.       With regard to cytology an earlier module mentioned using either a cytobrush or polyester swab, but the cytology lecture mentioned only the swab. Could you clarify? I had seen a lecture a couple of years ago by a colorectal surgeon that performed with cytobrush and that’s what I’ve consistently used – probably incorrectly?

Also, for the swab I’m assuming it would be an OB swab like OB/Gyn Swab Plastic Rayon Tip 8" Non-Sterile Oversized?

2.       Do you have any guidance on performing DARE without a chaperon in the exam room? While I never perform a cervical PAP on a female patient I find most male patients prefer the medical assistant not to be in the room. That’s never made me uncomfortable with cytology but as I think about performing DARE on MSM it makes me a bit nervous that the procedure could be perceived sexually? Appreciate any advice.