The utility of borescopes in visual inspection was initially established during an investigation of surgical site infections linked to contaminated instruments used in knee and shoulder surgery . When investigators used a borescope to look inside arthroscopic shavers , they found retained debris , including bone fragments and brush bristles . In a foundational study by Azizi et al ., visible residue or debris was detected inside 95 percent of 350 lumened surgical instruments .”
by structured homework , and an online booster session .
Damien Berg , BA , BS , CRCST , AAMIF , vice president of strategic initiatives for HSPA , says the impetus for this training program was steeped in a concept that HSPA had been considering for some time . “ In my previous role , where I managed sterile processing for multiple facilities — and now in my current role with HSPA — I have the privilege of visiting many departments and speaking with sterile processing professionals who perform their critical roles day in and out .”
Berg continues , “ Two questions that I hear frequently are , ‘ When should I do training ?’ and ‘ How long should we wait until we retrain ?’ We knew that complex skills are perishable ( that is , employees must work to stay focused , sharp and consistent and ensure their practices align with standards , instructions for use and best practices ), but there was no real data about how current training is retained and how long before refresher training should be performed to ensure skills remain where they need to be . This is what led HSPA to move forward and begin this novel research with Ofstead & Associates and develop this innovative training approach .”
Berg adds that during the preconference Educators Forum at the 2024 HSPA Conference in Las Vegas , participants will learn how to apply the new training model .
The need for this innovative type of hands-on , real-world training is evidenced by the seeming acceleration of the number of endoscopes that remain contaminated following processing activities .
The Precedent for ‘ Scoping the Scopes ’
Reports of infections and adverse events caused by contaminated endoscopes over the last two decades have been widely documented , and the Food and Drug Administration ( FDA ) has received numerous additional reports of patient exposures and infections that occurred when processing activities did not remove tissue , blood , or accessories from previous procedures .
For example , Hervé and Keevil ( 2013 ) were among the researchers beginning to point to the challenge of effectively cleaning and disinfecting luminal endoscopes . As the authors observed , “ The presence and potential build-up of patient material such as proteins in endoscope lumens can have significant implications , including toxic reactions , device damage , inadequate disinfection / sterilization , increased risk of biofilm development and potential transmission of pathogens .”
They evaluated potential protein deposition and removal in the channels of flexible luminal endoscopes during a simple contamination / cleaning cycle . Following observations in endoscopy units , factors influencing protein adsorption inside luminal endoscope channels and the action of current initial cleaning techniques were evaluated using a proteinaceous test soil and very sensitive fluorescence epimicroscopy . They found that both enzymatic cleaning according to the manufacturer ’ s recommendations and brushing of the channels were ineffective at removing all proteinaceous residues from new endoscope channels after a single contamination . Rinsing immediately after contamination only led to a slight improvement in decontamination outcome . They concluded that “ Limited action of current decontamination procedures and the lack of applicable quality control methods to assess the cleanliness of channels between patients contribute to increasing the risk of cross-infection of potentially harmful microorganisms and molecules during endoscopy procedures .”
In recent years , many facilities have obtained borescopes for processing personnel to use during visual inspection of endoscopes ’ ports and lumens . As Ofstead and Hopkins ( 2020 ) point out , “ The utility of borescopes in visual inspection was initially established during an investigation of surgical site infections linked to contaminated instruments used in knee and shoulder surgery . When investigators used a borescope to look inside arthroscopic shavers , they found retained debris , including bone fragments and brush bristles . In a foundational study by Azizi et al ., visible residue or debris was detected inside 95 percent of 350 lumened surgical instruments .”
Current guidelines from several standards -producing entities recommend the use of a borescope to inspect the channels of endoscopes ; this device provides illumination and magnification of the inner workings of an endoscope prior to high-level disinfection or sterilization . As Ofstead and Hopkins ( 2020 ) state emphatically , “ Visual inspection should be done every time because endoscopes are heavily contaminated during procedures , and organic soil and bioburden ( microbes ) must be removed prior to high-level disinfection or sterilization for those processes to be effective . In addition , endoscopes are fragile and commonly sustain damage that can harbor contamination during routine use .”
In their pioneering study , Ofstead and Hopkins ( 2020 ) inspected the ports and channels of 20 colonoscopes and gastroscopes three times during a seven-month period to determine whether damage and debris accumulated over time and whether more rigorous processing could eliminate contamination completely . The researchers explained that they had to develop their own protocol , as this was the first time a borescope was used to prospectively monitor endoscope cleanliness and damage over time . The researchers created their baseline by familiarizing themselves with the normal appearance of endoscope ports and lumens , then photographed specific points inside each endoscope to compare the appearance of each component at baseline with how it presented at follow-up assessments . The researchers say they found numerous irregularities : “ During these inspections , a variety of unexpected observations suggested the patient-ready endoscopes were not sufficiently cleaned or dried , had retained debris or device fragments , or were seriously damaged .”
The importance of visualization for bioburden or scope defects cannot be understated , researchers emphasize . Ofstead and Smart , et al . ( 2023 ) evaluated a visual inspection program using magnification and borescopes in an endoscopy department that had not previously utilized these tools . Site personnel were given visual inspection tools and training before systematically examining fully processed endoscopes twice during a two-month period . A risk assessment protocol was used to determine whether endoscopes required recleaning , repair , or other action , and findings were documented using log sheets , photographs and videos .
The researchers found visible damage , residue and / or debris in 100 percent of 25 endoscopes at both assessments , and 76 percent required repair . Defects included scratches ( 88 percent ); channel shredding or peeling ( 80 percent ); adhesive band disintegration ( 80 percent ); residual soil or debris ; retained fluid ( 52 percent ); and dents ( 40 percent ). The authors underscored that visual inspection with magnification and borescopes identified
14 • www . healthcarehygienemagazine . com • april 2024