AAMI’s recently released 2021 update to the ST91 national standard on “Flexible and semi-rigid endoscope processing in health care facilities” can help ASCs close safety gaps that risk patient infection. However, the updates will also present new challenges with more lengthy reprocessing and additional costs to meet requirements.
Today ASC leaders needing to know more about ST91 updates will get an inside perspective from endoscope processing expert Mary Ann Drosnock, MS, CIC, CFER, RM (NRCM), FAPIC, director of clinical affairs at Healthmark Industries and the former co-chair of the ST91 working group. She gave Expo Daily News a sneak peek at a few suggestions she will be sharing to help ASC leaders successfully implement five of the most challenging ST91 updates.
- Identify High-Risk Scopes
High-risk scopes such as duodenoscopes and bronchoscopes now have different processing requirements and recommendations identified in ST91, such as cleaning verification with each processing cycle and sterilization, if possible.
Start by creating an inventory of all endoscopes used within the facility and then prioritize those scopes that have new processing requirements in the standard, Drosnock suggests. “Think through how to implement specific cleaning verification tests, which are now required, and move to sterilization, if possible.”
- Track Timing for Point-of-Use Treatment
The time when point-of-use treatment happens must now be documented and conveyed to processing staff so they can confirm if they are in the one-hour limit to manually clean the scope or if extended soaking in detergent solution must be completed, per manufacturer’s instruction.
To capture this time stamp, try placing a tag on the scope, a label on the transport container, or a note in your electronic record, Drosnock advises. “Remember, the goal is to ensure processing staff can access this very specific time information.”
- Implement More In-Depth Inspection and Cleaning Verification
Inspection of endoscopes should now include use of lighted magnification, as well as cleaning verification testing as recommended in ST91 for the specific scope.
Identify a lighted magnifier that will be used to inspect each endoscope after manual cleaning but before disinfection, looking for debris or damage to the scope. Also, identify a cleaning monitor to use for performing cleaning verification testing on endoscopes and look to ST91 to determine cleaning verification frequency, Drosnock says. “Keep in mind that the best practice for cleaning verification is every scope, every time.”
- Shift to Automated Disinfection
Manual disinfection by soaking the scope in a basin of high-level disinfectant solution, is NOT RECOMMENDED in ST91 anymore. High-level disinfection should occur in an automated endoscope processor.
“This change could have a huge effect on ambulatory settings if they are still manually soaking scopes,” Drosnock acknowledges. She recommends determining which endoscopes, if any, are still being manually disinfected by soaking in a basin and then evaluating if an automated endoscope reprocessor can be purchased. “Remember that manual disinfection should only be in an emergency situation such as a power or water failure.”
- Improve Drying
Increased guidance in ST91 now says a final drying step should be performed after each high-level disinfection cycle, whether it was done manually (not recommended) or in an automated endoscope rerpocessor. Drying should consist of purging with instrument quality compressed air for 10 minutes through each channel or the endoscope should be placed into a drying cabinet to complete its validated cycle.
Implement process changes as needed to ensure all scopes are now completely dry prior to being reused on a patient or before going into storage, Drosnock suggests.
In looking at implementing all ST91 updates, she recommends prioritizing changes and implementing those high on the list first. “There is no mention in ST91 of how soon the changes have to be adopted, but you do want to be working on implementing the changes and have documentation, such as an implementation plan, to provide to surveyors if you are inspected before all changes are made.”
When you visit the Expo Hall, look for educational resources to help implement ST91 updates, including on-demand education you can take back to your team.