OBSERVE AND MONITOR Scope reprocessors are the least trained and least paid people in most facilities, yet they have a most vital role. Learn how to observe and monitor scope reprocessing procedures at your center.

When's the last time you ventured into the scope room? If you're like most OR leaders, it's probably been a while. After all, you don't know how to operate a flush pump, an automated endoscope reprocessor (AER) or a leak tester. What words of wisdom can you offer reprocessing techs who have years of experience? Plenty, it turns out. Yes, you're no expert, but there's much you can do to help your reprocessors perform their most vital role safely and efficiently. But you can do so only if you step foot in the scope room. Here's what to do once you're there.

1. Watch and learn
Shadow a reprocessing tech from start to finish as he performs the 200-plus steps involved in reprocessing a scope — from bedside cleaning to leak testing to manual cleaning to rinsing to visual inspection to high-level disinfection to rinsing (again) to drying to storage. Each of the directors of the 16 endoscopy centers that I oversee performs a monthly scope room audit. It's an invaluable exercise that will open your eyes to how mentally challenging and physically grueling the job is.

You can learn a lot during a 15-minute visit. You might discover that your techs are skipping steps or cutting corners, or that they each have their own way of reprocessing scopes. "This is the way I do it." But the scope room is not the place for individual expression. One way to get all your techs on the same page: Paper the walls with cheat sheets and manufacturer's posters that illustrate the different steps.

2. What should you be looking for?
If a tech doesn't follow or misinterprets manufacturer's reprocessing instructions — or follows them inconsistently — the results can be disastrous. Here are common reprocessing issues you should monitor and correct:

• Using products that are not approved to clean scopes: bleach, hydrogen peroxide and surgical instrument detergent, for example.
• Reusing disposable cleaning brushes because "the bristles are still good." Spot this by checking your supply ordering history against case volume. Other disposable/single-use items that shouldn't be reused: enzymatic solutions, valve brushes and inflation syringes.
• Failing to check the minimum effective concentration (MEC) with every high-level disinfectant (HLD) use. Instead of checking every cycle, some techs will check the HLD's MEC once a day, or once in the morning and once in the afternoon. But if it fails, when did it fail? You don't know.
• Miscalculating HLD expiration dates, and not documenting them on the AER.
• Not bedside cleaning: wiping the scope down and flushing water through it.
• Not properly diluting enzymatic detergent or using full strength on a sponge.
• Not disassembling and properly flushing reusable water bottles during high-level disinfection and rinsing.
• Placing scopes on the counter after reprocessing instead of hanging them to dry so any remaining moisture in the channels can drip out.
• Leaving the door to the scope room open all day and a cluttered work area.

Yes, that's a lot to monitor — and it's by no means a complete list. Consider appointing a supervising tech to be your eyes and ears.

3. Ask questions
Want to be certain your techs are on top of their game? Ask questions. Lots of questions. What temperature should the water be for this enzymatic detergent? How long does the scope need to soak in this enzymatic detergent? What do you do when a leak is detected? How often do you test MEC? Do you document when the MEC fails? How can you verify a scope was disinfected properly when removed from the AER? What process do you follow for scopes used on high-risk patients (hepatitis or HIV, for example)? How do you know when each batch of HLD is due to expire?

4. Simplify and standardize
You can simplify and standardize scope room procedures. Use an automated enzymatic dispenser that measures the exact amount for your sink and measures water temperature. Implement 24-hour tubing and eliminate the manual soak pan. Use forms that make documentation easier, such as calculating the expiration date for HLD for your scope washer. Store a binder in the scope room with all manufacturers' instructions. Keep all scope room supplies organized and never store similar chemicals/gallon containers together or on their side.

When physicians pressure techs to shorten or skip steps, tell your techs to reply with 10 words: OK, Doctor, what step would you like me to skip? You can't cut corners, even if you're in a hurry for a scope. The goal of excellence in scope reprocessing is patient safety. Your role is to give your techs the appropriate training, tools and support to clean and reprocess endoscopes according to manufacturer's instructions and industry standards every time. OSM

GET YOUR HANDS DIRTY
Scoping Out the Scope Room

LUNCH BREAK Robert Lacava, RN, the clinical administrator of the Advanced Surgery Center in Rockville, Md., works in the reprocessing room once a month.

I don't just visit the scope room once in a while. Once a month I gown up and reprocess scopes. It's my way of keeping tabs on what's going on and of giving our techs a much-needed break.

For me, it's natural to reprocess scopes. It's just like old times. Years ago when I worked as an endoscopy nurse at a hospital, I split my time between the procedure room and the scope room. Now that I'm the clinical administrator for a GI center, I still like to keep my hand in reprocessing — plus, I get to listen to the radio and work at my one pace. More than that, I feel like I can relate to the conditions and demands of the job more so than somebody who hasn't disinfected a scope.

The people that clean scopes are some of the lowest-paid people in the facility — making $15 to $20 an hour — yet they do an incredibly important job. I don't want them to view the job as unimportant. I think it helps that somebody higher in the company is willing to do that job. I'm not the only one. Our financial administrator is trained to clean scopes.

Even if you can't do the job, you need to be able to recognize what people are doing — and whether they're doing it to the manufacturer's recommendations. Go in and ask your techs questions. Have them show you their process from start to finish. Just go in as a fact-finder, not a fault-finder. "I'm curious because I need to know this," you might say.

— Robert Lacava, RN

Mr. Lacava ([email protected]) is the clinical administrator of the Advanced Surgery Center in Rockville, Md.