Endoscopes are delicate instruments and mishandling them can prove costly. Repair bills range from $300 for minor tuneups to $8,000 for major refurbishments. Never mind the $15,000 you'll drop to get a damaged specialty scope back in working order or the threat to patient safety posed by faulty equipment. Putting damaged endoscopes in the hands of your physicians or staff, no matter how skilled or efficient they are, will render their efforts meaningless. With a nod and a wink to Dr. Stephen Covey, here are my highly successful habits for limiting everyday dings and dents to the 50 endoscopes my staff uses in 7,000 cases each year.

Be proactive. Alternate between suctioning soap and water or diluted enzymatic cleaner and blowing air out through the scope's channels immediately after the insertion tube is removed from the patient. Bioburden remaining in the scope can dry, buildup, clog interior channels and increase cross-contamination risks. Next, gently wipe down the outside of the insertion tube with a moist, lint-free cloth.

Begin with the end in mind. Ask staff to dedicate themselves to proper endoscope handling techniques, from the time a scope is pulled for the first case until the endoscope storage cabinet is clicked shut at day's end. Tell them to carry and handle endoscopes with the same care that they would a newborn.

Hang scopes in well-ventilated storage cabinets. Keep insertion tubes straight to prevent moisture from pooling within the tube and to protect the angulation system and internal channels. Unlock dials and place variable stiffness scopes into neutral position. To maximize airflow through a scope's tubes and inner channels, remove its water-resistant cap and valves. Take care when storing scopes; hasty techs can easily bang scopes into the doors or walls of storage cabinets.

Transport scopes from procedure rooms to reprocessing areas in covered plastic containers. The containers protect the scope from damage during transport and prevent cross-contamination. Ensure the container is big enough — the scope should be coiled loosely in the container to prevent buckling of the insertion tube. We place transportation containers on a large cart to make the commute easier. Some manufacturers sell reversible container liners labeled "clean" on one side and "dirty" on the other to notify staff of the scope's status.

The liners are effective, but their additional cost is avoidable and unnecessary. We affixed a "dirty" sticker to our scope transportation cart as a failsafe against staff mixing up dirty and clean scopes while coming and going between procedure rooms and the reprocessing area. The storage cabinets in our reprocessing area are labeled "clean."

Remember that the reprocessing room circuit should be a one-way journey. Bring dirty scopes in one door and remove reprocessed scopes through another. Never transport high-level disinfected scopes back through the reprocessing room's decontamination area.

Put first things first. Before cleaning and reprocessing scopes, leak-test their integrity, looking for the small punctures that allow fluid invasion, perhaps the costliest and most damaging problem to repair.

Make sure the basin used for the test is large enough for the scope to be loosely coiled. Before the test, remove the scope's valves and attach the water-resistant cap to protect the scope's internal video components. Afterward, let the trapped air escape from the scope to prevent stretching of the insertion tube.

Think win-win. Taking the proper precautions during manual cleaning and disinfection will protect scopes from damage and patients from cross-contamination risks. During manual cleaning, use appropriately sized brushes and start slowly, with short, controlled brush strokes. If you meet resistance from debris when brushing, don't force the issue. Continued difficulty in passing a brush through a channel may signify a tear in the scope that needs repair.

Many automated endoscope reprocessor options dot the commercial market, from tabletop, single-scope models to large machines capable of disinfecting eight scopes at once. Whichever version you use, carefully follow the manufacturer's directives.

Seek first to understand and then to be understood. Even the best endoscope care policies are useless if they're not constantly reinforced on the front line. Train new employees on proper cleaning methods and handling techniques, and bolster those lessons with several in-services each year. My in-services can be intense. I'll watch over techs with detailed reprocessing competency standards in hand, making sure they follow each required step when reprocessing the scope.

Ask new physicians to spend a few minutes with your reprocessing techs. Have them watch the entire scope turnaround process. They need to understand how diligent your staff works to ensure scopes are in working order. That visual will hopefully reinforce the notion that physicians need to properly care for these delicate instruments during procedures.

Synergize. Scope damage is often the result of handling mishaps occurring in transit or in the procedure room. Physical errors will happen, no matter how thorough your preventative measures. I've seen scopes' heads dropped and cracked and lenses damaged when insertion tubes are smacked against walls or counters. You can cringe at those physical miscues, but ultimately you have to shrug them off. We're all far from perfect and bad things will always happen to good workers.

It's the mental mistakes you shouldn't tolerate. Make a note of common handling oversights you see and bring them to your staff's attention during new employee training and in-services. Forgetting to affix the waterproof cap to the scope during reprocessing is inexcusable, for example. During transport, scopes should be held upright in one hand, the insertion tube loosely coiled in the other.

That may seem obvious, but I've seen insertion tubes dragged along the floor and light guides dangled from an employee's arms. I've also watched in horror as a scope sheared in half after an employee tried to move the scope while it was still plugged into its light source.

Sharpen the saw. Perform regular inspections of each endoscope in your inventory. Make sure the light source is functional. Examine the entire length of the insertion tube, checking for cracks, buckling and discolorations — seemingly minor imperfections that harbor the potential for major impacts on scope function and patient safety if gone undetected.

Check for bite marks on endoscopes used for upper GI endoscopy. Twist a scope's knobs to move the bending section up, down, right and left. The bending section should move in proportion to the force applied to the controls. A knob with too much play indicates a problem with the scope's angulation system.