SCRUB IN The right sized brushes are a must for different sized lumens and channels.

Several of the biggest medical malpractice headlines in recent years have involved the improper reprocessing of flexible endoscopes. The thorough manual cleaning, decontamination and high-level disinfection of these complex instruments is critical to infection prevention and patient safety, but there's a lot of room for error in the process. These 4 pointers can help you manage your reprocessing staff to ensure they're delivering the cleanest possible scopes to your endo cases.

1. Don't cut corners
The easy efficiency of an endo doc who's on a roll is a thing to behold. For the sterile processing staff readying the scopes for his upcoming cases, though, the pressure of keeping up with the schedule can be intense. When people are rushed, it's easy for them to skip a step, intentionally or not, or lose their focus on the task at hand.

Endoscope reprocessing is no time for cutting corners. Your staff must follow each and every step of the scope manufacturer's instructions for use, from bedside pre-cleaning (use water and/or enzymatic detergent to remove gross soil from the exterior surface and flush the channels as soon as possible after use, enlisting your OR staff to assist) to post-reprocessing storage (hang the scopes vertically, with all detachable components removed). What's more, they shouldn't assume that all scopes can be reprocessed in the exact same way. Each model is different, and manufacturers' specifications are intricately detailed for a reason.

Routine in-service sessions and certification courses through professional organizations can reinforce the importance of process among your reprocessors. Also take advantage of your scope manufacturer as an educational resource. Many offer free laminated instruction posters, videos to download and training visits from company reps who always understand the scopes you're using inside and out.

As for the actual written copies of scope manufacturers' instructions, don't just file them and forget them. Be sure you have the most current version stored where your staff will be able to consult them in the event that reprocessing and handling questions arise. Surveyors are eager to see easily accessible instructions during their visits.

2. Invest in the right tools
Infection prevention is hardly the place to economize. Make sure your sterile processing team is adequately equipped to do the job. We often hear about departments that, due to thrifty management or budgetary constraints, lack the proper supplies to handle each device in accordance with its instructions. With regard to scopes, the brushes used for manual cleaning are a big issue. Having the right sized brushes for all the different-sized lumens and channels on a scope makes a big difference in reprocessing results. If the cost of single-use brushes seems high, reusable ones are available, but keep in mind that you may need several sets, as you'll always have to reprocess the brushes between uses.

Then verify that your central sterile staffers are putting these supplies to proper use. I've heard of techs who were under the mistaken impression that the process of manual cleaning involved brushing 3 times. You have to brush until the lumen is clean. If you brush 3 times and the brush still comes out dirty, 3 times clearly isn't going to be enough, and you'd better keep brushing.

Likewise, manual cleaning must be a consistent process and not a convenient one. Just because a physician didn't use the biopsy or suction channels during a particular case doesn't mean you shouldn't flush and brush each every time.

The proper use of supplies also applies to those intended to protect your staff. A full complement of personal protective equipment, including a face mask; goggles or an eye shield; a bouffant head covering; a long-sleeved, water-resistant gown; heavy, non-latex gloves; and shoe covers must be worn at all times that used scopes are handled in the decontamination room.

MAKE THE CONNECTION Whether your staff does it by hand or by machine, a thorough flush and soak is key to high-level disinfection.

3. Understand your AERs
Automated endoscope reprocessors can save your staff a lot of time. Depending on the product, they may offer channel flushing, leak testing and high-level disinfection at the push of a button. If there's a flaw in the scope or the process, the machine will let you know. Some AERs even let you enter a scope's serial number and a patient's name for safety tracking.

Remember, though, that labor-saving devices are not necessarily labor-eliminating devices. While the marketing for some of the earliest AERs suggested that they'd let reprocessing techs skip the elbow grease of manual brushing, the FDA has cleared only 2 devices, Advanced Sterilization Products' Evotech and Medivators, with that ability. And none of them let your staff forgo bedside pre-cleaning.

If you use automated reprocessing technology on your scopes, know its abilities and make sure the instructions are followed. The AER that both cleans and disinfects puts a time limit on how long a scope can sit before a cycle without manual cleaning. Tagging scopes with case times may be helpful to keep your staff ahead of the clock.

Keep in mind, too, that just because you have an AER that cleans as well as disinfects doesn't mean your scopes can't still be manually cleaned. The AER does not write your facility's infection control protocols; you do. And, of course, your staff needs to know how to manually reprocess a scope, in the event that the technology breaks down.

4. Spot-test to be sure
Are your endoscopes clean enough? There are 2 ways to be sure: the preemptive route of training, and the verification of spot-testing.

You probably encourage continuing education among your nursing staff. What about your reprocessing techs? Can your budget spare the funds and your schedule spare the time for them to get CEUs at conferences or online? Staff should be members of, and certified in their duties by, a professional organization. Competency levels among those who work in sterile processing should be established and verified. While the Joint Commission recommends every 3 years, I think annual competencies are important. And make sure the techs who are in charge of training new hires to the department are training them in the correct procedures.

Don't neglect routine spot-testing to assess the effectiveness of your scopes' reprocessing. There are several commercially available methods for accomplishing this quality assurance, including channel swabs that change color or can be scanned for adenosine triphosphate to detect the presence of residual organic matter; and test strips that can provide similar results when dipped into water that's been poured sterile through the channel and collected in a sterile basin.

Listen up
Don't take your sterile processing department for granted. Listen to what your employees there have to say. Their complaints may provide solutions. If, for example, your scope reprocessing techs have mentioned more than once that they feel rushed by the schedule's turnaround demands and often don't have time to complete their tasks properly, take the time to observe them at work. If their complaints are justified, consider hiring more employees, cross-training other employees to lend a hand when time and staffing are tight, or rethinking the schedule.