How to Handle the Colonoscopy Surge

Gastroenterology

By: Casey Czarnowski

Published: 2/3/2021

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Double down on sound endoscope reprocessing to provide safe and efficient care during even your busiest days.


This is a hectic time to run a GI center, isn't it? As you keep pace with newly scheduled colonoscopies and work through a backlog of postponed procedures, know the stakes are high for managing and maintaining a full schedule of screenings. In October 2020, the surgery center management firm AMSURG reported 200,000 of its patients had missed their scheduled colonoscopies since the start of the pandemic. That's alarming when you consider about 850 out of every 200,000 colonoscopy patients get diagnosed with colon cancer.

To keep cases moving through your facility in order to give more patients access to potentially life-saving care, reemphasize proper endoscope handling techniques, tap into advances in reprocessing technologies and rely on a properly trained staff. Running an efficient center has never been more important.

Standard rules apply

The six basic steps of scope reprocessing — point-of-use pre-cleaning, careful transport, leak testing, manual cleaning and flushing, disinfection and sterilization, and careful storage — should apply, no matter how busy your facility gets. Now certainly isn't the time to cut corners or take shortcuts to respond to increased caseloads. Changing or modifying any of these essential steps to proper endoscope care will do more harm than good.

QUICK RINSE Kits that contain the supplies needed for cleaning endoscopes at the bedside can help speed the process along.   |  Casey Czarnowski
  • Bedside care. Flush a scope's channels and wipe off the exterior of the insertion tube immediately after exams are complete and before the scope is transported to the reprocessing area. Pre-assembled kits containing a syringe, basin, sponge and soap make the point-of-use cleaning more efficient.
  • Safe transport. Scopes are fragile and expensive, so you need containers that will safely hold them in place as they're being moved to the reprocessing area. Federal regulations require containers to be labeled as carrying biohazardous material to alert staff that they contain soiled instruments. Make sure the containers are made of a sturdy, puncture-resistant plastic and are large enough for the instruments to lie in without the tubes crimping and high enough on the sides to keep coiled scopes fully contained.
  • Leak testing. When scopes arrive at the reprocessing area, leak test the scopes with either a dry or wet leak tester, following the tester manufacturer's instructions for use. Visually inspect the insertion tube, control body, light cord, and any sections that bend and the cord to look for holes or cracks in the coating that indicate the scope needs to be taken out of the rotation and repaired. Leak testers will detect leaks that the eyes of the techs cannot.
  • Manual cleaning and flushing. Once the scopes have passed the leak tests, the narrow channels within the scope must be brushed. It's important to use the proper size brushes designed to accompany each scope and scrub the entire device, including valves and buttons set in all positions. After manual brushing is complete, connect scopes to an automated cleaner that flushes channels with enzymatic soap and/or a high-level disinfectant.
  • High-level disinfection. Automatic endoscope reprocessors allow you to run the scopes though several cycles of cleaning, disinfecting, rinsing and alcohol flushes to ensure they are high-level disinfected. This can take up to 45 minutes to complete. The alcohol flush is important, as it dries internal channels before scopes are moved to the storage area. Examining scopes with a small-diameter borescope after high-level disinfection is recommended as an extra step to check the scopes' lumens for residual bacteria.
HIGH-TECH HANGING The latest storage cabinets stream filtered air into endoscopes to keep them dry and employ barcode technology to track where scopes are located.   |  Casey Czarnowski
  • Proper storage. To maximize drying and minimize the chance of recontamination, scopes should be hung vertically in specially designed storage cabinets. Some cabinets circulate air throughout the storage chamber to help keep scopes dry between uses. High-end storage units provide a continuous flow of air around endoscopes and feature tubing connectors that blow a steady stream of filtered air through the channels. Some of these advanced units also have smart features such as barcode technology that allow you to track a scope's cycle of use in addition to recording its time in storage.
  • Staffing and scheduling. Make sure your facility is adequately staffed, and consider scheduling screenings in the evenings and on the weekends. Expanding the schedule is a better option than trying to meet the heightened demand by rushing endoscope reprocessing cycles. If you maintain your normal business hours, you'll likely have to increase overall efficiencies by being smart about managing the day's schedule.

    If you're working with the same endoscope inventory and an increased caseload, when you schedule the cases during the day is more important than ever. If one type of endoscope that's normally used once or twice a day will be used more than that, make sure to schedule other types of cases in between so there is time to effectively reprocess them.
  • Training and role assignments. If you do decide to add scopes, make sure your staff is trained on how to handle and reprocess new or unfamiliar models. For example, make sure you have the properly sized brushes on hand to perform proper manual cleaning. Even if you buy a new scope that is the same model as the ones you currently have, the IFUs for the newer model could be different, and might require additional cleaning equipment or steps. You should designate a staff member to keep up with any new developments that the reprocessing staff needs to know about, whether it's updated IFUs, new professional society guidelines and or general industry publications.

Ready for what's next

No one can predict what the next year will bring and how COVID-19 will impact colonoscopy screening volumes. The virus could be contained, and we'll face packed schedules as we deal with scheduling new cases and continuing to work through the backlog of postponed procedures due to the pandemic's first wave. Whatever happens, you shouldn't respond by ramping up too fast or committing to too high of a case volume. Keep doing what you've always done: relying on sound practices to make sure your patients are treated effectively and safely. As long as you don't stray from that focus, you'll be able to handle an influx of patients, even as the pandemic surges on. OSM

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