One of the most common causes of costly repairs is
fluid invasion. This happens when fluids such as water, detergent
or reprocessing chemicals enter areas of the scope where they
shouldn’t be. The impact on the scope is damage to electronic
components, optical and angulation systems and other internal
elements. The end result is downtime with all its associated
costs.
So how does fluid invasion happen? And what can
you as a nurse, physician, technician or other scope handler do to
prevent it?
The causes for fluid invasion can happen anywhere
in the cycle of performing a procedure, including during
transport, handling, room setup, the procedure itself,
reprocessing and storage. Reducing the risk of damage is a team
effort. Continuous education, training and implementation of
proper processes for scope care and handling will go a long way in
preventing fluid invasion and its associated repairs.
Olympus educates our repair technicians about the
reasoning behind why a repair process needs to be performed in a
certain way. This is just as important as training them how to
perform that particular repair. Our repair technicians know that
no step in the process can be missed without affecting the outcome
of the repair. A similar principle applies to the care and
handling of your endoscopes. Each member of your team should
understand the "whys" and "hows" relative to their particular
scope responsibilities in order to appreciate their role in
minimizing repair expenditures.
In an environment that is in a constant state of
change with new technologies, responsibilities, turnover, etc.,
ongoing education and training becomes even more challenging.
Handle with care
Here are a few always-timely tips for avoiding
scope damage, which can lead to fluid invasion.
Handling: Protect the scope at all times.
• Avoid coiling insertion tubes too tightly.
• Avoid stacking scopes with accessories or other
scopes during transport.
• Use care when handling scopes around sharp
objects and metal surfaces.
Setup: Check compatibility and working condition.
• Examine condition and size-compatibility of
accessories to avoid damaging channels.
• Inspect and test scopes prior to each procedure
to catch damage early on.
• Regularly check caps, pistons and visible seals
for wear and tear to ensure the scope is watertight.
Endoscopy Procedure: Follow original equipment
manufacturer’s (OEM) operating instructions.
• Take care when picking up the instrument or
putting it down.
• Avoid exerting too much force on buttons,
switches, angulation cables or the control grip during use to
avoid punctures, cracks and buckling.
• Inspect each EndoTherapy device before inserting
it into the channel. Stop when you encounter a restriction and
don’t attempt to advance the device while the scope is angulated.
• Make sure the device is in the field of view
before opening or engaging; good communication between nurse and
physician is critical.
Reprocessing: Train, train, train.
• Avoid stacking a scope on its own distal tip.
• Do not reprocess scopes together unless using a
reprocessing machine specifically designed for reprocessing two
scopes in a single basin.
• Check sinks, drains and countertops for sharp
edges; remove unnecessary objects nearby.
• Ensure reprocessing staff has adequate
reprocessing time. Don’t rush.
Always follow all four reprocessing steps:
1. Bedside Cleaning
• Check integrity of water resistant cap and make
sure it is dry.
• Put the cap on before cleaning at beside.
• Clean at bedside before bioburden hardens to
avoid aggressive cleaning later.
2. Leak Testing
• Leak test before manual cleaning.
• Use a sink that is large enough to avoid
crimping the instrument.
• Post the appropriate OEM leak testing
instructions. (For scopes that fail leak testing, see
www.olympusamerica.com/ damagedscopes for instructions on
cleaning and high-level disinfection or sterilization of the
damaged endoscope prior to shipment to a service center for
repair.)
3. Manual Cleaning
• Avoid undue chemical damage by adhering to OEM
instructions for reprocessing time, temperature, and concentration
using recommended detergents and high-level disinfectants/sterilants.
• Follow the detergent manufacturer’s instructions
to ensure the proper detergent concentrations.
• Use appropriate cleaning brushes that are in
good working condition.
4. High-Level Disinfection (HLD) or
Sterilization
• Follow the scope manufacturer’s approved
protocols for high-level disinfection or sterilization.
• Follow manufacturer’s instructions for use of
automated endoscope reprocessors (AER) and high-level
disinfectants/sterilants.
• Use only endoscope-compatible liquid chemical
germicides recommended by the scope manufacturer that have been
tested for material compatibility.
Storage: Protect scopes when they aren’t in use.
• Store scopes in a clean, ventilated and
uncluttered cabinet (not in carrying case).
• Hang scopes vertically with valves and caps
removed and with locks in the "free" position.
Preventive Maintenance: Fix minor damage quickly
before it escalates.
• Regularly check endoscopic equipment and
accessories for wear.
• Ensure scopes are repaired to OEM
specifications.
• Retire outdated equipment and keep active scope
inventory levels on par with patient volumes.
• Keep appropriate staff trained on handling,
operating and reprocessing protocols. HPN
