FIRST THINGS FIRST Dirty scopes can’t be properly disinfected.

As an accreditation surveyor and CEO of a gastroenterology practice that performs 30,000 endoscopies a year in 4 facilities, I’m keenly aware of what it takes to turn around endoscopes efficiently and effectively. But perhaps more importantly, here’s my take on how to make scope reprocessing safer for the techs doing the dirty work and the patients who trust you with their care.

1. Know scopes inside and out
Best practice in scope reprocessing is to ensure standardized protocols are followed each and every time, right? It’s actually more complicated than that. Independent surgery centers often partner with a single scope manufacturer, which eases the burden on reprocessing technicians. The task becomes more involved in larger centers or hospital systems where techs might handle numerous high-end, complex scopes with unique reprocessing requirements.

It’s extremely important to train techs on every possible scope they might encounter. They must be able to identify the slight differences in various models — the number of ports or channel functions, for example — that demand specialized care.

Educate new employees on proper scope reprocessing and test competencies at least annually — ideally more often than that — or any time a new scope is added to the inventory. Company reps are typically available to run training sessions on the scopes they supply, although they shouldn’t be the sole source of education. Most major manufacturers provide large posters outlining the required reprocessing steps for their instruments. Hang the posters in the reprocessing area where they’ll serve as valuable visual aids and handy references for your techs.

2. Manual cleaning done right
As an accreditation surveyor, I’ve completed the AORN infection control education program. One essential I learned is that proper scope care is a two-step process: Blood and biofilm must be manually removed from scopes before they can be properly reprocessed. Manual cleaning is just as important as the automated steps of reprocessing. It reduces bioburden on the surface of a scope as well as in its working channels.

Is it OK to use the same brush to clean channels on more than one scope? Absolutely not, but when wearing my accreditation surveyor hat I’ve seen techs attempt to justify the worrisome practice by claiming they don’t want to waste a new brush at the end of a day. They also point out scopes are run through cycles in automated endoscope reprocessors (AERs) that integrate all of the channels. That may be true, but using the same brush on multiple endoscopes increases the risk, however small, of cross-contamination and should never be done.

CLEAN PLACE Scopes must be stored away from any risk of contamination.

3. Automated help
I’m surprised that some facilities with decent production volumes still reprocess scopes in trays instead of investing in AERs. Tray reprocessing interrogates a scope’s channels, but it can’t match the precise repetition of AERs. The automated devices run preset cycles until they’re completed. There’s no fudging the times, even if impatient physicians are calling for scopes from the procedure rooms. The same can’t be said for manual cycles overseen by techs, who might succumb to volume-driven pressures and remove scopes before required reprocessing times are met.

SMART SHOPPING
Customize Your Endo Cleaning Supplies

PACK MENTALITY Ensure techs have needed brushes and caps for each endoscope they reprocess.

Scope reprocessing techs are under a lot of pressure to keep up in busy GI centers. From their perspective, reprocessing scopes quickly is paramount. But they must have the tools and support to do it properly each time. We worked with our supply vendors to develop custom procedure packs that contain disposable cleaning supplies — the proper brushes and port caps, for example — needed to clean the scope used during the case. You need to purchase the supplies anyway. Opting for customized disposables is a cost-effective solution if you have the purchase power to demand competitive pricing.

— Frank Chapman, MBA

4. Disinfectant testing
It’s important to test high-level disinfectants — most facilities are opting for the overall effectiveness and relative short exposure time of ortho-phthalaldehyde (OPA) — at least daily to ensure they meet the Minimum Effective Concentration (MEC). Be sure to follow manufacturers’ directions for testing, which demands time-sensitivity and ensuring the proper test strip is used to monitor the accuracy of the results. We use glutaraldehyde in our washers and check the efficacy with each cycle that’s run.

Document the daily concentration levels to establish a baseline measurement of the disinfectant’s effectiveness, and use the log to track when it’s time to switch out the solution. Your techs likely replace the solution well before it’s necessary to, which avoids having to measure the MEC after each reprocessing cycle, but the daily tests will identify batches that lose concentration levels earlier than expected.

5. Proper PPEs
I’ve never seen a tech go without gloves when handling scopes, but I’ve witnessed several without proper eye protection — a face shield or safety glasses — leaving them susceptible to being splashed with high-level disinfectant, the nasty stuff that’s used to kill infectious biofilm. Why don’t techs properly protect themselves? Perhaps because they’ve lost respect for the constant dangers associated with the repetitiveness of their job. But a good tech remains cautious at all times.

6. Scope segregation
Ensure scopes can be moved between dirty reprocessing rooms and clean storage areas without meeting in the middle.

I’m lucky that our practice’s 31 physicians work in beautifully designed centers, one of which has 2-room procedure modules that sit on opposite sides of a hall. Doors in the procedure areas open directly into a room where the manual cleaning takes place. Beyond that room are 2 separate areas for automated reprocessing and clean scope storage.

Moving dirty scopes into adjacent rooms like these can be done with an open tray, but transporting them across a hall requires a specially designed cinch bag or closed container. Medicare and accreditation surveyors focus on the transition between dirty and clean areas and note if techs wear dirty PPE or bring contaminated scopes into clean spaces.

The last step of reprocessing is to wipe the scope and flush its channels with alcohol to facilitate drying. At this point, no further danger of contamination should exist in the room. If you reprocess and store scopes in a single space, be sure that cleaned scopes are protected from splashed contaminants. That means never working on dirty scopes while clean scopes are being placed in or removed from storage. I’ve talked to techs who’ve claimed splashes can’t reach across a room, but from a strict infection control standpoint, that argument doesn’t cut it.

DULY NOTED Track the minimum effective concentration of high-level disinfectants.

7. Accredit techs?
There’s currently no nationally accredited training program to ensure techs reprocess scopes the same way every time. Is one needed? Will one be developed? I believe so, on both counts. Accrediting scope reprocessing is a movement that’s gaining momentum. Online certification at the state level might be the most practical and cost-effective solution. Efforts must also be made to ensure the certifying agency running the program doesn’t turn the process into a profit grab by requiring frequent recertification and excessive continuing education credits each year.

The value of an accreditation program will depend on how succinctly it’s run and how narrowly the education component is focused on what matters most at the front line. How can we standardize a reprocessing accreditation program for large facilities or health systems that work with several different kinds of scopes? It might make more sense for scope manufacturers to offer certifications for the training they provide on specific scopes, but that might not be a realistic option.