There are two equally important endpoints in flexible endoscope reprocessing: time and thoroughness. Unfortunately, staffers trying to meet one of these may compromise the other, so we may end up making our physicians wait for thoroughly but slowly cleaned scopes, or keeping the schedule with scopes that were cleaned very quickly by cutting corners in our protocol. Neither is an acceptable outcome for facilities that strive for efficiency. Solving this dilemma takes a two-part approach: your facility has to have both the right equipment and the proper training for its staff.

Dollars and sense
Not having enough devices to ensure a quick turn-around for your endoscopes can slow down your schedule, but you don't want to spend more than you have to for capital equipment. To avoid wasting money by overbuying or losing productivity from under-buying equipment, you need to figure out the optimal rate of efficiency for the turnover of your equipment. Consider using this formula:

• Count the number and types of scopes you own;
• Determine the average time a scope is used and the amount of time it takes for it to be decontaminated and processed; and
• Use these numbers to determine the number of scopes needed to meet your schedule's demands.

The less time you have for reprocessing, the greater a need you'll have for mechanical systems. These can do the job much more quickly and thoroughly than a human being, as long as that human uses the systems correctly.

One benefit of mechanical devices is the consistency they offer in the process. According to Olympus, its Endo-Flush can clean the channels in 90 seconds, and all the scopes reprocessed in this manner are consistently cleaned to the same standards. Staffers doing the same job can take anywhere from two to five minutes depending on how skilled they are and how easy the scopes are to clean; the quality of their work is also widely variable.

A system that checks the scope for leaks, such as ASP's EvoTech, is a tremendous asset for a device. Leak tests are imperative for scopes because any holes in the skin or channels could lead to solution intrusion, which in turn will lead to a large repair bill. Even though testing a scope is as simple as attaching it to an apparatus, staffers who don't see it as an important part of the decontamination process often skip this step.

Steris's Reliance Endoscope Processing System is a high-level disinfection system designed to deliver consistent and repeatable results. It's said to be simple to load and operate, processing two flexible scopes in less than 30 minutes. It kills even the most challenging organisms, provides pre-programmed decontamination cycles to prevent biofilm formation in the processor and cleans itself when you activate the automated decontamination cycle, says Steris. It also reduces chemical exposure by generating germicide in a closed, automated process.

Miniature chemistry kits, such as the one offered by Healthmark, can be useful as a way of assessing the quality of your staffers' work. You can buy a kit like this to periodically test your scopes and be sure your scopes are being properly reprocessed. When doing this, you should be sure to get a kit that does not leave much room for a subjective assessment of the scope's cleanliness.

Ongoing orientation
There's no technological substitute for staffer know-how. Even systems like the Endo-Flush that remove a lot of the manual labor still require that the scopes be pre-cleaned.

One of your biggest challenges is constant staff turnover. Too often new personnel only get a quick orientation and then they're left on their own to do the job. When someone starts pressing them to do the work faster, it's not uncommon for them to adapt by developing a few shortcuts that could lead to sub-par reprocessing. Offer continued training to be sure your staff is following protocols. This usually means directly supervising staff as they reprocess a flexible endoscope to be sure that they're not skipping any relevant points. Coordinating such occasional reviews can prevent bad habits from leading to big problems later. Document competency at the initial training and for all the subsequent in-servicing, and you may want to schedule visits from manufacturers' representatives to provide your employees with periodic refreshers.

Quick and cost efficient
Once you've narrowed your search to a few vendors, ask each to provide an on-site demonstration of its system. This way, your staff will learn how to use the new devices and provide their input about which one might meet the center's needs. If the staff is happy with the equipment, they're unlikely to bypass the necessary steps in the process. And if the equipment is easy to use, they'll get the scopes reprocessed effectively and efficiently. Staff participation in the decision is a must for a successful purchase and outcome.

Olympus America
Endo-Flush Endoscope Flushing Pump EFP250
(800) 848-9024
www.olympusamerica.com
Price: $1,500
FYI: The EFP250 flushes an endoscope's channels with detergent, water and air to make reprocessing easier, says the company. This system features color-coded channel lines to make it easy to see what goes into which scope inputs and a double-pump system so all the channels are simultaneously cleaned in 90 seconds. It's compatible with Olympus flexible endoscopes, including most 140,160 and 180 series gastroscopes and colonoscopies, as well as most 140 and 160 series duodenoscopes and the 160,180, 200 and 240 series bronchoscopes.

Cygnus Medical
First Step Bedside Pre-Clean Kits
(800) 990-7489
www.cygnusmedical.com
Price: $1.12 per unit
FYI: Getting rid of bioburden immediately after performing a procedure is a critical step in processing flexible endoscopes. Everything you need to get this done is in the First Step Bedside Pre-Clean Kits, says the company. Each contains a ready-to-use packet of enzymatic detergent that gets suctioned through the channels and a contoured pad that's designed to clean the nooks and crannies of the scope's head.

Healthmark Industries
EndoCheck
(800) 521-6224
www.hmark.com
Price: $108 for a box of 12 kits.
FYI: The EndoCheck makes it easy to peek inside a flexible endoscope and verify that the scope has been adequately cleaned. Using this miniature chemistry kit is as simple as swabbing the inside of the biopsy channel with a long cotton-tipped swab (which comes included), putting the clipped-off swab tip into a green-capped vial and mixing in the active agent, says the company. After shaking the vial, the agent's color will change to blue/green if there is as little as 0.1mcg of blood residue in the channel, which means it should be reprocessed.

Advanced Sterilization Products (ASP)
EvoTech Endoscope Cleaner and Reprocessor
(888) 783-7723
www.evotechecr.com
Price: Not disclosed
FYI: Although it doesn't eliminate the need for pre-cleaning in a procedure room, the EvoTech eliminates practically all of the rest of the manual labor it takes to clean and disinfect the endoscope, says the company. To protect staffers from exposure to high-level disinfectants, EvoTech has integrated MEC monitoring and it automatically detects leaks to remove the need for manual inspection.

Steris Corporation
Reliance Endoscope Processing System
(800) JIT-4-USE
www.reliance-eps.com
Price: $38,650
FYI: Facilities with a high volume and a low margin for error may want to consider this system, which the company says is easy to load and can process two flexible endoscopes in less 30 minutes. It uses a high-level disinfectant solution to kill microorganisms through a closed, automated process that reduces the risk of chemical exposure for staffers. It also provides pre-programmed decontamination cycles to give you consistent results.