It's time to tip your surgical cap to the instrument techs. All too often their role in making your endoscopy services run smoothly (and safely) is overlooked. To do the job right and keep the schedule on track, they need equipment that runs as reliably, effectively and efficiently as they do. If it's been a while since you shopped the latest endoscope reprocessors, you may want to consider upgrading to a system that will work with your techs, not against them.

Finding the right match
Flexible endoscopes requiring high-level disinfection (HLD) are best and most efficiently pro-cessed in an automatic endoscope reprocessor (AER). Several different types of HLD solutions are used in AERs: glutaraldehyde/phenol, ortho-phthalaldehyde (OPA), hydrogen peroxide, hydrogen peroxide/peracetic acid, peracetic acid, or hypochlorite and hypochlorous acid. Your choice of device and HLD solution may be based in part on a number of facility-specific factors, such as size of your reprocessing room, water pressure available, power supply, plumbing specifications and ventilation system.

Some HLD chemicals are very harsh to inhale. Glutaraldehyde/phenol, for example, can be linked to throat and lung irritation or even occupational asthma and may cause headaches, drowsiness and dizziness. Because of these risks, you need to have special ventilation systems in place when using glutaraldehyde to ensure staff safety. Other HLDs, such as OPA, are less harsh. You can use them in a normal hospital or surgical facility setting with no additional ventilation needed.

In addition to these infrastructure considerations, the amount of time needed to reprocess your flexible endoscopes is a key consideration in choosing the AER that's right for your facility. While all AERs must have at least disinfection and rinse cycles, note that these cycles often differ from one machine to another and from one HLD to another in both soak time and the amount of times the disinfectant can be reused. Look at your schedule, caseload and desired scope turnaround times to determine which device matches your facility's needs.

Special features to consider
Besides your standard disinfectant and rinse cycles, you can add many components to an AER to make the entire process more efficient and effective.

• Heating capabilities. Having the option of heating the HLD can cut the soak time of the endoscope by more than half. For example, if you're using OPA as the disinfectant, a 12-minute cycle at room temperature can be cut down to 5 minutes with the HLD heated to 25 ?C.
• Automatic detergent flush. Some AERs can also clean scopes automatically with a detergent solution, which lets you eliminate the manual-flushing step of the pre-cleaning cycle.
• Alcohol and air-drying. These automated cycles help ensure that the channels of the scope are not harboring any water, which can begin to grow and house bacteria if left sitting in an endoscope.
• Connectors. Using the appropriate connector when reprocessing a flexible endoscope is critical to the disinfectant cycle. Scopes can have as few as 1 or as many as 4 different ports that you must reprocess. Some AERs let you connect 1 piece to all 4 ports, while others require you to hook each port up to the machine one by one, running the risk of overlooking one of the ports. I've had the chance to work with both types, and I find it less confusing and more efficient when you can use 1 connector that leads to all 4 ports.
• Automatic leak tester. This feature has 2 benefits: First, it can detect any leaks that the human eye may have missed. And if it does detect a leak, the leak tester lets out a constant flow of air to keep water from infiltrating the scope and causing water damage. A water-damaged scope requires a full factory refurbishment costing up to $9,000, so using an automatic leak tester can potentially save you thousands of dollars in repairs.
• Printing & documentation. In this time of increased scrutiny over infection control practices, it's imperative to document all reprocessing cycles thoroughly and correctly in case an infection investigation or audit by regulators or accrediting bodies occurs. AERs that have automatic documentation capabilities make this process much easier by letting you automatically record and print the time and date of the cycle and serial number of the scope, verifying that the scope has gone through every step necessary to be considered disinfected.
• Alarms. With alarms in place, an AER will immediately alert you when a cycle isn't functioning properly so you can address the issue right away. Some alarm systems even stop the entire cycle until the issue is corrected, then let it resume where it left off.

No substitute for knowledge
While all of these features and add-ons can be a big help in the reprocessing room, they are no substitute for a truly knowledgeable and well-trained staff. Ultimately, the most efficient and effective approach to reprocessing flexible endoscopes is to arm your staff with excellent equipment and to educate them thoroughly on how that equipment works and what their responsibilities are in ensuring all scopes are properly cleaned and disinfected. No matter how far we've come with automation, no equipment can fully replace the need for manual pre-cleaning. But if you simply install an AER in your facility and fail to properly educate your staff, they may end up cutting corners or skipping steps because they believe the equipment will take care of everything.