There are no excuses for improperly reprocessed endoscopes. Not anymore. We've all read about the unspeakable tragedies from inadequately reprocessed scopes. We know that any gaps in your procedures could lead to infections. Is your facility up to date with the latest scope reprocessing guidelines? Here are 7 takeaways from the most recent guidance.
Everyone knows the importance of point-of-use pre-cleaning, but some still aren't doing it. Pre-clean as soon as possible after the procedure is complete. The process should include both suctioning cleaning solution through the scope channels to moisten and remove organic soils, and wiping exterior surfaces with a damp, soft, lint-free cloth or sponge. Often overlooked, but equally important: Pre-clean all accessories, too, like suction valves and caps, and keep them with the scope they were used with until the final sterilization or disinfection is finished.
Once they're pre-cleaned, and while still damp, transport flexible scopes horizontally in closed, leak-proof containers labeled as biohazards, regardless of where they're being transported from endoscopy, radiology, the OR, or anywhere else. The one exception: if you're transporting directly from the procedure room into the cleaning room with no possibility that you'll encounter cross-traffic.
3. Manual clean
Along with leak testing, this is one of the most important steps in reprocessing. Done properly with the right tools for the right amount of time, it reduces the level of bioburden both on and in the endoscope, and thus promotes more effective disinfection or sterilization.
Brushes that are too large can damage the internal workings of a scope; brushes that are too small may leave some particulate behind. Use either the brush supplied by or recommended by the scope manufacturer. Plus, use only disposable brushes and use them only once. Using the same brush on multiple scopes is an all-too-common mistake that can have dangerous ramifications.
Visual inspection, even with magnification, isn't good enough to determine whether a scope is truly clean after manual cleaning. At a set time each day, as either the first or last thing you do, use cleaning verification tests that detect clinically relevant soils. Also use them every time you buy a new scope or send a scope out for repair. Tests such as adenosine triphosphate and chemical reagents can help determine whether your cleaning protocols are adequate, and help identify lapses in your manual cleaning. Testing costs money, of course, but not nearly as much as one serious infection might cost.
5. Mechanical reprocessing
Use an AER to mechanically clean scopes with a high-level disinfectant or liquid chemical sterilant. Mechanical reprocessing adds a layer of effectiveness and is safer than manual cleaning, because it reduces personnel exposure to biohazardous materials. Position scopes and accessories such that all surfaces are exposed to the processing solutions, and confirm that scopes are correctly connected to the AER. Also, if for any reason a cycle is interrupted, it should be repeated in its entirety.
Proper drying may be the hardest thing to get across. If there's one thing people don't do well, it's that they don't dry scopes adequately. The first thing to do once mechanical processing is complete is to ensure that all channels are thoroughly dried with instrument air, and that exteriors are dried with a soft, lint-free cloth or sponge. Any moisture that remains on the surfaces is an invitation for microbes to begin growing, once the endoscope is stored.
For storage, drying cabinets that circulate high-efficiency particulate air and force filtered air through the endoscope channels are optimal. The process continuously dries endoscopes and inhibits bacterial growth. In the absence of a drying cabinet, any fluid that remains inside the scope may let microorganisms breed and grow. The unresolved question is how long you can consider a scope clean and sterile, or clean and high-level-disinfected, once it's stored. The literature is all over the map on this. Study conclusions range from as short a time as 48 hours to as long as 56 days. Nor do professional organizations agree on maximum safe storage times.
7. Surveillance culturing
Implement a program for regular microbiologic surveillance culturing. Yes, it can be expensive and time-consuming, but it pays to build it into your budget. Talk with your chief of endoscopy, your infection-control practitioner and a nurse leader about how often it should be necessary: maybe once every 15 days, or once a month. And then talk to vendors about cost. What can you do through your GPO? Surveillance can help you monitor the quality of your reprocessing and the effectiveness of your corrective interventions. It can also help identify sources of contamination, and detect scopes that need service. Be sure to include your AERs in the surveillance schedule. Using a contaminated AER can end up re-contaminating every scope it comes into contact with. OSM