Trust the Process of Endoscope Reprocessing

Instrument Reprocessing and Care Infection Prevention

By: Tammy Richardson, RN, BSN, MHA

Published: 5/20/2021

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Daily diligence in high-level disinfection reduces the risk of cross-contamination.


REASSEMBLY LINE Three techs at a time reprocess endoscopes in the busy decontamination room at Community Endoscopy Center, which handles 55 to 60 cases a day.  |  All photos provided by Tammy

Reprocessing flexible endoscopes is a never-ending job filled with potential pitfalls that can jeopardize patient safety. Our endoscopy center performs about 60 cases a day, so our facility’s fleet of more than two dozen scopes needs to be reprocessed quickly and effectively. Despite the  time crunch, we never cut corners during the multi-step process and haven’t had a single patient infection during the nine years I’ve been working here.

Our well-oiled reprocessing machine begins at the bedside. After a procedure is finished, the nurse in the room precleans the scope. They use a detergent that’s diluted with water, so there’s a formula they need to follow. Generally, the process takes two to three minutes. We use rigid containers to transport the scopes to the decontamination area, which is adjacent to the procedure room. Because scopes are moved a short distance through a single door, we didn’t invest in medical-grade transport containers; we simply purchased clear plastic totes whose lids fit the size of our scopes perfectly when they’re wound. They are disinfected after each use.

Once scopes are in the hands of reprocessing techs, leak-testing is done, which takes a few minutes. Techs place a scope in a sink full of clean water and connect it to a wall-mounted leak tester. Next, techs do a manual cleaning in the sink, wiping off the insertion tube, checking all the channels and inserting cleaning brushes through them. 

After they hook the scope to a device that flushes the channels, it’s ready for a 26-minute high-level disinfection cycle in our automated endoscope reprocessor (AER). Toward the end of the cycle, the scope is flushed with water and alcohol, and then air for drying. When the cycle finishes, a tech brings the scope to our clean equipment room, dries residual fluid on the outside with a lint-free cloth, and hangs it in a storage cabinet that meets the appropriate ventilation requirement for next use. In addition to clean scopes, we also store dilators for upper endoscopies, guide wires and cautery devices. We also keep a couple older scopes around as backups and reprocess them every seven days.

People of the process

We employ six reprocessing techs, with three assigned every day to the decontamination room. Our techs rotate through dual functions and also work in the patient care area, where they help turn over rooms, stock supplies, bring patients to the procedure room and assist patients to their cars after surgery.

Three of our techs are certified registered central service technicians (CRCSTs), and three learned on the job. We make sure they all receive comprehensive education and training about scope handling — much of it from the manufacturer. When we onboard a new tech, our vendor rep provides their initial training; they go over the scope anatomy with them and make sure they understand the entire reprocessing process. We then send new techs to a conference our vendor conducts that provides a full day of training on infection control guidelines and scope anatomy, handling and reprocessing. Internally, we provide additional training and competency checks. The goal is to educate techs about the scope manufacturer’s guidelines, and those from the Society of Gastroenterology Nurses and Associates (SGNA) and American Society for Gastrointestinal Endoscopy (ASGE). We even designate a preceptor to make sure the new tech properly follows all aspects of our reprocessing.

Laminated signage in the reprocessing area reinforces our education and training, and the scope manufacturer’s guidelines are readily available to staff. Our nurse manager and I maintain an open-door policy and encourage staff to ask if they’re ever in doubt about reprocessing protocols. 

You want to protect techs from fatigue and soreness from all the repetitive motion of the job. We bought ergonomic anti-fatigue mats for the decontamination room, and chairs for when there’s downtime. Our staffing model gives techs a 30-minute lunch and two 15-minute breaks. If somebody needs an extra break, a floating tech can stand in. Since I’ve been here, our staff engagement scores have been 94% to 98%. 

10 Questions to Ask During Endoscope Cleaning Audits
SPOT CHECK
WATCHFUL EYE Hold endoscope cleaning audits to make sure all critical steps in your facility’s reprocessing protocol are being followed.

Even the most efficient protocols should be regularly reviewed. To ensure compliance, hold quarterly endoscope cleaning audits for the techs and nursing staff involved in your reprocessing, and ask yourself the following questions:

• Do they don appropriate PPE?
• Do they fill the sink with water to the appropriate line?
• Do they perform leak testing?
• Is leak testing performed before detergent is added?
• Is leak testing performed for 30 seconds while angulating in all directions under water?
• Is the appropriate amount of detergent added?
• Do they brush all the channels per policy?
• Do they complete the cleaning process without pausing to take a clean scope out?
• Do they check the high-level disinfectant in the AER to confirm the fluid is still good?
• Did they don a clean apron and gloves to remove the scope from the AER?

—Tammy Richardson, RN, BSN, MHA

Extending lifespans

FIRST THINGS FIRST Nurses in procedure rooms at Community Endoscopy Center consistently preclean endoscopes at the bedside before bringing them to the decontamination room.

We do a lot to maintain the condition of our scopes. Of course, we get damaged scopes repaired promptly, but we also exercise a lot of preventative maintenance. Our scopes are going on their sixth year in service; the next generation is supposed to come out later this year, and we’re planning to replace our current fleet with the newest models.

Because of our case volume, we generally send a couple scopes out for repair each month. Sometimes it’s for leaks, but other repairs are required just from frequent use. Our vendor also services our scopes, and we meet quarterly to review usage, repairs and ideas to improve their care. For example, last year our scopes experienced a lot of distal tip damage that cost us a lot of money. The distal tip is crucial because that’s where the camera and a lot of the functionality reside. As you’re hanging a scope in a cabinet or setting it up for a case, it’s easy to bang the distal tip against a wall or countertop. We asked our vendor rep how we could decrease this damage, and they suggested distal tip protectors. We adopted this added protection, and it has significantly decreased tip damage.

Every scope in our fleet is checked once a month for residual bioburden to ensure we are cleaning them appropriately. If they pass the inspection, they go back into circulation. If they don’t, we clean it a second time. If it doesn’t pass again, we culture it (test for bioburden in the channels), pull it out of circulation and wait for the culture results. These monthly safety checks are a proactive measure we take because it’s always better to be proactive than reactive, not because we’re having any issues. None of our patients have suffered an infection, and we intend to keep it that way. 

My mantra for every extra step or precaution is: “If I’m the patient, I would want this place to be doing this.” OSM

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