Standardize Flexible Endoscope Reprocessing

From focusing on common issues to spot checking staff, here’s how to maintain consistency.

Complex tasks require consistent protocols, as even seemingly minor variations can cause critical steps to fall through the cracks.

With up 100 intricate steps involved, few tasks are as maddeningly complex as flexible endoscope reprocessing. The key to getting a handle on this crucial GI task is to standardize your protocols and policies in a manner that complies with relevant guidelines from associations such as the Association for periOperative Registered Nurses (AORN) and the Association for the Advancement of Medical Instrumentation (AAMI).

Regardless of the specifics in your policy, the following best practices should help your team maintain consistency when working with flexible endoscopes.

Simplify the overall undertaking

When you look all those little steps involved in endoscope reprocessing in a vacuum, the monumental task of standardization can seem impossible. But everything suddenly becomes a lot more manageable when you break flexible endoscope care down into the major areas involved in the process. These are: Point-of-use (POU) care or precleaning, safe transport, leak testing, manual clean, high-level disinfection and storage.

Focus on common problem areas

A prime example is POU care. This essential first step in flexible endoscope care is often overlooked or improperly handled. Policies should clearly spell out when and how to tackle precleaning correctly. “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,” says Linda Beaver, RN, MSN, MHA, administrator of Gateway Endoscopy Center in St. Louis.

This should include everything from wiping and soaking the endoscope through the specific and crucial flushing process. “Soak the distal tip in detergent water and flush the air/water channel with water, then air,” Ms. Beaver says.

Transport is another component that’s been known to cause problems for facilities of all types. A strong policy is your best defense here. “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 Casey Czarnowski, BA, CRCST, CSPDT, CIS, CER, a perioperative consultant based in Rochester, Minn. “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.”

Lean on your veterans

To ensure consistency among your staff, let your new hires shadow a trusted and experienced staff member, one who can ensure each step is done the right way.

Christine Young, a surgical technician and cleaning room manager at Greenwood Endoscopy Center in Greenwood, S.C., shadowed a veteran tech who had worked at the facility for 16 years, all day, every day, and watched everything she did over and over and over until the trainer felt she was ready for hands-on learning herself. “Eventually, she’d say, ‘OK, go ahead and jump in there and you start now,’” says Ms. Young. “And if I was doing something wrong, she’d correct me.” Ms. Young’s trainer eventually handed the reins to her, and she handles endoscope reprocessing training using the exact same teaching approach as her predecessor.

Random spot checks, regular audits

Even with properly trained and certified technicians on staff, you still need to regularly audit your processes and monitor technicians closely to ensure that variations or personal preferences don’t seep into the workflow. To that end, Marisa C. Ynchausti, BSN, RN, clinical nurse manager at National Ambulatory Surgery Center in Los Gatos, Calif., recommends using an easy-to-follow checklist to guide your spot checks and random audits. “My center uses the HICPAC Sample Audit Tool for Flexible Endoscope Reprocessing, which is available for free on the CDC’s website,” Ms. Ynchausti says. (Access the tool here.)

Random spot checks combined with thorough, regularly scheduled audits are a proven formula for consistency. For instance, in addition to yearly audits where each staff member must demonstrate the steps in the center’s endoscope reprocessing checklists and perform the steps exactly as they were trained, Greenwood Endoscopy Center, conducts frequent reassessments, says Erin Walker, RN, an infection control nurse at the facility.

The practices outlined here should ensure standardization of flexible endoscope reprocessing. OSM