process . Have they at least made other FDA-approved medical products or are they totally new to the medical field ? Are there samples you can test ? Are there other hospitals that have purchased products from this manufacturer that you can ask about their experience ? Those are key points when considering non-traditional suppliers .”
The No . 8 issue , Poor Duodenoscope Reprocessing Ergonomics and Workflows Put Healthcare Workers and Patients at Risk , is a variation of an issue that has appeared many times on ECRI ’ s hazards lists in the past .
As the 2022 ECRI report observes , “ The failure to adequately reprocess contaminated duodenoscopes between uses is a well-known hazard , one that has led to the spread of deadly pathogens . Perhaps less well known are the risks of injury to the healthcare workers who perform this function , and the ways in which ergonomic and workflow factors can compromise reprocessing effectiveness , putting patients at risk .”
The No . 1 issue in ECRI ’ s 2016 report The Top 10 List for 2016 , Inadequate Cleaning of Flexible Endoscopes before Disinfection Can Spread Deadly Pathogens , advised that “ Instruments must be cleaned of biologic debris and other foreign material ; if this precleaning is not carried out effectively , the disinfection step may not be effective .”
The No . 5 issue in ECRI ’ s 2019 report , Mishandling Flexible Endoscopes after Disinfection Can Lead to Patient Infections , emphasizes that “ Cleaning and disinfecting flexible endoscopes between uses is known to be a challenging process . Failure to precisely follow a robust reprocessing protocol can lead to debilitating or even fatal infections . Less well known is that improper handling and storage practices can re-contaminate previously disinfected scopes , heightening the risk of patient infections . If endoscopes are not completely dried after being subjected to high-level disinfection , any remaining viable microbes can rapidly proliferate and colonize the instruments . To promote drying , ECRI Institute and relevant professional societies recommend purging endoscope channels with clean air at the end of the reprocessing process . The disinfected status of endoscopes can also be compromised if the instruments are handled with unclean gloves — a practice that ECRI Institute has observed . Endoscopes that have been cleaned but not yet high-level disinfected are still contaminated with viable microbes ; thus gloves used to handle an endoscope at that stage must not be used to remove the scope from the reprocessing machine . Recontamination can also occur when transporting and storing endoscopes . Disinfected and dried endoscopes should be transported in a clean enclosed container , dedicated to that purpose , and should be prevented from contacting potentially unclean surfaces .”
Schluth points to a 2021 ECRI survey of healthcare workers who routinely perform duodenoscope reprocessing — the cleaning and high-level disinfection ( or sterilization )— identified several significant patient and worker safety hazards :
• Obstacles to effective reprocessing , potentially increasing patient infection risks . Survey respondents cited time pressures and poor work environment ergonomics ( e . g ., work surfaces at an uncomfortable height ) as key concerns .
• The continued use of duodenoscopes with fixed distal endcaps , instead of scopes with single-use components . Duodenoscopes with fixed distal endcaps are more difficult to reprocess effectively , putting patients at increased risk of infection .
• A higher risk of healthcare worker musculoskeletal injuries due to poor workspace ergonomics
“ Duodenoscopes are difficult to clean and to disinfect because of the narrow channels and the numerous moving parts ,” Schluth emphasizes . “ If reprocessing is not performed correctly , there is a risk of spreading pathogens to patients . We surveyed more than 300 healthcare workers who perform pre-cleaning and manual cleaning of duodenoscopes to help us identify which factors come into play . We know complexity of the devices is important , but there are other factors in determining whether a scope gets effectively reprocessed or not . One of the most significant concerns was time pressure . Sterile processing professionals said they felt rushed to complete the job quickly and maybe too quickly , so that made the task even more difficult to complete effectively , and that poses increased risk for scope-related infections in patients . They also cited poor ergonomics in their work environment , so things like the counters at the sinks being at uncomfortable heights . So , poor ergonomics were cited as a factor that makes reprocessing challenging for healthcare workers , in addition to the lack of resources and time pressure . The more challenging the task is , the less likely is they ’ re going to do it effectively , which again increases the risk for patient infections . Poor ergonomics also increased the risk to the workers of musculoskeletal injuries from performing these repetitive tasks .”
Schluth continues , “ About three-quarters of the healthcare personnel who responded to our survey reported that they experienced fatigue or discomfort in at least one body part because of their work in decontaminating and cleaning these scopes . So , what we ’ ve focused on in the report regarding these ergonomic and workflow issues is encouraging facilities to take the time to examine your processes closely and identify and address problems that might exist . Investigate and implement solutions specifically related to workflow that could be injuring healthcare personnel from an ergonomics perspective and affecting their job performance . Solutions include things like using adjustable carts and sinks .”
As the ECRI report states , “ Correcting these problems requires facilities to take a close look at the workflow , the workspaces and surfaces , and the expected turnaround times for duodenoscope reprocessing , as well as re-evaluating the use of reusable duodenoscopes .”
“ Regarding the potential transition to single-use scopes or scopes that include single-use components , the Food and Drug Administration does recommend that it ’ s worth looking into doing that as a way to perhaps minimize some of these device-related infections . Scope-related infections is an issue that we ’ ve addressed in our reports consistently , and this year , we had some new data to speak to . It remains a topic of concern for the future .”