Myths debunked about endoscope processing

In this the Internet Age, it’s commonplace for sterile processing professionals to be exposed to a lot of noise online about cleaning, disinfecting and sterilizing endoscopy devices and equipment. Some of that noise may inspire questions or heated debate about manufacturer instructions, professional association guidelines and recommendations, internal departmental policy or even the departmental director, clinical education supervisor or colleague.

To clear away some of the fog, smoke and mirrors, Healthcare Purchasing News asked experts at three reprocessing companies to state and debunk any myths meandering through the sterile processing profession. Here’s what they had to say.

• Sterilization of endoscopes is the preferred standard of antimicrobial treatment. False. High-level disinfection (HLD) is recognized and accepted by all the relevant professional organizations, including SGNA, ASGE and APIC.

• Peracetic acid HLD cause endoscope damage. True and maybe. Three factors: Concentration of the peracetic acid, temperature of the solution and pH of the solution have an impact on the effects of peracetic acid on endoscopes. As a general rule, lower temperature, lower concentration, and near-to-neutral pH can reduce, if not eliminate, endoscope damage related to peracetic acid exposure.

• HLDs don’t destroy bacterial spores. False. The FDA requires all high-level disinfectants to have a "sporidical end point" determination. The time to achieve this endpoint is typically considerable longer than what is required to achieve high level disinfection.

• OPA-based HLDs are "safer" to use than glutaraldehyde-based formulations. False. The Personal Protective Equipment (PPE) requirements stated on labels and directions for use of OPA and glutaraldehyde disinfectants are the same, which indicates similar potential hazards of the chemicals.

• The FDA standard hang time for reuse of reprocessed endoscopes is three days; after three days, the scope must be reprocessed again. False. Unlike European standards, the FDA and professional organizations have no specific stated hang time for reprocessed scopes. However, many healthcare organizations do establish in-house guidelines.

• Flushing alcohol through an endoscope at the end of a reprocessing cycle helps facilitate drying of the scope channels. True. An alcohol flush, followed by a filtered air purge, removes excess water from the scope channels, facilitate the drying process, and may reduce the incidence of bacterial growth in the channels.

• An endoscope should be flushed and wiped as soon as possible after it is used in a procedure. True. Initial removal of bioburden, and minimized drying of residues on scopes helps ensure effective soil removal and high-level disinfection.

Terry Mistalski is vice president of global marketing and business development, Medivators, a Minntech Corporation Business Group

• Abbreviated autoclave cycles are an approved sterilization method so they’re acceptable. In fact, immediate-use sterilization, also known as flash sterilization, involves rapid heating and cooling that causes glass, glue and metal components to quickly expand and contract. This stresses the joints and seals and shortens the life of the endoscope as a whole. Bottom line: Don’t use quick cycles for routine sterilization or the life span of your expensive capital equipment will be significantly reduced. Immediate-use sterilization cycles should be used only in actual emergencies, when you experience high demand for a particular scope category because of unusual case volume. Otherwise, this method should not be used as it can shorten the life of endoscopes, increase repair costs, and lead to unnecessary down time. A periodic inventory review will help you determine whether you have too many or too few scopes in a given category; by adjusting your scope inventory accordingly, you can dramatically reduce the frequency of immediate-use cycles.

Lenny Jordan is executive vice president for surgical devices,
Integrated Medical Systems International Inc.

• Optimal manual cleaning is equivalent to automated cleaning. As shown in Dr. Michelle Alfa’s study last year, cleaning* for endoscope surfaces and channels using the EVOTECH ECR is superior to optimal manual cleaning. In fact, the EVOTECH ECR achieved greater than 99 percent compliance with all benchmarks for surfaces and lumens. Additionally, numerous studies of manual reprocessing indicate there is widespread difficulty in achieving recommended standards for manual cleaning and great variability in the manual cleaning performed.1

• Canceled cycles are "bad" and unproductive. Cancelled cycles can alert you to many potential issues that would have affected the integrity of the reprocessing process, for instance, that the endoscope has a leak or channel blockage. I always remind people that it’s better to be alerted to a problem midway through a cycle rather than finding out at the end that there was a problem that went unnoticed. Not only will a canceled cycle save you time, but there isn’t the accidental risk of using a device that has been improperly reprocessed – ultimately jeopardizing patient safety.

• The only risk posed by improper removal of bioburden is infection transmission. Bioburden film can actually lead to visual impairment for the physician during a patient procedure. In everyone’s book, a cloudy endoscope is a sub-optimal endoscope.

• You only have to test the minimum effective concentration (MEC) level once a day. The MEC concentration level needs to be confirmed for every cycle. Since this important testing process can be overlooked, the EVOTECH ECR has an automated MEC test.

• You don’t have to alcohol flush every time. An alcohol flush should be done after every cycle to ensure the instrument is properly dried. Viruses, bacteria, fungi or mycobacteria may grow in endoscopes that are incompletely dried. The EVOTECH ECR has a built-in alcohol flush, another time-saving, automated feature.

• Nearly all reprocessing methods put staff in contact with harsh chemicals. One of the great advancements as the industry moves away from manual cleaning is that healthcare professionals are able to spend more time on the patient and less time on the high-level disinfection process. The EVOTECH ECR features a closed system that reduces worker exposure to chemicals by automatically delivering fresh CIDEX OPA Concentrate Solution and CIDEZYME XTRA Multi Enzymatic Detergent for every endoscope reprocessing cycle.

• One size fits all in endoscope reprocessing. There are actually two important facts that make this a myth. First, just because a reprocessing technology is part of an endoscope IFU does not mean that the reprocessing technology would be part of the IFU for a similar endoscope – even an endoscope by the same manufacturer. You must always check the IFU for the specific endoscope you plan to reprocess. The second fact is that not all automated systems are created equally. The EVOTECH ECR is programmed for every endoscope for which it is an approved reprocessing technology, and individual pumps ensure the EVOTECH ECR can maintain positive pressure in the endoscope, preventing fluid invasion or damage to the endoscope during reprocessing.

*Does not eliminate bedside precleaning. Manual cleaning of medical devices (endoscopes) is not required prior to placement in the EVOTECHECR when selecting those cycles that contain a wash stage.

*SGNA Standards of Infection Control in Reprocessing of Flexible Gastrointestinal Endoscopes, 2009.

Carol K. Stevens, BSN, R.N., CGRN,
is clinical education consultant,
Advanced Sterilization Products

References

1. Gillespie EE, Kotsanas D, Stuart RL. Microbiological monitoring of endoscopes: 5-year review. J Gastroenterol Hepatol. 2008;23(7 Pt 1):1069-74.