3 Common Mistakes When Disinfecting Scopes in GI/Endoscopy-Driven ASCs

Shaun Sweeney, vice president of sales and marketing for Cygnus Medical, which specializes in products and services for the endoscopy suite, operating room and sterile processing department, describes three of the most common mistakes that occur in GI/endoscopy-driven ASCs when disinfecting scopes.

1. Not suctioning gross contamination out of scope channels and wiping down the scope post-procedure. Generally, GI/endoscopy-driven ASCs go through a multi-stage high-level disinfection process. The first stage requires removal of gross contamination by suctioning the scope's channel with a high volume of water and detergent in addition to wiping down the exterior of the scope after a procedure. Mr. Sweeney says GI/endoscopy-driven ASCs often fall into the trap of skipping this crucial first step with the belief that jumping ahead to the second stage of brushing the scope will be sufficient enough in removing gross contamination.

"One of the biggest misnomers that I've come across is ASCs believe there is no need to suction the channel and wipe down the scope before soaking and brushing the equipment," Mr. Sweeney says. "To this day, a lot of people don't understand this first step is critical to make sure there is no gross contamination because simply brushing is not intended to remove that amount of bioburden."

Mr. Sweeney explains ASCs should follow manufacturer recommendations, which may include using approximately 500 mL of enzymatic detergent and water to suction and flush out channels. Skipping the first step of suctioning enzymatic detergent through the suction channels will not only affect the efficacy of the channels being properly reprocessed but will also release high volumes of gross contamination into the soaking stage. "High-level disinfection is dependent on every stage being performed properly. A breakdown early on can affect the efficacy of the process later," he says.

2. Quantifying a certain number of times to brush a scope. Mr. Sweeney says another pitfall GI/endoscopy-driven ASCs run into is brushing scopes with a preconceived notion of how many times to brush. Some manufacturers present this as a marketing benefit, suggesting a brush only needs one pass through a channel. The number of times a scope must be brushed is completely dependent on how much gross contamination is present in the scope and whether it has had time to dry in the channels. The number of passes of the brush will depend on a multitude of factors, such as the amount of contamination, size of the brush, number of bristles and density of the bristles. Considering the variance in brush features and given that there is no published standard on how many times to brush a scope, Mr. Sweeney says GI/endoscopy-driven ASCs shouldn't quantify the number of times to brush but instead brush until there is no more debris exiting the scope.

"When you look at Society of Gastroenterology Nurses and Associates' video, they make it very clear not to pre-quantify the number of passes," Mr. Sweeney says. "Brushing is done underwater, so while you are brushing your scope, you can see if anything is coming out because it will float around in the water. Brushing underwater allows some visibility, and that's a standard that each manager of an endoscopy suites needs to address with their decontamination technicians."

Mr. Sweeney adds GI/endoscopy-driven ASCs should take extra precaution in ensuring brushing is always done underwater. Not doing so will lead to flicking of contaminated water particles into the air, causing reintroduction of contamination into an ASC facility.

3. Reusing detergents and brushes. No matter what type of enzymatic detergent your ASC uses to soak scopes into, Mr. Sweeney stresses the importance of changing — not reusing — detergents after each use for optimal effectiveness. Just as a household member would refill a sink with new water and new detergent to clean dirty dishes, ASCs should also be mindful of changing water and enzymatic detergent because detergent will break down, Mr. Sweeney says.

"This may be a case of someone not paying attention to the manufacturer's recommendations or trying to save money, but ASCs must not reuse enzymatic detergent with multiple scopes. Detergents absolutely break down and lose integrity after each use," he says. "ASCs will sometimes reuse a brush to clean a scope too, but they have to remember that there are disposable kinds and reusable kinds. If you use a single-use item, you're supposed to use that item just one time."

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