PROPER BRUSHING The endoscope contains tiny channels and crevices that need to be cleaned thoroughly, using special brushes.

Reprocessing endoscopes takes diligence every step of the way. From pre-cleaning to leak testing to automatic disinfection, your nurses and techs must pay careful attention to every part of the process. From withdrawal of the scope to storing it in a cabinet, the entire reprocessing should take roughly 45 minutes. Though the turnaround is quick, it comprises many technical steps that must be completed thoroughly every single time. Neglecting any step, however small, puts your facility at risk of transferring microbes. To refresh, let's revisit the 11 stages of a thorough reprocessing, starting with pre-cleaning, once the scope has been withdrawn from the patient.

1 Wipe the scope with a clean, lint-free cloth saturated with manufacturer-approved detergent solution. This step needs to take place before any detritus have time to dry and settle. All staff members who handle scopes during the procedure need to know this crucial stage of the process before the scopes go off to the techs in the Sterile Processing Department (SPD).

2 Suction detergent via pump through the channels. Using a suction pump, flush the air, water, and other channels with detergent solution, and then flush with air. Repeat this phase as per manufacturer instructions until you've cleared the channels with an air flush.

3 Disconnect the scope from the suction pump, attach a protective video cap and transport it in a bin. Once the scope has been thoroughly wiped and flushed in the pre-clean, it's ready to be taken to the SPD, where it will be scrubbed, soaked and tested for damage. The transport bin should be large enough to store the scope properly and closed off as it moves through the facility. Additionally, thoroughly clean and disinfect the transport bin after each use.

4 Remove valves and buttons and any detachable components and submerge them in detergent solution. Now that the scope has been handed off to the SPD, detach all removable pieces and completely submerge it in fresh detergent solution. The solution should be mixed per manufacturer guidelines.

5 Perform a leak test. Testing for leaks is hugely important because damaged scopes are the most susceptible to evading thorough disinfection and transmitting dangerous microbes from patient to patient. Attach the leak tester, submerge in clear water and contort the angulation-control knobs to see if pressure drops. Look out for bubbles that emit from leaks in the tubing.

6 Submerge the scope in cleaning solution. Again, this solution must be diluted to manufacturer recommendations. While the scope is submerged, wipe it down using a clean, lint-free cloth.

7 Thoroughly brush all channels of the scope. Use a manufacturer-approved brush while the scope is submerged in the cleaning solution. Ensure that the brushing is completed from proximal to distal tip.

8 Brush the valve cylinders clean. As with prior steps, the manufacturer's recommendation is crucial to ensuring you have a proper, clean brush.

9 Submerge the scope in clean rinse water. Using the cleaning adaptor, flush the scope to the manufacturer's recommendation. Check here that all debris and mucus have been cleared before the scope moves on to the automatic portion of disinfection. Anything remaining in the channels could potentially be walled against the effects of the disinfection, so you have to keep inspecting the scopes throughout the manual stages.

10 Transfer the scope to the automated endoscopic reprocessor (AER). Connect the scope, making sure that the entire scope will be below the disinfectant fluid, and activate the AER. Some newer AERs will suggest neglecting the manual stages listed above. In my opinion, though, machines aren't fool proof. They do fail, and although humans do, too, you need a set of human eyes in the room to pick up any remnant debris and scrub it away before the scope goes through the AER.

11 Store the scope in a ventilated cabinet. Once the AER has finished its job, remove the scope, dry it with a clean, lint-free cloth, and hang it in the cabinet so that any remaining moisture can naturally flush out of the channels. Remove the protective cap from the scope, as well. Also worth mentioning: Storage cabinets should be cleaned daily, at least, so that clean, reprocessed scopes don't pick up any microbes before going into another procedure.

Do your techs have all they need?
Taking a look at the process from a supply point of view, I've outlined some ways to stay on top of your inventory and use it as effectively as possible.

Lint-free cloths, sponges and brushes. These items make frequent appearances throughout the process, from beginning to end. First, make sure that all of these items are manufacturer approved. This point cannot be stressed enough. Secondly, these items need to be cleaned and disinfected after each use in the process, and because you need them often, make sure your supply is never wanting. At our surgical center, we draw from multiple manufacturers to keep the supply plentiful, and in the event that it's not, we barter with other facilities as needed. Sterile processing and reprocessing should be a high priority for your facility. You don't want a lapse in basic stock items to cause the entire system to collapse.

Bins and storage cabinets. Maintaining scopes is one thing. Maintaining what holds them is another, and it shouldn't be overlooked. I mentioned in the steps above that properly sized transport bins must be used to carry scopes from the procedure room to the SPD. These bins must be cleaned after each process, too, to reduce the risk of additional microbes transferring from scope to scope, or process to process. The ventilated storage cabinets, too, must be kept clean. They are, after all, meant to hold clean, hanging scopes. We clean our cabinets at least daily, and I recommend that other facilities do the same.

Detergents and solutions. I'm going to echo what I've repeated many times so far. Use products that are manufacturer approved. Bear in mind, as well, that the soil residing on scopes after a procedure can include proteins, fats, carbohydrates, chemical salts, blood and other bodily fluids. You need a detergent that can tackle a wide range of potential contaminants, and your manufacturer will likely point you in the right direction. Mix and dissolve according to their guidelines.

The endoscopes themselves. Now, it goes without saying that you'll need scopes to undergo reprocessing. This note, however, is a reminder of how often they need to be used to reduce contamination while meeting your facility's needs. Once a scope has been used in a procedure, it needs to be wiped down and pre-cleaned within half an hour. Scope channels can get caked in dry bioburden, otherwise, and they become much more complicated to clear and disinfect. And once a scope has been stored in the ventilated cabinet, it needs to be reused within at least 5 days. Despite daily cabinet cleaning and despite the ventilation, scopes can still pick up airborne microbes, especially if they're not used consistently. In short, don't let the scopes go stagnant. We have 19 scopes in our inventory, and they are all used about 3 or 4 times a day. The volume of our endoscope inventory works on 2 ends. On one hand, it keeps up with our demands, and on the other, it doesn't let scopes become contaminated again by hanging in a cabinet for extended periods of time. You need a double-edged strategy here.

Know your techs
While my title says clinical administrator, I still go to our scope room several times a week to help reprocess scopes and to check in on the process. I'm also reminding the SPD staff how important their role is. I ask them to verbally walk me through each of their steps. By talking through their process out loud, they stay acutely aware of the importance of each step, and they quickly pick up on any that they might be missing. OSM