Take Better Care of Your Endoscopes

Healthcare facilities continue to face challenges in performing safe and effective endoscope reprocessing. Is it any wonder? The complex design of endoscopes makes the devices difficult to clean, reprocessing techs must follow complicated and lengthy reprocessing directions while working in tight spaces with inadequate equipment and feel rushed or lack confidence to complete all of the reprocessing steps.

National organizations recommend visual inspection and cleaning verification of endoscopes after manual cleaning and before high-level disinfection or sterilization. Inspection and verification usually rely on your reprocessing techs abilities to identify defects and interpret spot-test results, which can sometimes lead to human error. The human factors of cleaning endoscopes get a boost by using the following technologies during routine reprocessing.

The channels of a scope, especially the biopsy/suction channel, can be damaged by the graspers or snares that are passed through during procedures. These defects can become traps for debris and cannot be seen with the naked eye. The dilemma of not being able to see inside the channel of a device that was made for visualizing channels within the human body is rather ironic.

Borescopes, a relatively new visual inspection technology in device reprocessing, can be used to identify damage or debris along the inside of an endoscope's channels. A borescope is basically a flexible scope used to see inside a flexible scope. There are a few different models on the market today, with varying lengths, image quality and price points. They're not outrageously expensive ($1,000 to $3,000), so purchasing one for your department should not be a barrier to performing this work.

You can run into trouble if your reprocessing team is not trained or educated to use a borescope and interpret what they're seeing. You should work with the borescope manufacturer to provide an in-service and training materials. Instructions and visual aids should be posted and available where the inspection takes place. If this is a new process for your department, ask your endoscope manufacturer to secure loaner equipment or expedite repairs. When implementing new testing or verification programs, it's common to discover problems with a high percentage of the fleet of devices.

Leak testing is important because it's used to identify areas of the scope that are damaged. Identifying leaks can prevent additional damage caused by fluid invasion during subsequent reprocessing and, most importantly, prevent fluid harbored in damaged areas from cross-contaminating patients.

Scopes that fail leak tests can have damage that was difficult to spot, or damage to an internal component that cannot be seen at all. For example, the control body contains delicate O-rings that can be disturbed, without any signs of external damage like cracks, if the scope is dropped or mishandled.

Unfortunately, leak testing is one of the most misunderstood and frequently missed steps in endoscope reprocessing. Manual dry or wet tests are common methods for leak testing, but there are several critical steps that need to be completed in order to perform them correctly.

• Manual leak test. The scope is pressurized and manipulated while the tech observes a pressure gauge, looking for changes in pressure.
• Wet test. The scope is pressurized and submerged in a sink of clean water. A tech manipulates the scope and looks for bubbles exiting the scope.

Both dry and wet leak tests rely on the attention and interpretation of the person performing the work. Sometimes, defects are missed. An automated leak tester can help simplify the process to make sure it's done correctly and consistently.

There are several models of automatic leak testers available. They can be expensive ($3,000 to $5,000), but the cost benefit is easily justified. Automated leak testing technology is more sensitive and consistent than using an un-aided eye to watch a pressure gauge during a dry test or searching for bubbles during a wet test.

Damage to scopes can also be caught early using an automated tester, so repairs and the costs associated with them should be relatively small, compared with damage that has to be obvious enough to catch during manual testing. Catching defects early also lowers cross-contamination risks.