sterile processing
sterile processing
By David Taylor , MSN , RN , CNOR
Are Your Endoscopes Clean ? Tapping the True Power of Visual Inspection Tools
Outbreaks of endoscope-related infections represent a global problem , and the clinical implications are sobering . Numerous peer-reviewed investigations have linked various problems , including infections and deaths , to visibly contaminated or damaged endoscopes . 1-6
The Association for the Advancement of Medical Instrumentation ’ s ( AAMI ’ s ) revised standard , ANSI / AAMI ST91:2021 Flexible and sim-rigid endoscope processing in healthcare facilities , underscores the critical importance of proper cleaning , and important new updates and recommendations are incorporated . The previous version of the standard had a conditional recommendation that internal channels may be inspected with a borescope . The 2021 version features stronger language , recommending the use of a clean borescope to visually inspect accessible channels of flexible endoscopes before sterilization or high-level disinfection ( HLD ).
Common problems associated with the internal channels during endoscope processing ( e . g ., gastroscopes , colonoscopes , duodenoscopes and more ) include but are not limited to :
● corrosion
● cracks and scratches
● other physical damage
● debris
● discoloration
● moisture
● foreign objects ( e . g ., lint , fibers , brush bristles and particles , and clips )
The use of a small-diameter borescope for inspecting internal channels should be part of a comprehensive visual inspection program to identify internal defects , damage or bioburden that would otherwise go undetected . Small-diameter borescopes serve as way to examine the full length of each channeled lumen . Not only does that help protect patients but also provides critical insight into an endoscope ’ s condition , which can prevent further damage , costly repairs and premature device replacement . Note : Visual inspection should include outside examination of the device with a magnifier or microscope ( ideally , with lighted magnification ), with internal channel inspection performed with a borescope .
It is recommended that the person performing the borescope inspection be adequately trained and competent in the task . Use of the borescope should always be aligned with the borescope manufacturer ’ s instructions for use ( IFU ). Healthcare organizations should identify high-risk flexible endoscopes , such as duodenoscopes , bronchoscopes , ureteroscopes and cystoscopes , and ensure they undergo appropriate cleaning verification testing after each use . The test results should be consistently recorded and maintained .
If an endoscope does not pass the cleaning verification test , the endoscope should be re-cleaned and re-tested . If the device repeatedly fails cleaning verification testing , it should be removed from service and clearly labeled as needing repair to prevent further use . Damaged endoscopes , along with their unique device
Using a borescope for enhanced visualization .
identifier and patient identification information , should be reported to Infection Prevention and Quality personnel , in accordance with the organization ’ s policy .
In conclusion , borescopes are useful tools for inspecting endoscope channels and interior components and detecting debris and other flaws that otherwise would likely be undetected ; however , it is essential that those responsible for visual inspection receive proper training and education to not only use the tools effectively , but also understand the defects detected and how to address them . Using quality visual inspection tools to identifying issues with endoscopes and other lumened devices , such as residual bioburden and cracks , scratches and other problems , is a prudent practice that will greatly improve patient safety and outcomes and reduce the risk for costly device damage , malfunction and , above all , infections .
David Taylor III , MSN , RN , CNOR , has served as a contributing author for the Healthcare Sterile Processing Association ( HSPA ) since 2019 . He is an independent hospital and ambulatory surgery center consultant and the principal of Resolute Advisory Group LLC , in San Antonio , Texas .
References images courtesy of the author / Healthcare Sterile Processing Association
1 . Ofstead CL , Hopkins KM , Eiland JE . Borescope inspection of endoscope working channels : Why and how ? Endosc Int Open . 2022 Jan 14 ; 10 ( 1 ): E109-E111 . doi : 10.1055 / a-1512-2813 . PMID : 35047340 ; PMCID : PMC8759935 .
2 . Ofstead CL , Hopkins KM , Smart AG , Eiland JE , Wetzler HP , Bechis SK . Reprocessing Effectiveness for Flexible Ureteroscopes : A Critical Look at the Evidence . Urology . 2022 Jun ; 164:25-32 . doi : 10.1016 / j . urology . 2022.01.033 . Epub 2022 Feb 3 . PMID : 35123986 .
3 . Ofstead CL , Buro BL , Hopkins KM , Eiland JE , Wetzler HP , Lichtenstein DR . Duodenoscope-associated infection prevention : A call for evidence-based decision making . Endosc Int Open . 2020 Dec ; 8 ( 12 ): E1769-E1781 . doi : 10.1055 / a-1264- 7173 . Epub 2020 Nov 17 . PMID : 33269310 ; PMCID : PMC7671768 .
4 . Galdys AL , Marsh JW , Delgado E et al . Bronchoscope-associated clusters of multidrug-resistant Pseudomonas aeruginosa and carbapenem-resistant Klebsiella pneumoniae . Infect Control Hosp Epidemiol . 2019 ; 40:40 – 46 .
5 . Rauwers AW , Troelstra A , Fluit AC et al . Independent root cause analysis of contributing factors , including dismantling of 2 duodenoscopes , to an outbreak of multidrug-resistant Klebsiella pneumoniae . Gastrointest Endosc . 2019 ; 90:793 – 804 .
6 . Kumarage J , Khonyongwa K , Khan A et al . Transmission of MDR Pseudomonas aeruginosa between two flexible ureteroscopes and an outbreak of urinary tract infection : The fragility of endoscope decontamination . J Hosp Infect . 2019 ; 102:89 – 94 .
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