3 Essential Steps in Endoscope Care

Gastroenterology

By: Daniel Cook

Published: 12/19/2019

Share:

Manual cleaning, internal channel inspection and proper drying are necessary to ensure that high-level disinfection occurs.


The long, narrow lumens of flexible endoscopes can make reprocessing the delicate instruments feel like an exercise in futility. But despite the inherent challenges associated with achieving high-level disinfection, there’s been no recent revelations about proper endoscope reprocessing.

“The whole process is still highly reliant on completing the manual steps thoroughly, and completing them in order,” says Bret T. Petersen, MD, a gastroenterologist at the Mayo Clinic in Rochester, Minn. “The steps are prone to error and lapses — depending on the facility, staff training, work environment and availability of appropriate resources to accomplish them.”

Use the following advice to give your reprocessing techs the support they need to ensure endoscopes are properly cared for between uses and returned to procedure rooms free of the bioburden that increases cross-contamination risks.

1. Clean correctly

High-level disinfection cannot not be done successfully if cleaning isn’t done properly, so training on proper endoscope cleaning practices needs to be thorough and followed by constant oversight and regular non-punitive competency training. “Some scope reprocessors are trained in an hour,” says Dr. Petersen. “It’s not feasible to learn the process in that amount of time.”

Frank Myers, MA, CIC, FAPIC, assistant director of infection prevention and clinical epidemiology at University of San Diego, Calif., suggests making sure your staff and reprocessing techs:

  • wipe down the entire exterior of scopes at the bedside;
  • transfer scopes from bedside to the reprocessing room in a solid container;
  • brush interior lumens enough times;
  • visually inspect the entire brush when it’s withdrawn to confirm that it’s clean;
  • work under adequate light to do the inspections; and
  • have adequate time to perform each cleaning step.
CHANNEL SURFING Are your reprocessing techs repeatedly brushing an endoscope's interior lumens? "One or two quick passes through a scope ... isn't enough to ensure the channels are clean," says an infection preventionist.   |  Dartmouth—Hitchcock Medical Center

“You hear stories about time constraints that are unbelievable, that simply are impossible to maintain,” says Dr. Petersen. “Well-trained reprocessing techs can do a good job only if they’re also given adequate time to do the job right.” 

Some facilities have even resorted to putting locks on the doors of the reprocessing room so physicians can’t enter the reprocessing area to tell techs to hurry up, according to Mr. Myers. That might not be as extreme a step as it sounds.

“Physicians, especially employees of health systems, are asked to perform a high-volume of cases, and scope capacity has to be able to keep up with that demand,” he says. “I understand those pressures, but I value patient safety more than my paycheck.”

Mr. Myers often asks his scope reprocessors how many times they’ve brushed the interior lumen of a scope, and is often told they pulled a brush through only once. “One or two quick passes through a scope without conducting 360-degree twirls isn’t enough to ensure the channels are clean,” says Mr. Myers.

There is also some data that suggest pulling a squeegee-tipped device through channels does a better job of cleaning than brushing. “When you push a brush down on a hard surface, the bristles separate,” says Mr. Myers. “The same thing happens inside an endoscope when reprocessing techs push them through — the bristles separate and leave bioburden behind.”

2. Inspect internal channels

HANDS ON Endoscope cleaning and disinfecting requires an attention to detail and access to the latest tools to do the job right.   |  Pamela Bevelhymer, RN, BSN, CNOR

Adenosine triphosphate (ATP) test strips, which detect the presence of microbial growth, are often used to spot-check the effectiveness of endoscope cleaning before high-level disinfection takes place. However, points out Mr. Myers, the FDA has not tested any of the currently available test strips for effectiveness in detecting the presence of live microbes inside an endoscope’s internal channels.

Last August, the FDA called for ATP strip manufacturers to submit data to support the clearance of their strips for this use. In the meantime, the FDA warns against relying on test strips to assess endoscope cleaning. Mr. Myers says off-label use of ATP testing is a piece of information that facilities can decide on their own to use, but they need to be aware of the FDA’s recent guidance.

If it’s universally known that endoscope cleaning is difficult to do and it’s now harder to validate, why aren’t all reprocessing techs using borescopes to see inside channels to confirm they’re free of bioburden and scratches and stains where manual cleaning might be ineffective?

“If they don’t have a borescope, they’re cleaning blind,” says Mr. Myers. “If they tell you a scope is clean, they better have examined it with a borescope. Claiming to clean a medical device without actually looking inside of it is baffling to me.”

3. Ensure adequate drying

Michelle Alfa, PhD, and Cori Ofstead, MSPH, each conducted studies that found residual water remained in endoscope channels after high-level disinfection (osmag.net/CQZqk3 and osmag.net/e4YyVQ, respectively). Both researchers independently identified the same problem, which was detectable only by looking inside the scopes, says Mr. Myers.

Constant air movement through a scope’s internal lumens after high-level disinfection is needed to keep the channels dry. “We now recognize the importance of adequate scope drying,” says Dr. Petersen. “A number of studies demonstrate that it takes a minimum of 10 minutes of forced-air flow through each of a scope’s channels to prevent residual water from forming. I would guess many centers are not up to speed on that requirement.”

Automated endoscope reprocessors include drying cycles, which often involve a very brief alcohol purge — not necessarily enough to prevent water from remaining in internal lumens during scope storage. Wall-mounted drying units with manifolds that hook up to a scope’s channels and newer endoscope storage cabinets circulate air through internal lumens during regular, prolonged intervals.

“Endoscope storage cabinets with integrated drying mechanisms are becoming more commonplace and, in my opinion, are a superior option,” says Mr. Myers. “My facility has decided to invest in drying cabinets moving forward, because the data on how many scopes remain wet in storage is so disturbing.” OSM

Related Articles