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It's well-known that reprocessing personnel must turn over an amazing number of scopes every day, so it's not uncommon for them to cut a few corners here and there to keep pace. As much as we'd all like to think that time doesn't matter, though, it does. Look at the literature: Any documented incident of an infection outbreak has been linked to a breach in reprocessing. To help keep a cross-contamination situation from occurring in your facility, let's take a look at four areas where such breaches happen far too often.
Building the foundation
We've had the "Multi-society Guideline for Reprocessing Flexible Gastrointestinal Endoscopes" for three years and SGNA standards since 1984, yet lack of training for standardization is still the root cause of reprocessing confusion, breakdowns and, sometimes, patient recalls. Thorough training of staff who'll be dedicated to the task is really the easiest way to ensure proper reprocessing. Of course, education is never easy, but plenty of resources are available to help. Join specialty societies such as SGNA and APIC to take advantage of their training materials, such as instructional wall charts and videos and the access to experts they provide. The manufacturers of your scopes, automated reprocessors and chemicals often offer educational sessions on the use of their products through reps or specialized trainers. Arrange visits from each manufacturer whose scopes your facility uses, as they'll know their products best and can impart detailed knowledge to your reprocessing staff.
What's more, education has a two-fold effect: If you provide extensive training at regular intervals to those who'll be dedicated to the reprocessing area and require that they demonstrate competencies at least annually, you'll decrease the chances of reprocessing errors.
Two steps: flush and brush
You may think it a waste of time for reprocessing staff to acquire an intimate knowledge of the scope, its internal and external components and how it works in addition to every detailed cleaning and disinfection step. After all, they're not repairing the scopes. But an understanding of scope anatomy will go a long way toward reprocessing that's done right every time. This is most crucial when it comes to the two steps involved in cleaning the scope internally: brushing and flushing.
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9 Ways to Make Scope Reprocessing Easier | ||
Here's a look at what manufacturers are doing to make endoscope reprocessing more efficient and standardized. | ||
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Advanced Sterilization Products |
Cygnus Medical |
Endoscopy Support Services |
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Fujinon |
Olympus America |
Pentax Medical |
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Steris Corp. |
Verimetrix |
US Endoscopy |
It's of the utmost importance to know that there are three separate main channels in gastrointestinal endoscopes: suction/biopsy, air and water. Only the suction/biopsy channel can be brushed (some GI scopes may have an additional suction/biopsy channel and bronchoscopes have only a suction channel). The other channels, plus any specialty channels (such as auxiliary water or ERCP elevator), must be purged. This involves filling the channel with enzymatic solution to loosen debris, soaking, then flushing to rinse out the debris. That step, in my experience, is underperformed a lot more often than proper brushing.
A final purge of all channels with alcohol is also critical to preventing an infection. Micro-organizms in retained fluid can grow and form biofilms that are very difficult to kill with standard disinfection chemicals. Only by flushing with alcohol and purging with air can you ensure that the endoscope will be properly dried before storage. Knowing what to perform - the brush or the flush - and when is crucial, and having an intimate knowledge of each scope's anatomy is essential to this.
Take a minute
Most people are aware of the risk of cross-infection that results when the exterior of the scope and the channels are not properly cleaned and disinfected. But organisms entering the inside of the scope pose an equal risk of cross-contamination.
Leak testing is your best defense against this. That's because fluid invasion lets organisms get into the scope - around the channels and other internal components - and cannot be reached with any amount of brushing and flushing. Even small amounts of fluid set up the prime environment for those organisms to flourish: damp and dark. As fluid builds up, the physician will see symptoms in blurry images or interference with electrical components of the scope, but by then the cross-infection risk has existed for some time.
A properly performed leak test should take at least one minute per scope and follow all required steps. I've seen reprocessing staff try to get away with 10 seconds. That's not enough time to pressurize the scope, let alone enough time for a leak to appear from the interior of the scope. One way to prevent short-cuts during leak testing is to use an automated process.
Mix and match
I teach a class at the annual SGNA conference that includes not only the structure of the scope and the required steps for reprocessing, but also understanding your products, because there's a very real lack of industry communication and coordination when it comes to all the pieces of the automated reprocessing puzzle.
Reprocessing staff need to know exactly what your AERs and chemicals are validated to do, and what connectors are needed for each and every endoscope. A recent CDC position statement recommends you have a written policy that identifies the procedure for hooking up every model of scope you have to every AER model in your processing room.
Having a grip on the chemicals is important too, because few are actually validated for use directly with the various AERs. Usually, your AERs are validated for their processes, and the chemicals are validated for their contact times, but the two may not be tested together. Your reprocessing staff should have a thorough knowledge of exactly what your reprocessor does, the steps it performs and how much time each step takes.
There have been several patient recalls for potential cross-infection because of these issues. You can see that reprocessing staff need to know not just how to place the scope in the machine or what to do when the readout fails, but the conceptual information as well.
Stay vigilant
Don't fall into the trap of having a false sense of security about scope reprocessing. Using automated reprocessors correctly only ensures high-level disinfection - nothing more. The enzymatic purge option should be used strictly as an adjunct to mechanical cleaning that's already been done. If you don't completely remove debris before hooking the scope up for high level disinfection, the cycle will be ineffective. Only with comprehensive training and annual competency validation of your reprocessing staff will you maximize patient safety in your endoscopy department.
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