ATTENTION TO DETAIL Endoscope reprocessing is painstaking, and there's no official validation system in place to ensure it's performed properly.

In theory, it's simple enough. Follow a straightforward process and endoscopes will be properly cleaned, disinfected and dried for the next time they're needed. But established guidelines aren't always followed on the front line when you have insufficient scope inventories and reprocessing techs feel pressured to meet the demands of jam-packed procedure schedules. Are any of these common mistakes happening on your watch?

1 Improper pre-cleaning
Pre-cleaning at the bedside removes bioburden before it has an opportunity to dry, and creates the momentum needed for complete and proper scope reprocessing. Unfortunately, staff sometimes skip this important first step because scopes look visibly clean and the aspiration of channels produces no bioburden. Never assume endoscopes are clean; they must always be treated at the point of use.

I've also frequently seen the detergent used at the bedside prepared improperly. Follow the detergent manufacturer's specifications for dilution in water and required temperature of the water-detergent solution.

Wipe down the insertion tube with detergent, even if it's not visibly soiled. Aspirate detergent through the biopsy channel, even if the secretions in the suction canister look clear. Flush the auxiliary water channel, even if it went unused during the procedure.

2 Ineffective leak testing
Reprocessing techs sometimes skip leak testing altogether if endoscopists didn't pass instruments through the biopsy channel. Why? They incorrectly assume the integrity of the scope couldn't have been compromised.

To perform proper leak tests, remove detachable parts such as air/water valves and biopsy port caps, and ensure angulation control wheels and stiffener controls are in the free and unlocked position. Prepare a basin or sink with fresh water that's deep enough for the entire scope to be completely immersed without having to tightly coil the instrument.

Never reuse the fluid, and never add enzymatic detergent. Doing so can cause the detergent to bubble as it passes through the scope, which could mask small leaks. Allow sufficient time — 30 seconds to a minute — for the solution to flow through the scope's channels. Manipulate the scope during the test; leaks have gone undetected at the distal tip and function buttons because techs didn't push the buttons or angulate the scope.

PRODUCT PLACEMENT Take care when loading endoscopes in automatic endoscope reprocessors to eliminate risk of compression damage.

3 Misguided manual cleaning
I've seen techs use reusable brushes that haven't been properly reprocessed between cleanings and, in ill-advised efforts to control costs, use single-use brushes on multiple scopes.

Instead, ensure proper brushes are in good working order. They should be free of kinks that can damage endoscope channels. Bristles should be intact and the proper diameter for the channels of the scopes in your inventory.

Cleaning should cover all valves, channels, connectors and detachable parts. Disconnect and disassemble the scope and completely immerse it and its components in an appropriately diluted detergent, according to the scope manufacturer's instructions. Flush and brush accessible channels to remove residue. Clean the external surfaces and components of the scope with a soft cloth, sponge or brush.

Ensure exterior and interior surfaces are exposed to the detergent for the time required by the scope's manufacturer, and use manufacturer-recommended cleaning adaptors when flushing detergent from the channels.

4 Assuming with AERs
Always follow manufacturers' directions when operating automatic endoscope reprocessors. Use the recommended tubing and adaptors — they must have valuated instructions for use — to attach scopes to AERs. The techs I've seen who use homemade adapters certainly get high marks for ingenuity, but would fail reprocessing exams.

When loading scopes, configure them in ways that will avoid compression damage when closing the AER's lid. Properly placing scopes also prevents harm to their delicate components — avoid placing scopes in positions that crimp or bend the insertion tube, which could cause undue strain on the angulation wheels — and ensures effectiveness of the reprocessing cycle.

Don't push "start" and assume AERs will take care of the rest. Make sure cycles begin correctly, and read over each cycle's report to ensure the recommended time, temperature and minimal effective concentration of the disinfectant have been reached.

Newer AERs incorporate an alcohol flush at the end of the reprocessing cycle to promote drying and keep the scope's channels clear of residual water that could cause harmful bacteria to grow while the instruments are stored between uses. But still double-check to ensure scopes are completely dry and free of residue upon removal from the AER. Also ensure there is minimal alcohol left in channels following the automated drying purge.

DRY TIME Your techs should wipe endoscopes down before hanging them vertically in secured storage cabinets.

5 Careless handling
Accreditation surveyors are focusing on the proper transportation of scopes from procedure rooms to reprocessing areas. Move scopes in closed, rigid containers or plastic drawstring bags to ensure bioburden isn't leaked and devices remain protected from harm along the way. Place scopes in a large, loose coil, with angulation knobs turned to the free-play position and varying stiffness settings on neutral, in order to prevent damage to internal controls. Each container or bag should contain only 1 scope and its component parts.

A word of caution if you use plastic bags: Be sure bagged scopes are placed in a secure area in the reprocessing area so they don't suffer compression damage before techs remove them for leak testing.

Flexible scopes must be hung vertically in storage cabinets, but I've seen facilities coil infrequently used scopes for storage in hard cases. That's unacceptable. Don't reattach components removed for reprocessing — function buttons, suction valves, biopsy port covers — before storage. Instead, allow air to circulate through scopes' channels.

Visual inspection is part of every reprocessing step, from point of use to hanging for storage. Check for obvious defects to the scope (kinks, bends or holes in the insertion tube) and work the angulation controls to ensure the scope retroflexes correctly.

6 Lack of oversight
Scope reprocessing is a tedious process that requires conscientious attention to detail during each and every step. There's no official validation system in place to ensure it's performed properly, so you must be engaged in your facility's efforts. For example, check minimal effective concentration logs daily to ensure liquid high-level disinfectants are being used to automatic endoscope reprocessors' specifications. Ensure techs wear proper personal protection equipment: Eyes, mucous membranes and the mouth must be protected at all times. Donning PPE is fundamental practice, but I've seen reprocessing personnel go without masks or eye protection.

Equip your reprocessing team with fluid-resistant gowns strong enough to protect against strike-throughs and exposure to cleaning solutions. Glove cuffs should extend well past the wrist to protect against fluid invasion. Nitrile gloves withstand cleaning chemicals better than natural latex or vinyl rubber gloves. Don't wait until annual competency reviews to evaluate all staff involved in reprocessing. Conduct regular ad hoc surveys of the reprocessing area to ensure recommended techniques are being followed. The more you watch, the more you can be sure your endoscopes are being cared for properly.