A strong education program should begin with a thorough assessment of current hospital procedures for the handling and management of endoscopes. Assessment emphasis should include identification of process and logistic inefficiencies, regulatory or patient safety risks, and improper staff care and handling techniques.

During assessments it is not unusual to uncover processes that place undue risks on the medical staff or patients. As an example, the Cardinal Health Onsite Services team recently helped a customer change a process in which select endoscopes were not properly being decontaminated when they failed a leak test. Inadvertently, these unmarked contaminated devices were handled by personnel in multiple departments without proper protection. Left unchecked these processes could have led to health and cross contamination issues with both hospital staff as well as vendors.

Another common opportunity uncovered in assessments is to assist hospitals in establishing standard operating procedures for the care and handling of their endoscopes. At a recent customer engagement, sub-optimal leak testing, care and handling techniques and transportation methodologies were discovered. Although none of these issues caused patient safety risks, they unnecessarily exposed the scopes to excessive abuse. Left unchecked these processes could likely lead to scope repair and replacement costs.

When a hospital has established an effective operating procedure for managing its endoscopes, it is then able to effectively utilize equipment tracking programs to monitor their scopes. One such equipment tracking program is Cardinal Health’s OnSite Services Repair Manager. This program monitors usage and repair rates for each scope. It provides visibility into repair trends and helps identify abusive patterns that can then be targeted for education and preventive maintenance training.

Example of Fluid Invasion in the control body. (Note the corrosion in and around the wires)

In fact, at one facility the Repair Manager program helped pinpoint excessive repair and replacement patterns in which multiple endoscopes from the same department were experiencing major fluid invasion damage. With a $5,000-or-greater replacement cost for each individual endoscope, the problem was extremely expensive. Through regular monitoring of the Repair Manager software and by implementing a pro-active preventive maintenance education program, the facility established a process in which they could perform leak tests prior to the automated reprocessing of endoscopes, thus detecting damage to the equipment that was not being picked by their traditional inspection methods. Although this preventive maintenance process added an additional step in the reprocessing, it proved to be an excellent time investment for the department.

The benefits of implementing an endoscope management program with a trusted repair vendor are significant. One Cardinal Health OnSite Services customer reported an annualized savings in excess of $300,000 after implementing the program, as well as an increase in end-user satisfaction.

While a well-run endoscope management and repair service can eliminate many problems for the hospital, it is still important for the hospital to maintain inspection processes for repair scopes that are reentering the facility.

Inherent product damage risks exist when sending an endoscope to an outside vendor for repair. The importance of this is underscored by the fact that the endoscope is an invasive medical device, which if not properly cared for, can lead to patient injury or infection. Complicating matters further, endoscopes are delicate devices containing complex mechanical parts and electronics. To minimize such risks, a hospital should use great care and pay attention to the packaging and shipping processes used by the repair vendor and perform a thorough product inspection prior to re-using the returned endoscope on a patient.

There are three key components to the inspection process that one should follow:

Test by turning the up/down, left/right control knobs located on the control body grip

Visual inspection: All endoscopes should be visually inspected for nicks, dents, or scratches that may result in sharp edges, and if undetected, may inadvertently cause patient injury. On flexible endoscopes the insertion tubing should be inspected for blisters, adhesive separation, peeling, cuts, and scrapes, all of which may allow bio-burden to collect and potentially create cross contamination or surgical site infection risks.

Functionality testing: Articulate the distal tip to make sure that proper degree of articulation is observed. This will validate the mechanical function of the angulation system and ensure that the physician will have proper viewing capabilities during the procedure.

Leak testing: This safety check ensures that fluid invasion will not occur during the medical procedure and thus prevent unnecessary physician frustration and expensive repair or replacement costs.