6 Ways Administrators Can Ensure Properly Reprocessed Endoscopes — Every Time

Processing endoscopic equipment is one of the biggest concerns when it comes to infection control. A recent study presented at the 40th Annual Conference of the Association for Professionals in Infection Control and Epidemiology found that approximately 15 percent of endoscopes were above the 200 relative light unit ATP threshold.

It's no wonder that this is the case, as the process itself is incredibly involved. Endoscope processing is already an exact science, and increasing equipment complexity exacerbates the difficulty of the task. Small parts, teeth, hinges, and numerous inconspicuous debris-trapping spaces, make endoscope cleaning a job full of pitfalls to success.

The good news is that having properly processed endoscopes is a realistic goal for any healthcare setting, especially with proper administrative support. Marcia Patrick, RN, an infection preventionist and teaching consultant for APIC with 30 years of experience in hospital and ambulatory care infection control, shared how hospital management can improve processing of endoscopes.

1. Have realistic processing expectations. "Probably the biggest problem we see is technicians taking too little time to process endoscopes," says Ms. Patrick. This may happen when administrators require a turnover time for equipment that is physically impossible according to the manufacturer's cleaning specifications. "Administrative support cannot require equipment turned over in 15 minutes when it has a 12 minute soak time," says Ms. Patrick, indicating that such policies lead to improper processing in the rush to meet deadline. The time required for processing is highly variable and depends on the particular equipment and chemicals in question. The trick here is for administrators to check in with processing team management and come to an appropriate agreement on processing turnover time so no one is expecting miracles.

2. Evaluate the process periodically. The complexity of the endoscope cleaning process demands a robust monitoring system. Do technicians have the proper equipment to do their jobs? The proper training? Are they handling equipment according to manufacturer guidelines for each product? Is there a robust quality control system in place? Getting an efficient and effective scope processing system in place takes many steps, a lot of work and a significant time commitment. It's easy for something to slip between the cracks after this system is established without regular thorough systemic evaluation.

3. Triple check that policies match equipment. To combat equipment complexity's negative effects on processing,, it is critical that written policies and procedures reflect design features for all endoscopes processed. Different design plans have different cleaning procedures. Another consideration with endoscope design is to try and order the same brand of scope every time new equipment is up for order. The infection control department should have input in new equipment ordering; while ordering a new style of scopes may be cheaper on the front end, proper cleaning of a style with which technicians are not familiar requires many more man hours for training and processing.

4. Make sure technicians have access to required cleaning equipment. There are some essential tools for processing quality control. These may include, but are not limited to, timers and thermometers for ensuring proper soak times and temperatures, dipsticks for checking high-level disinfectant effectiveness and logbooks for proper documentation of each step of the process to facilitate quality control in case of a failure in processing. Administrators should check with processing managers to see if they are missing any auxiliary equipment that might improve the cleaning process.

5. Keep the right tools for the job on hand. There is no room for shortcuts. For disposable pieces of equipment, such as single-use brushes, allow only one use. If cleaning equipment is in less-than-prime condition, replace it immediately. Using cleaning equipment for longer than it's designed is not a safe or acceptable way to cut costs. In addition, have the right tools for your facility's needs. If a hospital or center has high volume scope usage, having enough scopes to handle expected patient volumes builds cushioning time into the cleaning process, eliminating undue time pressures and ensuring a safer experience for the patient.

6. Invest in comprehensive training and recertification processes. Every technician must have access to comprehensive training to ensure competency in endoscope processing. "You want to avoid the situation where the 'good person' takes a day off, and the fill-in technician isn't properly educated. This can cause lapses," says Ms. Patrick. Even when all technicians are competent, it is important to support the processing program with individual competency evaluations at the time of hire and at least annually thereafter. These evaluations are also necessary if any processes or equipment change. In addition, well-chosen supervisors are another vital component for ensuring consistent, top-notch processing every time.

Ms. Patrick emphasizes that with proper attention to each step of the process and proper oversight, proper endoscope cleaning should be 100-percent achievable. "There isn't a magic solution or process for endoscopes: They must be thoroughly cleaned and disinfected with adequate time for processing and comprehensive training. And remember, there isn't any room for shortcuts," she says.

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