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KSR Publishing, Inc.
Copyright © 2016

         Clinical intelligence for supply chain leadership



November 2012

2012 Endoscope Care Guide


Reprocessing endoscopes begins at bedside

by Matt Smith

Many of today’s medical devices and products are transitioning to disposable from reusable. While there could be a number of reasons for this increasing, it is mainly because in many cases proper reprocessing of these instruments is often difficult and sometimes seems impossible.

What about instruments that aren’t disposable? Physicians are performing minimally invasive procedures using endoscopes, cameras and other instruments that cost thousands of dollars or more, and this new technology requires sterilization with methods other than saturated steam under pressure in an autoclave.1 As new technology gets introduced to the medical field, current methods and processes needs to be reviewed, and sometimes changed, in order to ensure proper instrument reprocessing.

Flexible endoscopes are one of the instruments that can be complicated, and reprocessing this equipment can be very challenging. As with all medical devices, endoscopes must be thoroughly cleaned prior to disinfection/sterilization.2 The reprocessing procedure begins at the point of use to prevent organic soils from drying on the equipment.2 Once organics have dried on and in the scope, it makes the removal process more difficult and the possibility that the disinfection/sterilization process will be less effective or ineffective altogether.3

There are a variety of bedside cleaning products on the market today, including pre-measured, diluted detergent in single-use packets. Of note, in December 2011, in an effort to improve endoscope bedside reprocessing efficiency, Olympus announced a revision to the GI Endoscope Reprocessing Manual. Olympus validated the use of water alone to perform endoscope pre-cleaning at the patient’s bedside. (Please check the model of your scope to see if water alone can be used). This eliminates the need to prepare and hold detergent in the procedure room.4

Mary Ann Drosnock, Infection Control Scientist at Olympus America Inc. noted, "We re-validated our guidelines and reprocessing manual because the findings, following a series of rigorous tests, concluded that using water was just as effective as detergent in the reprocessing procedure. Of course, facilities are still free to continue to use detergents if they choose to, but anytime you can remove a chemical from the patient’s room and especially in the OR, it typically increases the safety of patients while reducing the overall costs to a healthcare facility."

These new procedures, plus improvements in illustrations and additional informational material, are contained in the revised GI endoscope reprocessing manual available from Olympus.5

Immediate action post-procedure

Pre-cleaning is performed at bedside immediately following the patient procedure in the room. The protocol calls for action immediately after removal of the insertion tube from the patient and prior to disconnecting the endoscope from the power source. Pre-cleaning is performed at the point of use so bioburden doesn’t dry before decontamination. When performing bedside pre-cleaning of endoscopes, make sure you have the following available:6

1. personal protective equipment (gloves, eye protection, impervious gown, face shield or simple surgical mask that will not trap vapors)

2. container with detergent solution

3. sponge or soft, lint-free cloth

4. air and water channel cleaning adapters per manufacturer’s instruction

5. protective video caps if using video endoscopes.7

The appropriate personal protective equipment should be worn during pre-cleaning as well as the remainder of the reprocessing procedure. During pre-cleaning, the insertion tube is wiped from the control section to the distal end with a moistened lint free wipe or sponge. After wiping down the scope, all internal channels must be flushed with water or detergent solution to remove gross debris and to verify that the channels aren’t obstructed. The water or detergent solution and air are alternately suctioned through the biopsy/suction channel until the solution is visibly clean. Solution should always be flushed or aspirated through any additional channels, including (if applicable) the air/water, elevator wire, and auxiliary water channels, according to the manufacturer’s instructions.8

When all channels are flushed or aspirated, the endoscope should be disconnected from the light source and suction pump. During the transport of soiled scopes it is essential to follow OSHA standards. Scopes should be placed gently inside a container or package marked with a biohazard symbol for transport. If further reprocessing is likely to be delayed for more than an hour, consideration should be given to employing methods which will prevent organic soils from drying.

After pre-cleaning the scope, personnel should remove all PPE, wash their hands, and cover the transport container. Whatever products you choose to use to bedside clean the scope, they should be treated as a biohazard and properly discarded after use.9

Pre-cleaning tools, such as soft, lint-free towels or sponges and brushes that are used should specifically be designed for cleaning flexible endoscopes. Remember, effective cleaning reduces disinfection failures by reducing the presence of organic soil that harbors microorganisms and can interfere with disinfection/sterilization.2

The procedures performed in GI/Endoscopy departments are highly sophisticated and the processing practices are highly regulated. Be sure your staff is up-to-date on the understanding of decontamination, packaging and handling of flexible endoscopes and accessories.

This is accomplished in many ways:

  1. Certification classes are available for staff to take to help ensure they know the basics of Endoscope reprocessing. Organizations such as SGNA, CBSPD and IAHCSMM, to name a few, offer such programs.

  2. Schedule at least yearly inservices by the various companies who provide your supplies and equipment (i.e., scope companies, cleaning solutions companies, repair companies, cleaning verification companies, etc.).

  3. Attend workshops and seminars to keep staff updated on the dynamic changes happening in this field.

All of this will help ensure that your facility is implementing the "best practices" when it comes to bedside cleaning and all of the steps in the reprocessing of flexible endoscopes.

Matt Smith is a Marketing Analyst at Healthmark Industries.

1. Central Service Technical Manual Pg.1

2. Central Service Technician Manual, 7th edition Pg.220.

3. The Basics of Flexible Endoscope Reprocessing; First Edition, pg.21

4. Olympus America GI Manual Reprocessing Customer letter http://www.olympusamerica.com/files/GI_ReprocessingManualCustomerLetter.pdf

5. http://www.olympusamerica.com/msg_section/cds/cds_reprocessing.asp

6. American Society for Gastrointestinal Endoscopy Quality Assurance in Endoscopy Committee et al., 2011

7. SGNA.org; Standards of Infection Control in Reprocessing of Flexible Gastrointestinal Endoscopes

8. The Basics of Flexible Endoscope Reprocessing; First Edition, pg.1

9. The Basics of Flexible Endoscope Reprocessing; First Edition, pg.120