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KSR Publishing, Inc.
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         Clinical intelligence for supply chain leadership

 
 
 

INSIDE THE CURRENT ISSUE

November 2012

2012 Endoscope Care Guide

 
 

CPDguy offers C.H.I.P tips for flexible endoscopes

by Stephen M. Kovach

CH.I.P. tips are helpful tips concerning the care, handling, inspection and prevention for medical devices from the "CPDguy." These are based on my many years of working in various departments within a medical facility along with observations from visiting many different types of medical facilities. The C.H.I.P. tips below pertain to units that reprocess flexible endoscopes.

Leak testing

When leak testing is done manually I see two areas of concern:

  1. Many times technicians do not angulate the tip of the flexible scope during the leak-testing step. It is important to angulate the tip in all directions to stretch the bending sheath material and thus open any pinholes.

  2. After a leak test it is important to release pressure by opening the valve on the leak tester unit. Relieving this pressure is important. I have seen staff forget this step and just unplug.

Daily preventive maintenance of the scope.

Many manufacturers recommend that staff polish the objective lens on a routine basis. I do not often see this done. It is very simple:

  1. Apply the approved polish to the objective lens making sure to stay away from the air/water nozzle (jet);

  2. Then remove the polish with an appropriate applicator also making sure the wiping motion is away from the air/water nozzle (jet).

Another preventive maintenance issue is when using reusable caps. Some instructions for use state that they need to be lubricated with specific silicone to help preserve the seal. Lubrication is used to ensure optimal functioning of both endoscopes and accessories such as caps and valves. The "O"’ rings on suction and air/water control buttons require lubrication to prevent the buttons sticking in the depressed position, and I do not observe this being done on a regular basis, if at all.

Detachable parts

I see bins with caps and valves just randomly selected when a scope is needed. Detachable parts that are to be reused (e.g., suction valves/pistons) should be reprocessed together with the corresponding endoscope as a unique set in order to allow traceability (BSG Guidelines for Decontamination of Equipment for Gastrointestinal Endoscopy-February 2008). Valves should be dried and lubricated according to the manufacturer’s written instructions for use. Again, for cleaning, all detachable parts should be removed from the scope and kept together as a set, regardless if manually or automatically reprocessed.

Alcohol and air flush

This is one of the last steps in the reprocessing of flexible scope and a very important one because it is essential not to leave any moisture inside or outside of the scope. Unfortunately, I often see shortcomings in this area. If moisture is left behind it provides an excellent medium for various microorganisms to grow. Flushing with a 70 percent-80 percent alcohol flush, followed with medical grade air (avoid high pressure and check with the scopes manufacture for the pressure setting to use) must be done to ensure a dry scope. One method I’ve seen employed to remind staff of this critical step is to use a tag with a check-off box on the tag stating this has been done.

Storage and labeling

Many scopes just hang in a storage cabinet with no information and no specific valves attached with that scope. Each scope should be labeled in such a way to ensure that when pulled from a storage cabinet the user knows it has been reprocessed and is ready for use.

Endoscopes should be hung vertically (bending can break inner components) in a ventilated area with the distal tip hanging freely, not touching bottom of the cabinet. All scopes should be labeled properly and all reusable parts should be with the scope. Utilizing a method of tracking is a must to determine how long the scope has been in storage.

Quality monitoring

This is an area where many units just do not understand what they need to do. Currently many facilities respond after an incident and that is not the way to prevent the unwanted from happening. In my view, a quality monitoring program should include training, annual competency reviews for all staff (certification of staff as a requirement), testing of equipment for functionality and monitoring the key process steps associated with flexible endoscope reprocessing.

The frequency of monitoring equipment has been established as a minimum of weekly for automated reprocessing equipment (ANSI/AAMI ST79). Also, Joint Commission is requiring the monitoring of the inventory and repair of the scopes by the biomedical department. From my observation, many facilities still have not implemented a program to do this. For the other steps in the process like water quality, testing for organic soil left inside of the scope and other key parameters, no time frames have been established for frequency of testing. It is incumbent on each facility to establish the frequency of testing for itself. Look at your facility’s process and making sure even these simple observations are put in place to help improve the quality of the your process.

A Multisociety [the American Society for Gastrointestinal Endoscopy (ASGE) and the Society for Healthcare Epidemiology of America (SHEA) among others] position paper states, "Healthcare facilities should develop protocols to ensure that users can readily identify whether an endoscope is contaminated or is ready for patient use." The question remains, are you proactive or reactive when it comes to understanding your facility’s process for flexible endoscope reprocessing?

Stephen M. Kovach is Director of Education at Healthmark Industries.