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Q I work in a very busy outpatient clinic where we do a high volume of endoscopic procedures. All endoscopes are processed by hand and each tech is responsible to care for the scopes and equipment used in the rooms they are assigned to. I have noticed that not everyone uses compressed air or alcohol to flush the lumens. Some techs immediately take the scopes back to their rooms after the final rinse is completed. When I have confronted my colleagues about this some feel that if a scope is going to be reused during the shift it is not necessary to do the alcohol flush. What do you think is the best protocol to follow? A Endoscope reprocessing is a multi-stepped process that renders a contaminated used endoscope safe for reuse on another patient. The steps include thorough cleaning, followed by complete immersion in a liquid chemical sterilant (LCS) or disinfectant for the prescribed period of time recommended by the chemical manufacturer to achieve high-level disinfection or liquid sterilization. After removal from the chemical soak, endoscope lumens and surfaces must be copiously rinsed with water to completely remove chemical residual.Endoscopes must be carefully handled and stored. Endoscope drying can be easily, quickly, and inexpensively achieved by flushing the endoscope’s internal channels, and wiping its external surfaces, with 70–90% ethyl or isopropyl alcohol, to facilitate drying after reprocessing, followed by flushing with compressed air. Wetness or moisture left inside or on scopes can be a source of contamination creating a breeding field for microbes. The longer moisture remains in or on a scope the greater the likelihood for contamination as organisms multiply. The environment and storage condition can also impact the rate and degree of microbial growth. Drying of endoscopes maybe as important to the prevention of nosocomial infection as is the cleaning and disinfection. Wet or inadequately dried endoscopes can pose an increased risk of contamination and have been associated with transmission of waterborne microorganisms and nosocomial infection. Properly cleaned, disinfected and thoroughly dried endo-scopes have not been linked to nosocomial infection. Not all healthcare facilities dry their endoscopes after reprocessing. Published guidelines and individual hospital policies vary. Some guidelines and policies recommend drying the endoscope after completion of every reprocessing cycle, both throughout the day and before storage, while others deemphasize the importance of routine drying and recommend endoscope drying only before storage. Instead of recommending endoscope drying before storage, some guidelines and hospital policies recommend reprocessing endoscopes before the first patient of the day. Endoscope manufacturers also are required to provide users with cleaning and reprocessing instructions. Regardless of what guidelines or manufacturers’ recommendations may indicate no harm can be done to endoscopes by drying after each cleaning process. I am very much in favor of having a standardized procedure in place for the reprocessing and drying of all endoscopes which is followed by all personnel consistently throughout the day. The likelihood of error and the transmission of infectious agents are increased when processing protocols are varied allowing individuals to alter processing methods. Each and every patient deserves the same quality of service and care regardless of where their procedure may fall on the daily schedule. We know that moisture allowed to stand in scopes can provide a reservoir for bacteria and with the passage of time the bacteria will multiply; waterborne organisms and inadequately processed scopes have been linked to disease transmission between endoscopic procedures and patients. Properly processed endoscopes, which included thorough drying, with an alcohol flush, have never been linked to a nosocomial infection. In my opinion, the best practice would therefore include the drying of all endoscopes by flushing scope lumen channels, (in accordance with manufacturers’ instructions) with 70–90% ethyl or isopropyl followed by compressed air.
Q I have been trying to eliminate flash sterilization in our O.R. Over the course of the past year I have succeeded to reduce the practice by 30%. Despite my efforts I continue to meet resistance to change from the O.R. staff. We are still running anywhere from 5 – 8 flash cycles per day in the O.R. I know that professional groups like AORN are against flash sterilization and I am concerned that our patients are at risk by the continuation of this inferior practice.A From strictly a technical and scientific perspective when managed and done correctly flash sterilization is not an inferior sterilization process. The problems and concerns relative to flash sterilization are more related to equipment utilization and the human element. The term Flash in of itself implies Fast and like anything that is done in a rush the risk associated with human error, and or complacency is increased. The primary concerns with flash sterilization has centered on the improper cleaning and preparation of instruments for sterilization and the aseptic transportation and transfer of the sterilized goods from the flash sterilizer to the operating room. AORN is not against flash sterilization but their recommended practices do provide guidelines for the safe and proper application of the flash sterilization process.AORN Recommended Practice IV 2006 addition states that: Flash sterilization should be used only in selected clinical situations and in a controlled manner. Use of flash sterilization should be kept to minimum. Flash sterilization should be considered only if all of the following conditions are met. a. The device manufacturers instructions are available and followed b. Items are disassembled and thoroughly cleaned with detergent and water to remove soil, blood, body fats, and other substances c. Lumens are flushed with the cleaning solution and rinsed thoroughly d. Items are placed in a sterilization container or tray in a manner that allows steam to contact all instrument parts e. Measures are taken to prevent contamination during transfer to the sterile field f. Documentation of cycle information and monitoring results ia maintained to provide for tracking of the flashed items to the individual patient g. Flash sterilization should be used only when there is insufficient time to process by the preferred wrapped or container method. Flash sterilization should not be used as a substitute for insufficient instrument inventory. h. Flash sterilization should not be used for implantable devices It sounds like you have made some great progress in
reducing your flash cycles by 30%. In today’s hospital environment it
may not be possible or for that matter even practical to expect to
eliminate the use of flash sterilization. Flash sterilization is a
reality and necessity; when done properly and managed it does not pose
increased risks to patient care or equate to an inferior process. I
would suggest that you establish a quality improvement team consisting
of representation from the O.R., CPD, and IC to review your current
practices and to establish process improvement initiatives and related
procedures that would ensure the proper application and use of the Flash
process. New technology, 
About the Author: Ray Taurasi is director of professional services for Case Medical Inc. Ridgefield, NJ. His healthcare career spans over three decades as an administrator, educator, technologist and consultant. Taurasi has been a faculty member of numerous colleges teaching in the divisions of business administration and health sciences.
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Flushing
scope lumens; reducing flash sterilization
