High-tech Options In Endoscope Reprocessing

Manual cleaning follows leak testing. Use appropriately sized brushes to clean the endoscope's channels twice, each time checking the brush to make sure it emerges clean. After manual cleaning is complete, attach the endoscope to an automated flushing unit — wall-mounted or countertop models are available — which facilitates flushing cleaning solution and rinse water through all channels of the scopes.

• Drying and storage. Automated endoscope reprocessors run scopes through several cycles — cleaning, rinsing and an alcohol flush — that take about 25 to 30 minutes to complete. The alcohol flush makes sure scopes are as water-free as possible after the high-level disinfection process is complete and before they head to the drying storage cabinets.

In our facility, scopes that have been high-level disinfected are hand-carried from the clean scope room to the procedure rooms, which is where our storage cabinets are located. The same tubing used to flush the scopes in the reprocessor stays attached to the scopes and is used to deliver the filtered air into the scopes in the drying cabinet. Using the same tubing is more efficient, because it only has to be attached once, and it also reduces the risk of cross-contamination. One set of tubing also makes identifying the source of organisms easier should an infection occur.

The tubing is connected to the scope's biopsy channel, air/water channel and other channels. HEPA-filtered air flows continuously into each of the channels to keep internal lumens dry, which goes a long way to preventing moisture from forming that increases cross-contamination risks. Storage cabinets with integrated drying technology are an advancement over storage units that simply circulate air throughout the chamber and are light years better than simply hanging scopes in conventional storage cabinets and relying on gravity alone to keep internal channels free of moisture.

Newer cabinets also feature smart storage features. An employee must scan a barcode on a scope to load it into the storage unit. The cabinet's screen confirms the hook number on which the scope has been placed. Once the tubing is connected to the cabinet's airflow, the door is closed and locked. The process is repeated when removing a scope so the amount of time it's been in storage — and who put it in and who took it out — can be traced.

In fact, RFID detection technology lets us trace a scope at every stop through the reprocessing cycle, including the dry leak tester and the automated endoscope reprocessor. All the devices produce printouts that show which employee was caring for the scope during those reprocessing steps and which patient the scope was used on.

Studies have indicated that bacteria can begin to grow in scopes after 7 days of not being used. Therefore the standard is to reprocess scopes again after they've been in a cabinet unused for a week before they should be used again on patients. With newer high-tech storage cabinets, scopes are scanned in and timed automatically, meaning you don't have to manually keep track of how long they've been hanging. The cabinet displays how many hours the scope has been in storage and a red light comes on when a week has gone by, signaling that the scope needs to return for reprocessing.

Because scopes have a limited time they can hang in storage before having to be disinfected again, so you certainly don't want too many in your inventory. But, obviously, you need to have enough to keep up with your caseload. We have two procedure rooms and perform 12 procedures in each room per day. We have six upper scopes and six colonoscopes, as well as two pediatric scopes. They're all used frequently, but our reprocessing process is efficient enough that we never find ourselves delaying procedures to wait for scopes. We were even able to keep procedures moving recently when we sent two scopes out for repair at the same time.