Endoscope reprocessing and sterilization system

• US 6,585,934 B1
• Filed: 03/09/2000
• Issued: 07/01/2003
• Est. Priority Date: 10/01/1998
• Status: Expired due to Term

• Current Assignee: Medivators, Inc. (Steris PLC)
• Original Assignee: Minntech Corporation
• Inventors: Sly, Ward J., Marxer, John E., Weimer, Kurt J., Oberleitner, Raymond Paul, Worsnick, Gregory, Onstad, Bradley K., Martin, Bruce D., Henderson, Mary Beth, Stanley, Patricia M.
• Primary Examiner(s): Jones, Deborah
• Assistant Examiner(s): MCNEIL, JENNIFER C
• Application Number:
  US09/522,006
• Time in Patent Office: 1,209 Days
• Field of Search: 422/292, 422/300, 422/28, 134/170, 134/26, 134/22.12, 134/95.3
• US Class Current: 422/28
• CPC Class Codes: A01N 2300/00 Combinations or mixtures of active ingredients covered by classes A01N27/00 - A01N65/48 with other active or formulation relevant ingredients, e.g. specific carrier materials or surfactants, covered by classes A01N25/00 - A01N65/48
• CPC Class Codes: A01N 37/16 containing the group; Thio analogues thereof
• CPC Class Codes: A01N 59/00 Biocides, pest repellants or attractants, or plant growth regulators containing elements or inorganic compounds
• CPC Class Codes: A61B 1/00057 provided with means for testing or calibration
• CPC Class Codes: A61B 1/123 using washing machines
• CPC Class Codes: A61B 1/125 using fluid circuits
• CPC Class Codes: A61B 2090/701 for flexible tubular instruments, e.g. endoscopes
• CPC Class Codes: A61B 90/70 Cleaning devices specially adapted for surgical instruments
• CPC Class Codes: A61L 2/16 using chemical substances
• CPC Class Codes: A61L 2/186 Peroxide solutions
• CPC Class Codes: A61L 2/24 Apparatus using programmed or automatic operation
• CPC Class Codes: A61L 2202/122 Chambers for sterilisation
• CPC Class Codes: A61L 2202/14 Means for controlling sterilisation processes, data processing, presentation and storage means, e.g. sensors, controllers, programs
• CPC Class Codes: A61L 2202/17 Combination with washing or cleaning means
• CPC Class Codes: A61L 2202/24 Medical instruments, e.g. endoscopes, catheters, sharps
• CPC Class Codes: C23F 11/04 in markedly acid liquids
• CPC Class Codes: C23F 11/08 in other liquids
• CPC Class Codes: C23F 11/10 using organic inhibitors

Abstract

A system for reprocessing and sterilizing a previously used endoscope having at least one lumen is disclosed. The reprocessing system includes a reaction chamber into which individual chemical components of a sterilant are transferred by pneumatic force. The system includes a central processor which controls the asynchronous reprocessing and sterilization of at least two endoscopes. A novel sterilant is also disclosed. Also disclosed is a combination of the sterilization device and the sterilant and methods of using the same.

Claims

1. An apparatus for sterilizing a medical instrument having a lumen, said apparatus comprising:

(a) at least one reprocessing bay, each said bay comprising;

(i) walls and a door together defining an interior reprocessing chamber, said door providing selective access to said reprocessing chamber;

(ii) at least one fluid inlet;

(iii) a fluid outlet permitting removal of accumulated fluid in said reprocessing chamber;

(iv) a fluid dispensing unit operatively coupled to at least one said fluid inlet for at least one of spraying fluid onto and flushing fluid through a lumen of a medical instrument disposed in said reprocessing chamber, said fluid dispensing unit including a rotating arm unit rotatably mounted to one of said walls so as to be disposed within said reprocessing chamber, said rotating arm unit including at least one rotating arm member having an interior fluid passage fluidly connected to said fluid inlet, a plurality of orifices defined in said rotating arm member, said orifices being in fluid communication with said fluid passage, so that fluid can pass from said fluid inlet, through said fluid passage, through said orifices and into said reprocessing chamber;

(b) at least one chemical sterilant component container;

(c) at least one sterilant conduit extending between and fluidly coupling said at least one chemical sterilant component container to said reprocessing chamber;

(d) at least one water conduit fluidly coupling a water supply to at least one of said reprocessing chamber, said at least one chemical sterilant component container, and the conduits extending therebetween;

(e) a transfer control system for selectively transferring at least one chemical sterilant component from said at least one chemical sterilant component container to said reprocessing chamber, and for selectively transferring water from a water supply through said at least one water conduit;

(f) a heater for controlling a temperature of said at least one chemical sterilant component; and

at least one medical instrument supporting cassette movably mounted within said reprocessing chamber.

2. An apparatus according to claim 1, in combination with at least one endoscope having a lumen which terminates at one end with a first connector, and wherein said fluid dispensing unit comprises a second connector, complementary to said first connector, said second connector being in fluid communication with at least one said sterilant conduit.

3. An apparatus according to claim 1, wherein said cassette is configured to removably hold an endoscope within said reprocessing chamber.

4. An apparatus according to claim 1, wherein said reprocessing bay is vertically oriented, said vertical orientation keeping said medical instrument in a suspended position above accumulated fluid in said reprocessing bay.

5. An apparatus for sterilizing a medical instrument having a lumen, said apparatus comprising:

(a) at least one reprocessing bay, each said bay comprising;

(i) walls and a door together defining an interior reprocessing chamber, said door providing selective access to said reprocessing chamber;

(ii) at least one fluid inlet;

(iii) a fluid outlet permitting removal of accumulated fluid in said reprocessing chamber;

(iv) a fluid dispensing unit operatively coupled to at least one said fluid inlet for at least one of spraying fluid onto and flushing fluid through a lumen of a medical instrument disposed in said reprocessing chamber, said fluid dispensing unit including a rotating arm unit rotatably mounted to one of said walls so as to be disposed within said reprocessing chamber, said rotating arm unit including at least one rotating arm member having an interior fluid passage fluidly connected to said fluid inlet, a plurality of orifices defined in said rotating arm member, said orifices being in fluid communication with said fluid passage, so that fluid can pass from said fluid inlet, through said fluid passage, through said orifices and into said reprocessing chamber;

(b) at least one chemical sterilant component container;

(c) at least one sterilant conduit extending between and fluidly coupling said at least one chemical sterilant component container to said reprocessing chamber;

(d) at least one water conduit fluidly coupling a water supply to at least one of said reprocessing chamber, said at least one chemical sterilant component container, and the conduits extending therebetween;

(e) a transfer control system for selectively transferring at least one chemical sterilant component from said at least one chemical sterilant component container to said reprocessing chamber, and for selectively transferring water from a water supply through said at least one water conduit; and

(f) a reaction vessel; and

wherein at least one said sterilant conduit extends between and fluidly couples each said chemical sterilant component container to said reaction vessel, at least one said sterilant conduit extends between and fluidly couples said reaction vessel and said reprocessing chamber; and

the transfer control system selectively transfers at least one chemical sterilant component from said at least one chemical sterilant component container to said reaction vessel, and selectively transfers sterilant from said reaction vessel to said reprocessing chamber.

6. An apparatus according to claim 5, comprising at least two reprocessing bays and wherein the transfer control system includes two pumps, one for each reprocessing bay, each fluidly connected to said reaction vessel for moving fluid from said reaction vessel through respective sterilant conduits to a said fluid inlet of the respective reprocessing bay.

7. An apparatus according to claim 6, wherein said transfer system further comprises a central processor, said central processor being operatively connected to said pumps, said central processor having sufficient processing capability to selectively asynchronously operate said pumps.

8. An apparatus according to claim 7, further comprising a user interface, said user interface being operationally connected to said central processor.

9. An apparatus according to claim 5, wherein the transfer control system includes an air compressor, said air compressor being pneumatically connected to said chemical sterilant component container, wherein said air compressor has a capacity to provide sufficient air pressure to said chemical sterilant component container to selectively effect transfer of a chemical sterilant component from said chemical sterilant component container to said reaction vessel.

10. An apparatus according to claim 5, wherein said at least one chemical sterilant component container comprises a first component container and a second component container.

11. An apparatus according to claim 10, in combination with at least one endoscope having a lumen which terminates at one end with a first connector, and wherein said fluid dispensing unit comprises a second connector, complementary to said first connector, said second connector being in fluid communication with at least one said sterilant conduit.

12. An apparatus for sterilizing a medical instrument having a lumen, said apparatus comprising:

(a) at least one reprocessing bay, each said bay comprising;

(i) walls and a door together defining an interior reprocessing chamber, said door providing selective access to said reprocessing chamber;

(ii) at least one fluid inlet;

(iii) a fluid outlet permitting removal of accumulated fluid in said reprocessing chamber;

(iv) a fluid dispensing unit operatively coupled to at least one said fluid inlet for at least one of spraying fluid onto and flushing fluid through a lumen of a medical instrument disposed in said reprocessing chamber;

(b) at least one chemical sterilant component container;

(c) at least one sterilant conduit extending between and fluidly coupling said at least one chemical sterilant component container to said reprocessing chamber;

(d) at least one water conduit fluidly coupling a water supply to at least one of said reprocessing chamber, said at least one chemical sterilant component container, and the conduits extending therebetween;

(e) a transfer control system for selectively transferring at least one chemical sterilant component from said at least one chemical sterilant component container to said reprocessing chamber, and for selectively transferring water from a water supply through said at least one water conduit;

(f) a reaction vessel; and

wherein at least one said sterilant conduit extends between and fluidly couples each said chemical sterilant component container to said reaction vessel, at least one said sterilant conduit extends between and fluidly couples said reaction vessel and said reprocessing chamber; and

the transfer control system selectively transfers at least one chemical sterilant component from said at least one chemical sterilant component container to said reaction vessel, and selectively transfers sterilant from said reaction vessel to said reprocessing chamber; and

(g) a chemical concentration detector, said chemical concentration detector being located within said reaction vessel and operatively connected to said central processor.

13. An apparatus according to claim 12, wherein said chemical concentration detector detects chemical concentration based on refractive index of a fluid sample.

14. An apparatus according to clam 12, wherein said chemical concentration detector includes a source of light energy and at least one of a window or notch through which said light energy is directed at a fluid sample to be measured.

15. An apparatus according to claim 14, wherein said source of light energy comprises a point source LED.

16. An apparatus according to claim 14, wherein said light source comprises a laser.

17. An apparatus according to claim 14, wherein said chemical concentration detector includes at least one of a prism and a reflective surface for redirecting light in said detector.

18. An apparatus according to claim 17, wherein said detector includes first and second prisms for redirecting light passing therethrough.

19. An apparatus according to claim 17, wherein said detector includes a chemical concentration detector array for receiving redirected light that passes through said fluid sample, said chemical concentration detector array comprising a plurality of closely spaced pixels, thereby to determine the refractive index of the fluid sample.

20. An apparatus according to claim 19, further comprising a thermister for measuring a temperature of at least one of the prism and the fluid sample.

21. An apparatus according to claim 19, wherein the detector comprises an elongated probe made of glass.

22. An apparatus according to claim 21, wherein said source of light energy and the chemical concentration detector array are disposed at a common, proximal, longitudinal end of said probe.

23. An apparatus as in claim 22, wherein one of a prism and a surface for redirecting light is disposed at said first longitudinal end for redirecting light from said light source to pass along a length of said probe to a distal end thereof and wherein at least one of a prism and a plurality of surfaces for redirecting light are disposed at said end to direct said light to pass through said window or notch and longitudinally of the probe to said chemical concentration detector.

24. An apparatus for sterilizing a medical instrument lumen, said apparatus comprising:

(a) at least one reprocessing bay, each said bay comprising;

(i) walls and a door together defining an interior reprocessing chamber, said door providing selective access to said reprocessing chamber;

(ii) at least one fluid inlet;

(iii) a fluid outlet permitting removal of accumulated fluid in said reprocessing chamber;

(iv) a fluid dispensing unit operatively coupled to at least one said fluid inlet for at least one of spraying fluid onto and flushing fluid through a lumen of a medical instrument disposed in said reprocessing chamber;

(b) at least one chemical sterilant component container;

(c) at least one sterilant conduit extending between and fluidly coupling said at least one chemical sterilant component container to said reprocessing chamber;

(d) at least one water conduit fluidly coupling a water supply to at least one of said reprocessing chamber, said at least one chemical sterilant component container, and the conduits extending therebetween;

(e) a transfer control system for selectively transferring at least one chemical sterilant component from said at least one chemical sterilant component container to said reprocessing chamber, and for selectively transferring water from a water supply through said at least one water conduit;

(f) a reaction vessel; and

wherein at least one said sterilant conduit extends between and fluidly couples each said chemical sterilant component container to said reaction vessel, at least one said sterilant conduit extends between and fluidly couples said reaction vessel and said reprocessing chamber; and

the transfer control system selectively transfers at least one chemical sterilant component from said at least one chemical sterilant component container to said reaction vessel, and selectively transfers sterilant from said reaction vessel to said reprocessing chamber; and

(g) a load sensor, said load sensor being connected to said reaction vessel and being operatively connected to said central processor for sensing and indicating an amount of material in said reaction vessel.

25. The apparatus for sterilizing a medical instrument having a lumen, said apparatus comprising:

(a) at least one reprocessing bay, each said bay comprising;

(i) walls and a door together defining an interior reprocessing chamber, said door providing selective access to said reprocessing chamber;

(ii) at least one fluid inlet;

(iii) a fluid outlet permitting removal of accumulated fluid in said reprocessing chamber;

(iv) a fluid dispensing unit operatively coupled to at least one said fluid inlet for at least one of spraying fluid onto and flushing fluid through a lumen of a medical instrument disposed in said reprocessing chamber;

(b) at least one chemical sterilant component container;

(c) at least one sterilant conduit extending between and fluidly coupling said at least one chemical sterilant component container to said reprocessing chamber;

(d) at least one water conduit fluidly coupling a water supply to at least one of said reprocessing chamber, said at least one chemical sterilant component container, and the conduits extending therebetween; and

(e) a transfer control system for selectively transferring at least one chemical sterilant component from said at least one chemical sterilant component container to said reprocessing chamber, and for selectively transferring water from a water supply through said at least one water conduit,

wherein said at least one chemical sterilant component container comprises a first component container and a second component container,

in combination with a sterilant, said sterilant comprising;

an anti-microbial two-part concentrate system comprising;

a first component comprising hydrogen peroxide and water;

a second component comprising formic acid and water;

a block copolymer of ethylene oxide and propylene oxide, said block copolymer being present in said first component, said second component, or said first and second components;

phosphoric acid present in said first component, said second component, or said first and second components; and

benzotriazole present in said first component, said second component, or said first and second components,

wherein, prior to mixture to form said sterilant, said first component and said second component are respectively contained in said first component container and said second component container.

26. The combination according to claim 25, wherein said second component contains said block copolymer and said phosphoric acid and, and further wherein said first component contains said benzotriazole.

27. The combination according to claim 26, wherein in the two-part concentrate system:

said second component comprises about 25 wt % to about 95 wt % of said formic acid, about 3 wt % to about 12 wt % of said block copolymer, and about 4 wt % to about 20 wt % of said phosphoric acid, and

said first component comprises about 30 wt % to about 50 wt % of said hydrogen peroxide, and about 2 wt % to about 10 wt % of said benzotriazole.

28. The combination according to claim 27, wherein in the two-part concentrate system:

said second component comprises about 25 wt % of said formic acid, about 3.3 wt % of said block copolymer, and about 5 wt % of said phosphoric acid, and the remainder water; and

said first component comprises about 50 wt % of said hydrogen peroxide, about 2.3 wt % of said benzotriazole, and the remainder water.

29. The combination according to claim 25, wherein said two-part concentrate system is substantially free of an alcohol reactable with said formic acid to form an ester.

30. The combination according to claim 25, wherein said two-part concentrate system is devoid of a sulfur-containing catalyst.

31. The combination according to claim 25, wherein a ratio of said first component to said second component is 60:

40.

32. A method of sterilizing a medical instrument having a lumen, said method comprising:

(I) providing an apparatus, said apparatus comprising;

(a) at least one reprocessing bay, each said bay comprising;

(i) walls and a door together defining an interior reprocessing chamber, said door providing selective access to said reprocessing chamber;

(ii) at least one fluid inlet;

(iii) a fluid outlet permitting removal of accumulated fluid in said reprocessing bay;

(iv) a fluid dispenser operatively coupled to said at least one fluid inlet for at least one of spraying fluid onto and flushing fluid through a lumen of a medical instrument disposed in said reprocessing bay, said fluid dispenser including a rotating arm unit rotatably mounted to one of said walls so as to be disposed within said reprocessing chamber, said rotating arm unit including at least one rotating arm member having an interior fluid passage fluidly connected to said fluid inlet, a plurality of orifices being defined in said rotating arm member, said orifices being in fluid communication with said fluid passage, so that fluid can pass from said fluid inlet, through said fluid passage, through said orifices and into said reprocessing chamber, said fluid dispenser further including a medical instrument connector for providing a fluid tight connection to at least one lumen of a medical instrument disposed in the reprocessing bay for delivering fluid for sterilizing said at least one lumen of said medical instrument;

(b) at least one chemical sterilant component container;

(c) at least one sterilant conduit extending between and fluidly coupling said at least one chemical sterilant component container to said reprocessing chamber;

(d) at least one water conduit fluidly coupling a water supply to at least one of said reprocessing chamber, said at least one chemical sterilant component container, and the conduits extending therebetween;

(e) a transfer control system for selectively transferring at least one chemical sterilant component from said at least one chemical sterilant component container to said reprocessing chamber, and for selectively transferring water from a water supply through said at least one water conduit; and

(f) a heater for controlling a temperature of said at least one chemical sterilant component;

(II) disposing a medical instrument to be sterilized in a said reprocessing bay;

(III) transferring at least one chemical sterilant component from said chemical sterilant component container to said reprocessing chamber; and

(IV) forcing said sterilant under pressure through said plurality of orifices into said reprocessing chamber to effectively sterilize said medical instrument; and

(V) flowing said sterilant through said medical instrument connector and through said at least one lumen of said medical instrument, said sterilant flow receiving a superimposed pulsating flow of air for producing a scrubbing action on a wall of said at least one lumen of the medical instrument.

33. The method of claim 32, wherein said apparatus comprises at least two bays, said bays being selectively operated asynchronously with overlapping operating time cycles.

34. The method of claim 32, further comprising, after disposing the medical instrument to be sterilized in a said reprocessing bay and before transferring sterilant to a said reprocessing bay, the steps of:

cleaning said medical instrument with soap, and rinsing said medical instrument with water.

35. The method of sterilizing a medical instrument having a lumen, said method comprising:

(I) providing an apparatus, said apparatus comprising;

(a) at least one reprocessing bay, each said bay comprising;

(i) walls and a door together defining an interior reprocessing chamber, said door providing selective access to said reprocessing chamber;

(ii) at least one fluid inlet;

(iii) a fluid outlet permitting removal of accumulated fluid in said reprocessing bay;

(iv) a fluid dispensing unit operatively coupled to at least one said fluid inlet for at least one of spraying fluid onto and flushing fluid through a lumen of a medical instrument disposed in said reprocessing bay;

(b) at least one chemical sterilant component container;

(c) at least one sterilant conduit extending between and fluidly coupling said at least one chemical sterilant component container to said reprocessing chamber;

(d) at least one water conduit fluidly coupling a water supply to at least one of said reprocessing chamber, said at least one chemical sterilant component container, and the conduits extending therebetween; and

(e) a transfer control system for selectively transferring at least one chemical sterilant component from said at least one chemical sterilant component container to said reprocessing chamber, and for selectively transferring water from a water supply through said at least one water conduit;

(II) disposing a medical instrument to be sterilized in a said reprocessing bay;

(III) transferring at least one chemical sterilant component from said chemical sterilant component container to said reprocessing chamber; and

(IV) forcing said sterilant under pressure through said fluid dispensing unit and through said plurality of orifices into said reprocessing chamber to effectively sterilize said medical instrument,

further comprising a reaction vessel and at least two chemical sterilant component containers, each of said containers containing one part of a two-part chemical sterilant concentrate system to be prepared in said reaction vessel; and

wherein at least one said sterilant conduit extends between and fluidly couples each said chemical sterilant component container to said reaction vessel, at least one said sterilant conduit extends between and fluidly couples said reaction vessel and said reprocessing chamber; and

the transfer control system selectively transfers said chemical sterilant components from said at least two chemical sterilant component container to said reaction vessel, and selectively transfers sterilant prepared in said reaction vessel from said reaction vessel to said reprocessing chamber and further comprising the steps of;

preparing a sterilant in said reaction vessel;

transferring said sterilant from said reaction chamber to a said reprocessing bay.

36. The method of claim 35, wherein said part of said two-part chemical sterilant concentrate system in each of said chemical component containers is transferred from said respective chemical component container to said reaction vessel by pneumatic force.

37. The method of claim 36, wherein said pneumatic force is provided by an air compressor.

38. The method of claim 35, further comprising after preparing a sterilant in said reaction vessel and before transferring said sterilant from said reaction chamber to said reprocessing bay, maintaining the temperature of said sterilant from about 20°

C. to about 55°

C.

39. The method of claim 35 wherein the apparatus further comprises a load sensor, said load sensor being connected to said reaction vessel for sensing load data from said reaction vessel, and a central processor operatively connected to said load sensor and wherein transferring at least one chemical sterilant component from said chemical sterilant component container to said reaction vessel comprises the transfer of one chemical component and wherein sensing the load data of the reaction vessel and transmitting said load data from said load sensor to said central processor occurs after said transferring at least one chemical sterilant component from said chemical sterilant component container to said reaction vessel, said transferring and said sensing being repeated in order at least once.

40. The method of claim 39, after the at least once repeated transferring and sensing further comprising:

calculating a dilution measurement amount of water in the central processor; and

transferring said dilution measurement amount of water to said reaction vessel.

41. The method of claim 39, wherein said central processor is programmable to effect an apparatus self-sterilization cycle after completion of medical instrument sterilization.

42. The method of claim 41, after forcing said sterilant under pressure further comprising:

self-sterilizing said apparatus.

43. A method as in claim 35, further comprising detecting a leak in a jacket of the medical instrument by pressurizing the instrument jacket with a predetermined air pressure and monitoring air pressure loss to determine the presence of a leak.

44. A method of sterilizing a medical instrument as in claim 43, wherein a leak is determined by comparing monitored air pressure loss to predetermined values.

45. A method of sterilizing a medical instrument as in claim 43, wherein when a leak is detected, operation is terminated and a leakage message is presented.

46. A method as in claim 35, wherein the transfer control system includes a compressed air source, said compressed air source being pneumatically connected to said chemical sterilant component container, wherein said compressed air source has a capacity to provide sufficient air pressure to said chemical sterilant component container to selectively effect transfer of said chemical sterilant component from said chemical sterilant component container through said sterilant conduit, and wherein said transferring step includes providing compressed air from said compressed air source to said chemical sterilant container and using the pressurized air to transfer the chemical component.

47. A method of sterilizing a medical instrument having a lumen, said method comprising:

(I) providing an apparatus, said apparatus comprising;

(a) at least one reprocessing bay, each said bay comprising;

(i) walls and a door together defining an interior reprocessing chamber, said door providing selective access to said reprocessing chamber;

(ii) at least one fluid inlet;

(iii) a fluid outlet permitting removal of accumulated fluid in said reprocessing bay;

(iv) a fluid dispensing unit operatively coupled to at least one said fluid inlet for at least one of spraying fluid onto and flushing fluid through a lumen of a medical instrument disposed in said reprocessing bay;

(b) at least one chemical sterilant component container;

(c) at least one sterilant conduit extending between and fluidly coupling said at least one chemical sterilant component container to said reprocessing chamber;

(d) at least one water conduit fluidly coupling a water supply to at least one of said reprocessing chamber, said at least one chemical sterilant component container, and the conduits extending therebetween; and

(e) a transfer control system for selectively transferring at least one chemical sterilant component from said at least one chemical sterilant component container to said reprocessing chamber, and for selectively transferring water from a water supply through said at least one water conduit;

(II) disposing a medical instrument to be sterilized in a said reprocessing bay;

(III) transferring at least one chemical sterilant component from said chemical sterilant component container to said reprocessing bay;

(IV) forcing said sterilant under pressure through said fluid dispensing unit to effectively sterilize said medical instrument;

(V) releasing a predetermined volume and pressure of air from an air reservoir;

(VI) flowing said volume of air to said lumen of said medical instrument;

(VII) monitoring an air pressure through said lumen; and

(VIII) determining, based on said monitored air pressure, a blockage of said lumen.

48. A method of sterilizing as in claim 47, further comprising the step of terminating operation and presenting a blockage message upon detection of a blockage.

49. A method of sterilizing as in claim 47, wherein said blockage determining step comprises comparing changes in at least one of pressure and flow rate from predetermined values.

50. A method of sterilizing as in claim 47, wherein said medical instrument is an endoscope.

51. A method of sterilizing a medical instrument as in claim 50, wherein the medical instrument is an endoscope.

52. A method of sterilizing a medical instrument as in claim 51, wherein air pressure is maintained in the endoscope jacket during reprocessing to protect the endoscope jacket and its contents from exposure to fluids.