New standards help staff work out scope processing kinks

by Julie E. Williamson

Central Sterile Supply Department professionals who bear the responsibility of processing and handling endoscopes know that the job isn’t an easy one.

This is especially the case for flexible endoscopes, which have difficult to clean internal channels that can hide bioburden and infection-causing microorganisms, and limit the effectiveness of proper disinfection. What’s more, the scopes are delicate, yet require diligent, thorough and consistent cleaning — in a manner that doesn’t cause damage to the devices.

Given these challenges, it’s little wonder one needn’t look far to find reports of endoscope processing and handling errors — and subsequent patient exposures to infection-causing microorganisms. But those reports hardly convey the full picture. Many CSSD professionals can share stories of endoscope-related processing challenges or mishaps that could have placed patients at risks. Even though many of these incidents never make headlines, they’re no less dangerous or risky.

This point was further underscored when, for the past two years, flexible endoscopes ranked amongst the most dangerous health technology hazards on ECRI Institute’s Top 10 list (this year, the devices earned the top spot on the list). With an estimated 15 million flexible endoscope procedures performed annually in the United States alone — and those procedures performed in a variety of settings and by different healthcare professionals (some of whom may not even be properly trained in endoscope processing), it becomes clear why scope-related challenges continue to rear their ugly head.

Standards-based competency critical

Safety- and quality-focused processing professionals understand that proper cleaning is essential for reducing flexible endoscope-related risks. They also know that no device can be effectively disinfected or sterilized if it hasn’t first undergone proper and thorough cleaning.

To help individuals responsible for endoscope reprocessing manage the tasks effectively, the Society of Gastroenterology Nurses and Associates Inc. (SGNA) offers specific guidance in its Standards of Infection Control in Reprocessing of Flexible Gastrointestinal Endoscopes. These guidelines, first introduced in 1996, were most recently revised in 2012 (prior to this, the most recent updates were in 2008). These standards were developed to complement the 1996 position statement, Reprocessing of Flexible Gastrointestinal Endoscopes-An American Society for Gastrointestinal Endoscopy White Paper and were developed by the American Society for Gastrointestinal Endoscopy (ASGE), Association for Professionals in Infection Control and Epidemiology (APIC), and SGNA. The current version complements SGNA’s 2009 Guideline for the Use of High Level Disinfectants and Sterilants for Reprocessing of Flexible Gastrointestinal Endoscopes.

While the transmission of infectious organisms during gastrointestinal endoscopy is considered rare (1 in 1.8 million cases), ongoing emphasis on infection control issues is nonetheless critical. Quality assurance is of highest priority in settings where gastrointestinal endoscopy is performed. Such settings must have an effective quality assurance program with special emphasis on cleaning and high level disinfection of flexible endoscopes, SGNA notes in its standards.

Guidelines for endoscope reprocessing prescribe the following steps:

1. precleaning,
2. leak testing,
3. manual cleaning,
4. rinsing after cleaning,
5. rinsing after high-level disinfection,
6. drying, and
7. storage.