July 5, 2023

To avoid confusion surrounding meticulous and lengthy IFUs, try these six steps.

Northwell Health
WHERE TO START? Needless to say, endoscopes are complex instruments that are difficult to clean, so following their IFUs is crucial.

How do well-meaning sterile processing professionals make sense of and track the myriad complex steps in a typical endoscope manufacturer’s IFUs? They do so by breaking the processes down into six major chunks that naturally separate, according to Katharine Hoffman, MPH, CIC, NCMA, LSSGB, and Chrystia Johnson, MSHS, MLS(AMT), CIC, LSSYB, infection prevention community health program manager and director of infection prevention/quality division, respectively, of JPS Health Network in Fort Worth, Texas.

Here are Ms. Hoffman and Ms. Johnson’s six major focus areas:

Point-of-use treatment. Determine requirements for initial precleaning at the point of use. Endoscope channels must be flushed prior to transport to the reprocessing area.

Cleaning. This step removes soil, contamination and potential bioburden but does not kill microorganisms that may be on or inside the endoscope.

High-level disinfection (HLD) or sterilization. Check the IFU to see if the endoscope is compatible with HLD and/or sterilization. While sterilization is the preferred method for reprocessing, some IFUs provide only guidance for HLD if the device cannot undergo sterilization.

Device reprocessing. Automated endoscope reprocessors can be utilized for HLD, but first confirm that the endoscope is compatible with these devices and supports HLD solutions. If only manual reprocessing is supported by the manufacturer, ensure the linear process steps can be accomplished. For endoscopes that require or can undergo sterilization, review the IFU to determine the compatible sterilization method.

Transport requirements. Consult the IFU of the endoscope to determine specific transportation requirements. It is also important to review the IFU of the transport bin or container for its own proper cleaning and disinfection methods.

Storage requirements. Carefully check the IFU to ensure the device is stored in a manner that prevents damage, contamination and water retention.

Ms. Hoffman and Ms. Johnson say that by focusing on these areas and the tiny steps within each, endoscope reprocessing should become much more manageable for your staff.

Is your center leaving money on the table?

Shakeel Ahmed
ADDITIONAL OPTIONS Dr. Shakeel Ahmed says centers might be missing profit-generating opportunities if they aren’t offering a variety of ASC-safe GI procedures.

Ambulatory surgery centers (ASCs) can be odd beasts, acknowledges Shakeel Ahmed, MD, who owns a cluster of them in the Midwest.

On one hand, there is always an interest to adopt the shiny new objects in the industry, which these days are total joint replacements and spine surgeries. At the same time, there is generally a reluctance to broaden the horizons of an existing GI service line beyond colonoscopies and esophagogastroduodenoscopies (EGDs or “upper endoscopies,”) even though there are numerous additional GI procedures that can not only be safely but also profitably performed and reimbursed at ASCs.

Those GI line expansion opportunities include simple endoscopic retrograde cholangiopancreatography, endoscopic ultrasound, BARRX and hemorrhoid ablation, endoscopic gastric balloons and spinal implant placement. “These additions are essentially sitting right under your nose and might be easier to add than more fashionable new procedures in other specialties,” says Dr. Ahmed. “They might be more profitable as well, as they often require less equipment and a smaller OR team.”

If you are considering an expansion of the GI service line at your center, Dr. Ahmed offers three suggestions:

Cast a wide net for providers and patients. Looking beyond your immediate neighborhood can net you both. “You don’t need to stick to your local health system when looking for surgeons or stay within your immediate zip code while seeking out patients,” explains Dr. Ahmed.

Think beyond the box. If you can’t find new specialists, encourage the physicians who perform EGDs and colonoscopies at your facility to attend seminars and take educational courses that allow them to do additional procedures, such as gastric balloons.

Adopt a creative and entrepreneurial mindset. This can be difficult in health care, especially when your center’s status quo may already be profitable.

“Outpatient GI centers will always be profitable just with colonoscopies and upper endoscopies, but there’s so much more,” says Dr. Ahmed. “The new procedures ripe for the outpatient arena aren’t experimental surgeries. They’re all established and approved procedures with rock-solid indications. The sky’s the limit once you start thinking along these lines.”

Dr. Ahmed urges GI facility owners to not overlook the idea of expanding their existing GI service lines. “I’ll take the revenues generated by an EGD over a new, more complicated procedure with a list of potential complications anytime,” he says.

For more insight from Dr. Ahmed, read his full May 2023 cover story here.

Plus, Your Staff’s Efficiency and Turnaround Time Can Be Improved With Technology.

Stryker

Healthcare professionals in the GI space are busy. But even with the current boom of colonoscopies, efficiency and safety are paramount. However, changing a canister during a procedure is labor intensive and presents the possibility for accidents.

Connie Hall, RN, is a certified gastroenterology nurse at a facility that performs hundreds of colonoscopies per month.¹ For most of her career, Hall used wall canisters that occasionally had to be changed multiple times during a procedure. However, she knew there had to be a more efficient way to work than manually changing canisters and searching through GI waste for lost polyps.

When Hall was on the design team for her new facility, it adopted Stryker’s Neptune Waste Management System. Facilities that use a constantly closed waste management system with integrated specimen collection like the new Neptune S system eliminate the need to empty canisters during a procedure and reduce the possibility of splashes, spills and lost polyps.^**

With at least 1,000 patients waiting to be scheduled for a colonoscopy, Hall says the facility she works at keeps track of staff utilization for efficiency. Stryker’s Neptune has also helped with quicker procedure turnaround time. “We need more doctors, space, nurses, and Neptunes,” she states.

While switching to a closed waste management system has made a difference for Hall and her colleagues, unfortunately not many people in the GI space are aware of the options. “When nurses see what we have, they think it’s great and are amazed they don’t have to be exposed to the waste,” Hall says. She believes having technology like the Neptune System helps with staff retention.

In addition to improved efficiency and staff retention, Hall says the reduced exposure to hazardous waste is another key difference from a traditional canister system. By adopting a closed waste management system, facilities can help boost their reputation because safety is made a priority.

“Safety is a bigger commitment than it’s ever been in healthcare,” Hall concludes.

Help protect yourself and fellow staff from splashes and spills that can happen under the current standard of GI care. Join Stryker on our Journey to Zero* exposure at safeor.com.

Notes:
*Zero splash and spills, zero airborne contaminants, zero smoke, zero retained surgical sponges, zero blind spots, zero trips and falls, zero drug diversion, zero maternal harm, zero lost polyps, zero exposure, and zero doubt messages are not guarantees and are aspirational in nature.
^**Polyps 2 mm or larger

References:
1. This is a paid interview with a Stryker nurse consultant, conducted March 22, 2023, on behalf of Stryker.