CS Questions ● CS Answers

Cleaning scopes with brushes; humidity control; EO monitoring badges

with Ray Taurasi

Questions can be e-mailed to jakridge@hpnonline.com, called in to Jeannie Akridge at HPN, (941)927-9345 ext.202, or mailed to: HPN CS Questions, 7650 So. Tamiami, Ste 10, Sarasota, FL 34231. Names and hospital identification will be withheld upon request.

CS Question:
I recently took a second job at an out patient clinic that does a lot of endoscopic procedures. At the hospital I work at, we were trained that it was necessary to use a brush when cleaning the scopes .However ,at this clinic brushes are not used for cleaning. I asked the charge nurse about this and she said that as long as we flushed all the channels fully until there was no sign of visible soil and wiped the external areas with a cloth, that brushes were not necessary. Do you think it is necessary to use a brush or is she right?

CS Answer: It is important to remember that the goal of cleaning is to remove all soil from any object, which is going to be sterilized or disinfected. Any soil visible or invisible that is not removed may present a barrier to the required contact of the sterilant or disinfecting agent and thus sterilization or disinfection may not occur. Remaining soil increases the bioburden/ microbial load and can inactivate the efficacy of the chemical agent and may also present too high of a microbial count to achieve sterilization utilizing conventional exposure times. In addition to the infection risks, residual soil remaining on processed instruments, scopes and lumen devices can become dislodged during subsequent use being left in a patient as a foreign body presenting a threat to a patient’s safety and welfare.

Therefore it is absolutely essential to use a brush when cleaning all endoscopes. All surfaces and channels of an endoscope, which can be accessed, must be subjected to vigorous cleaning action utilizing a soft bristled brush designed for this purpose. Failing to clean with a brush, the suction and instrument channel, as well as the suction and air/water valves, is a breach of technique and increases the liability and the risk of disease transmission from patient-to-patient.

The design of some endoscopes and instrumentation poses a real challenge to the cleaning process. The water jet channel on many scopes is too small to clean with a brush. Generally these lumens are copiously flushed with an enzymatic detergent, rinsed, chemically disinfected, rinsed again, flushed with alcohol and air dried. To date there have been no reports of nosocomial infections linked to a water jet channel cleaned in the aforementioned manner.

Advancements in technology and instrument design are dynamic. This coupled with user demands for more appropriate cleaning instructions is bringing about improvements in reprocessing this critical patient care equipment ensuring patient safety and welfare.

It remains the responsibility of users to demand, obtain and follow manufacturers’ recommendation for the care, handling and use of all medical devices.

CS Question: Could you please provide information on the proper humidity to be maintained in the sterile processing area? What is the best way to control and monitor this?

CS Answer: The humidity within the Sterile Processing Department should be controlled between 30 – 70% in all work areas. The ideal would be 50% in the preparation and packaging area and no less than 35% relative humidity (RH). It is critical that the humidity level never exceed 70% in the sterile storage area. Excessive humidity levels could result in moisture and the formation of condensate, which could pose a real threat to the sterile integrity of wrapped sterile goods. There are all sorts of equipment available for monitoring humidity levels ranging from hand held probes, traditional, and digital gauges to more sophisticated computerized devices. Some of these devices have built in alarming mechanisms, continuous and intermittent recording systems. Most SPD departments I have visited are utilizing basic humidity monitoring gauges that are digital or traditional, which must be viewed and visually read. In situations like this where there is no automatic recording system a log should be maintained adjacent to the monitoring device and the humidity conditions should be documented at specified times throughout the day. Depending on the size, design and layout of the department it might be necessary to have monitors strategically positioned in the various work areas. It might be wise to consult with the HVAC specialist in your engineering /facilities management department to determine the most appropriate device and locations for monitoring in your department.

CS Question: We are still utilizing EO for sterilization and run approximately 3 – 4 cycles a week. Our previous head nurse used to require us to wear monitor badges once a month to be sure we were not being exposed to any dangerous chemicals. We got a new boss about a year ago. When he first arrived he made us wear the monitors a few times but he has not done any personal monitoring for at least the past eight months. I am concerned that he isn’t following the regulations and that we might be in danger. What should we do?

CS Answer: OSHA (Occupational Health Safety and Health Administration) is a governmental regulatory agency and has strict regulations regarding employee monitoring for potential EO exposures in the work environment. OSHA has established that the Permissible Exposure Limit (PEL) not exceed 1 ppm over an eight hour TWA (Time Weighted Average) or 5 ppm over a 15 minute Short Term Exposure Limit (STEL). Employers are held responsible to conduct personal exposure tests for both the PEL and STEL for all representative work areas and personnel where EO is utilized. OSHA has also established an action level of (0.5 ppm for 8 hr. TWA) which determines requirements for repeated monitoring. If the STEL is at or below 5 ppm and if the 8 hr TWA is at or below the action level of 0.5 ppm no further monitoring is required (unless specified changes and circumstance arise). Circumstances that would require additional monitoring include changes in production process, personnel changes, sterilizer repairs, or any suspect events. Taking this all into account the monitoring your manager conducted may have yielded results, which indicated no additional monitoring was required. Employers are required to notify employees of monitoring results within 15 days of receipt. I would urge you to voice your concerns to your manager and request that he provide you with the monitoring documents. The use of continuous environmental monitoring systems sensitive to EO greatly guards employees from over exposures. HPN

Ray Taurasi is director of professional services for Case Medical Inc., Ridgefield, NJ.