Seamless Flexible Endoscope Care

Pay close attention to the areas where crucial steps in the process are often overlooked.

Flexible endoscope care is a complex, multilayered process rife with opportunities for errors and missed steps.

Of course, those problems are far less likely to happen at facilities where SPD staff have a seamless, standardized process during which each step is given the attention to detail it deserves.

“Properly caring for your fleet of scopes is critical during every step along the reprocessing pathway,” says Linda Beaver, RN, MSN, MHA, administrator of Gateway Endoscopy Center in St. Louis. 

All in the details

What does such an efficient process look like in practice? At standout centers, it looks like a well-oiled machine where everything — from precleaning straight through to storage — is given meticulous attention to detail. Here are major areas of reprocessing where issues tend to present themselves.

• Precleaning is paramount. Point-of-use (P.O.U.) cleaning is a critical — and often overlooked — part of the endoscope care process. This should begin as soon as the procedures are completed, according to Ms. Beaver.

“Point-of-use cleaning at the bedside should begin as soon as procedures are completed. It makes the most sense to have nurses in the procedure room perform the cleaning because they’re already wearing the necessary personal protective equipment.” she says. This bedside cleaning should include wiping down the insertion tube with ready-to-use, pre-saturated detergent wipes, suctioning detergent water through the scope and flushing the air/water channel with water, then air. “Soak the distal tip in detergent water and flush the air/water channel with water, then air,” Ms. Beaver says.

Casey Stanislaus Czarnowski, BA, CRCST, CSPDT, CIS, CER, is in full agreement about the importance of P.O.U. care. Mr. Czarnowski, who serves as the sterile processing educator at interventional platform education at Stanford Health Care in Palo Alto, Calif., suggests equipping rooms with kits specifically designed to tackle P.O.U. post-procedure. “Endo technicians are less likely to miss steps in P.O.U. care when a kit contains all of the things they need to perform the work,” he says. “There are many commercial products available, and some medical supply companies will create a custom kit based on the facility’s scope IFUs.”

• Transport with care and clarity. After the precleaning is complete, there’s the transport phase, one of the two areas of endoscope reprocessing in which Mr. Czarnowski says knowledge gaps tend to exist — and often lead to issues. “Two areas that facility leaders must keep top of mind are transportation regulations and extended cleaning protocols,” he says. We’ll get to the cleaning protocols in a minute, but first transport. Here, one of the ways to ensure consistency and compliance is via a formal policy. “Writing a scope transportation policy based on OSHA transportation regulations, as well as on common sense, is a critical aspect of any scope reprocessing program,” says Mr. Czarnowski. “I have visited facilities that weren’t designed with safe scope transport in mind, but were able to develop workable transportation protocols once they understood the regulations and were able to educate executive leadership about them.”

In terms of how you get the scopes to where they’re going, pay careful attention to the route staff take. “Transportation of scopes should not be through public areas of a facility, they should be transported backstage to prevent any possibility of exposure to facility visitors,” says Mr. Czarnowski, adding that a used scope being taken to the processing area must be marked as biohazard during transport.

Last but not least, everyone who transports scopes must be properly trained. “This may include materials management, supply chain or even third-party couriers,” says Mr. Czarnowski. “We have to make sure that everyone who handles a contaminated scope understands what they have in their hands and how to protect themselves and others from possible exposure.”

• Testing for defects. Once the scopes are successfully transported to where they need to go, test the equipment for damage. Ms. Beaver is a big proponent of dry-leak testing. “We bought an automated dry leak tester, which is about 95% effective in detecting tears or punctures, compared to an approximate 35% detection rate from a manual wet test,” she says.

The wet test involves submerging the scope’s tubes in water and looking for bubbles, while the dry test hooks the tube up to the tester and uses leak-sensing technology to scan the tubes. “Dry leak tests take the human element out of the process,” says Ms. Beaver. “The endoscope is hooked up to a device that uses leak-sensing technology to scan the endoscope’s channels and prints out a report of the results after each test.” She believes this process is more effective than manual tests at detecting small defects that increase cross-contamination risks and that could lead to further damage and costly repair bills.

• Meticulous manual cleaning. Both Mr. Czarnowski and Ms. Beaver stress the crucial important of proper, thorough manual cleaning. “Two areas of great importance in manual cleaning of flexible endoscopes are rinsing and brush selection,” says Mr. Czarnowski. “Rinsing is of critical importance, and all staff who process endoscopes should be trained to follow the scope’s IFU for rinsing and educated as to its importance.”

Brushes should be selected based on the scope’s IFU and should be single use. As Mr. Czarnowski states, the extended cleaning protocols are an essential part of proper endoscope care. Unfortunately, there are still plenty of SPDs that are unaware of the finer points.

“Extended cleaning protocols are also an important part of the scope’s Instructions for Use, but I have talked with many programs that are unaware of them,” he says. “Most flexible endoscope IFUs now contain extended cleaning protocols, and general information can be found in AAMI Standards.”

Standardization is the goal

Obviously, areas such as visual inspection of the scopes, high-level disinfection or sterilization, storage and documentation are also a key part of a complete endoscope reprocessing protocols, but the areas discussed here in detail involve many places where SPD leaders find inconsistencies or missed steps in protocols.

Remember, the goal is standardizing the process as much as possible, something Mr. Czarnowski says requires education, monitoring and a reliable point person. “A person should be designated to be in charge of establishing and recording educational activities,” he says. “This ensures all staff understand the reasons behind the reprocessing steps.” OSM