Manual Disinfection End User
*
1.
Country
(Required.)
2.
Facility
*
3.
Product(s) Used
(Required.)
GUS Disinfection Soak Station for Endoscopes
GUS Disinfection System for Transesophageal (TEE) Probes
GUS Disinfection System for Endocavity Probes
Disinfection Soaking Cup
TEE Probe Manual Disinfection and Storage System
4.
Item Number(s) Used
*
5.
Probe or Scope Types Used
(Required.)
General Purpose Probe
Transesophageal Probe (TEE or TOE Probe)
Transvaginal Probe
Transrectal Probe
Endoscope
Bronchoscope
Laparoscope
Cystoscope
ENT Scope
Other (please specify)
*
6.
Type of High-Level Disinfectant Chemical Used
(Required.)
Glutaraldehyde
Hydrogen Peroxide
OPA
Peracetic Acid
7.
Rate satisfaction on a scale of 1 to 5 (1 being the lowest level of satisfaction & 5 being the highest level of satisfaction)
1-Low Satisfaction
2
3
4
5-High Satisfaction
Based on product design, how well does the soaking station secure the probe during use?
1-Low Satisfaction
2
3
4
5-High Satisfaction
Comment
Based on product design, how well does the product support your facility high-level disinfection policy for reusable devices?
1-Low Satisfaction
2
3
4
5-High Satisfaction
Comment
How satisfied are you with the quality of this product?
1-Low Satisfaction
2
3
4
5-High Satisfaction
Comment
How well does this disinfection system protect the user from chemical exposure (including fumes or spills)?
1-Low Satisfaction
2
3
4
5-High Satisfaction
Comment
8.
Based on your clinical expertise, do you believe there is added infection risk associated with the use of this disinfection system?
No
Yes (if yes, please explain in Comment box below)
Comment
9.
Based on your clinical expertise, do you believe there is an added risk of probe damage associated with the use of the disinfection system?
No
Yes (if yes, please explain in Comment box below)
Comment
10.
Based on your clinical expertise, do you believe there is an added risk of chemical exposure specifically associated with the use of this disinfection system?
No
Yes (if yes, please explain in Comment box below)
Comment
11.
Please provide your email address in order for CIVCO to respond to any concerns.
