Even with all the attention given to endoscope reprocessing in recent years and the increased scrutiny given by accreditation surveyors, many sterile processing departments still struggle with applying the mountain of regulatory direction to everyday best practices. Still, a number of reprocessing teams are making great strides in this area. Here are 10 tips for endoscope reprocessing excellence I gathered from experts across the country who are leading from the trenches.

1 Segregate your scopes. Work with your team to nail down a process that avoids co-mingling of scopes with other scopes of any kind, says Jenny Crnkovich, assistant director and educator in the department of sterile processing at NorthShore University Health System in Chicago, Ill. Every time a reusable medical device is received in decontam or the dirty room, what it's been exposed to is unknown. When items are segregated, the process allows for a low occurrence of improper cleaning and reduces overall risk to reprocessing staff. Segregation also assists in the bi-directional tracking of the device, a key step all facilities should perform.

2 Use new disposables to clean every scope. Using fresh, single-use chemistries, disposable brushes, sponges and other one-time use consumables to clean a scope reduces the risk of cross-contamination and is often required by reprocessing instructions for use, says Ms. Crnkovich. Reusing contaminated cleaning agents is poor practice and puts patients and staff at risk — especially if there is an exposure.

3 Keep quality records. A key element of maintaining properly cared for scopes and having them safe for use on patients is keeping excellent quality monitoring records, says Ms. Crnkovich. Specific and special attention to detail is a key element in following the guidelines for reprocessing and proper hang time. Each person in the department should receive training and be competent in endoscope reprocessing. This should happen on an annual basis with records to match paperwork/e-files. If your process gets updated, be sure to have an addendum to your competencies and a sign off sheet by all staff, including the date. The following year those updates would be included in your competencies.

4 Point-of-use clean before disinfection. It's critical to adequately clean flexible endoscopes at the point-of-use before disinfection. This step ensures that you remove bioburden from the scope's surfaces and channels before it's able to multiply and form biofilm, says Arlene Bush, CRCST, supervisor of sterile processing and high-level disinfection at Parrish Medical Center in Titusvile, Fla. When considering a point-of-use cleaner, always review the original equipment manufacturer's instructions for use for each scope in question. Cleaning chemistries can differ depending on the specific scope. Using the wrong point-of-use cleaner could harm your scope. It could also create a biofilm on the scope, which makes cleaning harder.

5 Properly transport clean and dirty scopes. Gone are the days when GI techs could snatch a scope from the storage cabinet and carry it right into the room, holding the scope against their body. Transport bins have now become the norm in GI suites, and must be big enough so the endoscope can fit without being damaged, says Ms. Bush. When transporting contaminated scopes, be sure the bins are labeled as biohazardous.

6 Dry scopes before you hang them. The use of forced medical grade air to aid the drying process of endoscopes is essential for reducing microbiological growth. Today, there are drying cabinets that provide a filtered, warm medical grade air delivery system that aids in the removal of moisture from the internal channels of the endoscope, says Ms. Bush. Drying endoscopes is a must — moisture in the internal channels of the endoscopes could let microbial growth thrive. Dry your scopes before you hang them with an appropriate air hose or in a cabinet during storage.

7 Follow instructions for manual cleaning. In the manual cleaning of endoscopes, you must follow specific steps in sequence to minimize any possible cross-contamination into the next patient, says Melvin Gonzalez, the training and education manager of the sterile processing department at Mount Sinai Hospital in New York, N.Y. These instructions dictate time and duration of each step for an effective cleaning process. Proper enzymatic solution and temperature must be in range for effectiveness. You must use the right-sized brush when brushing lumens — be sure to properly dispose of brushes after every use. And be sure to use fresh water to rinse residual enzymatic.

8 Measure cleaning efficacy. The use of real-time indicators of cleaning efficacy, such as ATP, protein, hemoglobin or carbohydrate, can help your sterile processing department pinpoint breakdowns in manual cleaning processes, says Mr. Gonzalez. These kits let you measure the decontamination process at peak hours when employees might be tempted to take shortcuts in the recommended reprocessing steps or department protocol.

9 Handle scopes with care and cleanliness. These are often overlooked points when discussing scope reprocessing. When storing or preparing for use, endoscopes must be handled using proper hand hygiene and with clean gloves, says Afif J. Escheik, BA, CHL, CIS, CRCST, CST, regional director of operations for the sterile processing division at Crothall Healthcare in New York, N.Y. The scopes should not touch any common surfaces, such as cabinetry, clothing or other endoscopes. When carrying scopes from one part of the workflow to another, one hand should support the control body and the other should hold the distal end to prevent damage, says Mr. Escheik.

10 Make good use of vendor resources. Major flexible endoscope manufacturers, such as Olympus, Karl Storz and Pentax, have many educational resources available for surgery centers and hospitals and can provide onsite training and competency checks for scope reprocessing technicians. "Leaders should ensure they are taking full advantage of this expertise and use it to supplement existing training programs," says Mr. Escheik. "Some companies will even provide accredited continuing education units for certified technicians."

Continuous improvement

Don't expect to implement all 10 of these best practices overnight, but be committed to improving your endoscope reprocessing. And as with every industry, there is no reason to reinvent the wheel when it comes to process improvement. Hopefully, these tips will help your sterile processing team continue on its journey to endoscope reprocessing excellence. OSM