Healthcare Hygiene magazine November 2019 | Page 23

In a presentation at the IAHCSMM annual meeting in
April of this year, Ofstead summarized findings from a survey
of IAHCSMM members (see related article on page 26), with
the overall conclusions that:
• Endoscope reprocessing does not work as envisioned
• Patients and technicians are at risk of infection and injury
• Contributing factors include: endoscope design and dura-
bility issues; inadequate guidelines and IFUs; lack of sufficient
education; and pressure to cut corners
• Solutions require active collaboration by all stakeholders
She advised that manufacturers develop tools for success by:
• Simplifying IFUs and evaluate their clarity/feasibility
• Confirming that IFUs can be followed precisely and
consistently
• Conducting real-world research to ensure products work
as intended in real-world settings and identify gaps
• Addressing the real-world challenges reported by techs
• Responding to scientific evidence with innovations
She advised that guideline-issuing bodies, regulatory
agencies and accrediting agencies:
• Recognize the need for clear direction in the field
• Address the complexity and inconsistency of standards
• Require competency assessments for all personnel
• Ensure that adequate time and resources are allocated
• Develop customizable quality checklist for auditors
• Make sure surveyors are trained sufficiently to assess
endoscope reprocessing set-ups and practices
She also made the following recommendations
for technicians:
• Review IFUs and guidelines
• Embrace opportunities to learn from vendors and IPs
• Take the time to do every step correctly, every time
• Approach cleaning verification with curiosity
• Document findings from visual inspections
• Collaborate to troubleshoot Issues
• Share insights with others
She also made the following recommendations for sterile
processing supervisors and managers:
• Invest in continuing education for reprocessing staff
• Ensure IFUs, policies and guidelines are accessible
• Arrange for routine, preventive maintenance
of equipment
• Insulate your staff from pressure to cut corners
• Foster a spirit of continuous quality improvement
• Empower technicians to report issues and challenges
• Provide healthcare institution leaders with evidence of
SPD-related capabilities and needs
Researchers have found the ill effects of improperly
dried scopes, in that moisture may foster microbial growth
and biofilm development in endoscopes and retained fluid
is associated with higher ATP levels and microbial growth.
Ofstead and Heymann, et al. (2018) evaluated the
effectiveness of fully reprocessed endoscope drying and
storage methods and assessed associations between retained
moisture and contamination. Examining scopes in three
hospitals, researchers performed visual examinations and
tests to detect fluid and contamination on patient-ready
endoscopes. Fluid was detected in 22 of 45 (49 percent)
www.healthcarehygienemagazine.com • november 2019
endoscopes. High adenosine triphosphate levels were found
in 22 percent of endoscopes, and microbial growth was
detected in 71 percent of endoscopes. Retained fluid was
associated with significantly higher adenosine triphosphate
levels. Reprocessing and drying practices conformed with
guidelines at one site and were substandard at two sites;
damaged endoscopes were in use at all sites.
As the researchers point out, “Reprocessing guidelines
describe drying as critically important, but there is no con-
sensus among experts and guideline-issuing bodies on best
practices for endoscope drying and storage. Alfa and Sitter
reported that 10 minutes of purging with forced air reduced
Gram-negative bacilli in endoscope channels. However, this
method has not been widely embraced because it requires
space, equipment and time. Instead, many institutions rely
on alcohol flushes and brief air purges before hanging
endoscopes vertically in hopes that residual fluid will drain
out or evaporate.”
The researchers also observed substantial defects in all 45
endoscopes, and these irregularities included discoloration,
white or black residue, scratches, gouges, non-intact chan-
nel lining, debris inside endoscopes, damaged distal ends,
insertion tube buckling, and dented channels.
Multiple reprocessing deficiencies were observed, where
dirty-to-clean workflow and PPE use were substandard. At
these sites, leak testing and manual cleaning were inade-
quate, and site personnel stated that their AERs’ automated
cleaning cycles had been disabled to save time. Technicians
wore the same gloves for handling manually cleaned endo-
scopes, loading AERs, and removing disinfected endoscopes.
No hand hygiene was performed between reprocessing
activities. No cleaning-verification tests or visual inspections
of endoscopes were done.
As Ofstead and Heymann, et al. (2018) observe, “After
HLD, dripping-wet gastrointestinal endoscopes at Site A
were carried by hand to a storage cabinet and hung vertically
without wiping external surfaces. Alcohol was flushed through
channels manually because their reprocessing system did
not perform alcohol flushes. Residual fluid drained onto the
cabinet floor. Ventilation grills had visibly dirty filters that
were reportedly never changed, and there was no active
ventilation. Wet cystoscopes, ureteroscopes, and intubation
endoscopes were removed from the automated reprocessing
system and carried by hand to a small, unventilated, metal
storage cabinet. Insertion tubes were inserted into dirty,
reused Styrofoam blocks, which technicians reportedly used
to protect distal ends. Due to insufficient storage space, one
ureteroscope was stored horizontally on the cabinet bottom.
There was no protocol for cleaning storage cabinets, which
were visibly dirty. Following HLD, the AER at Site C performed
an alcohol flush and air purge. After removal from the AER,
technicians wiped external surfaces with reused towels and
used an air pistol for 15-20 seconds to evacuate fluid from
channels while holding the endoscope with dirty-gloved hands.
The air pistol did not have a pressure regulator, and pressures
were high enough to result in spray being ejected in a visible
plume from the distal end during brief bursts of forced air.
Endoscopes were stored vertically in closed cabinets with
ventilation grills. Cabinet fans were present but unplugged or
disabled. Although a weekly cleaning protocol was described,
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