AER ADVANTAGE Automated endoscope reprocessors promote rapid scope turnarounds and less labor for your techs.

If your techs manually reprocess dozens of flexible GI endoscopes every day, what are the odds they they're cleaning the first scope's channels as well as the 20th scope's channels? Automated endoscope reprocessors (AER) take human worker variability out of the equation, producing flow rates that are stronger than those produced by manual flushing and delivering more consistent results. These are both key factors in preventing endoscope-related infections.

Besides patient safety, there's also staff safety to consider. If you're asking staff to soak and hand-clean flexible endoscopes, you may be exposing them to dangerous, potentially carcinogenic, liquid chemical germicides — chemicals that can have toxic fumes and the potential to splash onto skin or into eyes.

Generally, AERs include a wash phase, a high-level disinfection exposure phase and a rinse phase. The AER immerses the endoscope in the cleaning or disinfectant solution and pumps liquid chemical sterilants and/or high-level disinfectants through the scope's channels. Some also spray the surfaces of the endoscope that aren't immersed and don't contact patients. Once the disinfection period ends, the AER rinses and flushes both external and internal surfaces with filtered water to remove residue left by the sterilant and disinfectant solutions.

It's important to understand what pre-cleaning is and what it isn't. Some AERs have cycles that state they can replace manual cleaning processes in sterile processing. While the FDA validates this cleaning claim, it's clear that it doesn't replace pre-cleaning. As William A. Rutala, PhD, MPH, one of the foremost experts in reprocessing, says, "Any deviation from the recommended reprocessing protocol can lead to the survival of microorganisms and an increased risk of infection."

An intelligent consumer
When trying to determine which AER best suits your needs and your workflow, here are some of the questions you should ask:

1. What's the cycle time? Some AERs have shorter cycles but only process one scope at a time. But if your scope inventory struggles to keep up you with your caseload, you might want to look at a dual-scope AER with a short cycle time and separate basin(s) for independent cycle times so you can reprocess 2 scopes at once.

2. What's the cost per cycle? AERs involve a lot of add-ins and consumables, such as chemicals, filters and maintenance costs. It's vital to drill down and find out how much those things are going to cost on a per-cycle or per-month basis. Manufacturers aren't always forthcoming when it comes to the exact cost per cycle, but they know, and it's important for you to know, too.

If enhanced reprocessing methods or sterilization become standard for endoscopes, your cost per cycle will become much more important. Recent outbreaks involving duodenoscopes have the CDC recommending such "enhanced" reprocessing methods as double high-level disinfection with periodic microbiologic surveillance. Dr. Rutala recommends a shift from disinfection to sterilization. "To protect the public health we — FDA, industry, professional organizations — must shift endoscope reprocessing from high-level disinfection to sterilization," says Dr. Rutala. "FDA should mandate that duodenoscopes — preferably all GI scopes — used in healthcare facilities be sterile by 2018."

3. Are your scopes compatible with the AER? Be sure to confirm compatibility with both the AER manufacturer and your endoscope manufacturer. You don't want to make a mistake and end up having to buy new scopes due to an unforeseen compatibility issue. The AER manufacturer may use color-coding or numbering systems to help match endoscopes with the appropriate connectors and to ensure proper orientation.

4. How big's the footprint? How much space will the AER occupy in your central sterile department. A counter-top style AER will work if you need to reprocess 1 or 2 endoscopes at a time, but you should consider a standalone dual-basin model if you need to reprocess multiple scopes at once; some standalone models are half the size of their competitors. Also ask whether you'll need special plumbing or power supply.

5. Which features come standard? Are all the features being sold to you standard, or are some optional? Some manufacturers offer leak-testing and pre-cleaning capabilities as extras. Some AERs have ultrasonic cleaning capabilities. Some flush the channels with alcohol followed by forced filtered air to help dry the channels and prevent waterborne pathogenic microorganisms from growing during storage. And some control the temperature of the cleaning solution by controlling the temperature of the incoming water the AER uses for dilution and rinsing.

6. Does it keep good records? It's important to know which scope is used on each patient, so find out which AER will best help you comply with documentation guidelines. Does the AER interface with your EMR to ensure traceability?

7. Is staff education available? Does the vendor have ongoing support and education for new staff and subject experts providing CEUs for staff? OSM

Advanced Sterilization Products
Evotech ECR
aspjj.com
(888) 783-7723
Pricing: not disclosed
FYI: The Evotech ECR feat
ures a rotating spray arm in each of its 2 independent basins to facilitate cleaning and prevent pooling under the scope. To detect leaks and blockages, you can connect each endoscope channel to a separate pump before reprocessing. Windows on top of the machine let you see the activity in each basin. At the end of the cycle, alcohol is automatically flushed through each channel to help facilitate drying. To prevent contamination, a foot pedal can be used to open the lid. A computer tracks all critical cycle parameters, and an optional bar code scanner lets you quickly enter endoscope and other information.

Medivators
Advantage Plus
medivators.com
(800) 444-4729
Pricing: not disclosed
FYI: Designed to be fully compliant with all makes and models of flexible endoscopes, the Medivators Advantage Plus has 2 reprocessing basins, which it monitors independently for blockage and proper flow. Other features include a computerized system designed to eliminate human error in both the selection and connection of hookups, a foot pedal for hands-free lid operation, continuous automated leak testing, and an air purge and alcohol flush. Reprocessing cycles can be as short as 28 minutes. You can view cycle data on a large, flat-screen monitor. Remote diagnostic capability allows for faster problem resolution, often with no need for a service call.

Medivators
DSD Edge
medivators.com
(800) 444-4729
Pricing: not disclosed
FYI: At roughly three-quarters of the price of its Medivators counterpart and not as technologically advanced, the DSD Edge offers many of the same features as the Advantage Plus and can be even faster — requiring as little as 22 minutes per cycle. Like the Advantage Plus, it's compatible with all current models of endoscopes, including those with elevator wire channels, and it features 2 fully-independent reprocessing basins, automated leak testing, and an air purge and alcohol flush. An optional data-management system can provide electronic cycle tracking and recordkeeping.

Olympus
OER-Pro
medical.olympusamerica.com
(800) 848-9024
Pricing: not disclosed
FYI: The 18-inch wide OER-Pro requires less than half the space of conventional AERs, and its casters make it easier to move. It's FDA-cleared to automate 7 of the 11 manual endoscope cleaning steps, including manual flushing of channels with detergent, water and air — the most labor-intensive and variable parts of the process. Its one basin can simultaneously reprocess 2 scopes in 26-29 minutes. A built-in RFID system automatically traces endoscope serial and model numbers, operator and time of reprocessing. You can use a foot pedal to open the lid, which automatically locks during operation to prevent accidental exposure, spills or splashing.