At minimum, endoscope reprocessing problems, when discovered, can inconvenience patients and create anxiety; at worst, they can lead to life-threatening infections. "These incidents are almost always associated either with failure to follow established cleaning and disinfection/sterilization guidelines and instructions or with the use of damaged or malfunctioning equipment," ECRI stated. "Flexible endoscope reprocessing requires consistent adherence to a multistep procedure: Failure to properly perform any step, including some necessary manual tasks, could compromise the integrity of the process." 2011 marks the second year in a row that flexible endoscopes made the ECRI Top Ten list.

Flexible endoscopes are particularly challenging to clean and disinfect because they often contain many internal channels. If bioburden remains in any of these nooks and crannies, proper disinfection cannot occur and patients may be exposed to infectious microorganisms.

"Technicians are asked to clean areas impossible to visualize and hard to reach," explained IAHCSMM educational director Natalie Lind.  Complicating matters further, the scopes themselves are very delicate and the cleaning process must be thorough, and at the same time, be conducted in a manner that will not damage the scope.

Time-related challenges are also an issue. "Scope preparation and reprocessing takes time and, as we all know, time is in short supply in many reprocessing areas," added Lind.

Given that an estimated 15 million flexible endoscope procedures are performed annually in the US alone – and that procedures may be performed in a variety of settings and by different healthcare professionals (some of whom may not even be competent in regard to endoscope processing), it becomes clear why scope-related challenges and problems continue to be so prevalent.

The endoscope processing and handling missteps that have captured the media spotlight have led to some positive developments, however, with increased educational efforts being one of the most significant.

The International Association of Healthcare Central Service Materiel Management has long offered targeted education regarding the proper care, handling and reprocessing of scopes (from articles and book chapters to discussion forums and hands-on sessions at annual meetings). The Association has also fostered productive partnerships with allied organizations – including the Society for Gastroenterology Nurses and Associates, the Association for Professionals in Infection Control and Epidemiology, the Association for the Advancement of Medical Instrumentation, and the Association of periOperative Registered Nurses – to drive standards-based practices that promote quality, safety and consistency.

Other groups have stepped up their educational efforts as well. In November 2009, the US Food and Drug Administration issued a joint safety communication with the Centers for Disease Control and Prevention and the Department of Veteran Affairs to outline the necessary steps for the prevention of cross-contamination in endoscope processing. This communication, which was reviewed by the Joint Commission, cautioned healthcare facilities – including hospitals, ambulatory care facilities and private practices – about the risks to patients if flexible endoscopes and their accessories are not processed properly; it then recommended steps to reduce these risks. The communication also reminded manufacturers of endoscopes and endoscope processing equipment of their responsibilities in helping assure proper endoscope processing in healthcare facilities. [Note: The FDA guidance was not intended to be all inclusive or comprehensive. CSSD professionals and others who bear scope processing responsibilities should refer to the CDC/HICPAC Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008, and the Multi-Society Guideline for Reprocessing Flexible Gastrointestinal Endoscopes, 2003, for comprehensive information on endoscope processing and quality control. Further, Chapter 12 of the IAHCSMM Central Service Technical Manual, Seventh Edition, features detailed information on endoscopic instruments, along with related photos.]

It’s also critical that CSSD technicians and other professionals who bear responsibility for scope processing be well-versed on the different types of flexible endoscopes. "Not all scopes are alike," stressed Lind. "Technicians must be able to recognize the differences in scopes and the differences in the processes needed to adequately process them."

Inventory and service tracking of endoscopes are two other functions that have also moved front and center now that the Joint Commission imposed a requirement that makes clinical engineering departments responsible for including flexible and rigid scopes in their medical equipment inventory. These departments can still determine the frequency of preventive maintenance on scopes, however, and the responsibility of scope maintenance can fall on clinical engineering or the gastroenterology lab, the accreditation agency noted.

While having a methodology in place to track endoscope processes is undoubtedly a good idea, it’s important that healthcare facilities understand the critical role that the CSSD plays in the process.