5 big endoscope reprocessing risks in ASCs: How to avoid them

Ambulatory surgery centers are considered high-quality sites of care, and many centers with gastroenterology conduct their own endoscope reprocessing.

They have small staffs with checks-and-balances to make sure everyone does their job correctly. But in reality, people become distracted or have memory lapses and crucial steps in endoscope reprocessing are easily overlooked.

More recalls than ever are reported in the peer review journals now due to issues with endoscope reprocessing. There were 30,000 patient recalls due to reprocessing lapses from 2005 to 2012, according to recent literature, and that's unacceptable. The lapses might be due to missed steps, distraction or other issues at the ASC, and if the scopes aren't cleaned they won't be disinfected properly.

In 2008, a Centers for Medicare and Medicaid Services investigation of 68 ASCs where nearly half performed endoscopy yielded unfortunate results: 39 facilities had infection control deficiencies warranting citation and 19 facilities failed to properly reprocess instruments. An observational study that was published in Gastroenterology Nursing in 2010 found only 48 percent of the 183 endoscopes were properly processed. Non-adherence hit 99 percent when the centers used manual methods to clean endoscopes.

Unclean endoscopes have several negative implications. First and foremost, patients may experience infections or serious injury. Those complications require additional treatment, hospital admissions and extra resources to correct a preventable issue. One of the most common complications from inappropriate endoscope reprocessing is Pseudomonas, which can have a huge economic impact on treatment. Another potential complication is Clostridium difficile, costing hospitals around $9,000 to $11,000 on average.

Major lapses and errors in endoscopy reprocessing include:

•    Noncompliance with internal and manufacturer guidelines
•    Skipped steps in the process
•    Improperly executing some or all steps
•    Contamination between endoscopes
•    Blocked channels
•    Using expired chemicals
•    Improper endoscope storage
•    Patient exposure to damaged and/or contaminated colonoscope

An article published in a 2013 issue of the American Journal of Infection Control examines these issues in the literature as well as popular media and other reporting outlets. "Improper endoscope reprocessing is an ongoing and pervasive problem that has the potential to cause significant patient harm," the article authors concluded.

However, the best minds in the industry have not let this issue go unnoticed. New technology and equipment — such as the ENDORA™ Endoscope Tracking System — is being developed and released to help providers appropriately reprocess endoscopes and ensure their scopes are clean before reuse using advanced automated technology.

"Because of the increasing volume of procedures and complexity of endoscope design and reprocessing, utilizing a system that provides reliable reprocessing management is critical to patient safety," said Don Byrne, president of Medivators Endoscopy Business Group.

The ENDORA Endoscope Tracking System verifies that each reprocessing step is completed on time and in the correct order therefore preventing a contaminated endoscope from being used on a patient.

"ENDORA has actually saved us a couple of times by verifying the process that the endoscope went through in preparation for the patient and prevented us from missing steps in our reprocessing workflow," said Cheri Borgstede, OR business manager at Singing River Health System. "It's a safety net and a reminder to the staff to follow all protocol at all times."

Here are five ways endoscope reprocessing can put ASCs at risk and how to prevent these lapses:

1. Forgetting steps during reprocessing. Missing any step in endoscope reprocessing not only impacts the single endoscope, but the entire reprocessed batch due to contamination. It's extremely important staff members are focused only on endoscope cleaning during that time and double-check their work before taking the next step.

ASCs with endoscope reprocessing are required to have protocol following the manufacturer's instructions as well as any other best practices from healthcare organizations and certification bodies. These guidelines are in place to protect the patient from harm and ASC from liability in the future.

"I thought we were doing a great job with our scopes and processes until we implemented the tracking system," said Ms. Borgstede. "ENDORA really has impacted the care of our patients and the life of our scopes."

2. Manual documentation. For years, ASCs have gotten by with manual documentation — often checking off boxes on a slip of paper — leaving room for significant human error. More ASCs are adopting automated technology or software programs to remind them about the different steps, but that still leaves room for staff members to check-off a task without completing it properly.

One of the best new solutions is automated tracking systems — including the ENDORA Endoscope Tracking System — that documents the endoscope workflow from the procedure through reprocessing and storage. The system can tell if an unclean endoscope goes through reprocessing and alerts managers to the issue. Automated documentation is great for quick and easy reporting in the event of an infection caused by a procedure.

Automated systems can also timestamp each procedure step so the center complies with reprocessing time requirements.

3. Attempting to disinfect blocked endoscopes. The disinfection process is useless if the endoscope is blocked. However, the AJIC journal article noted several instances where "researchers identified debris in lumened instruments, including endoscopes, as a result of inadequate reprocessing." In one report, protein residue and water was noted in the endoscope despite thorough cleaning. Automated endoscope reprocessors with channel monitoring like Medivators Advantage Plus Reprocessor can detect blockages in an endoscope channel.

There have been some instances where patient infections and viruses were tracked directly to lapses in reprocessing. Negative outcomes hurt the ASC's reputation among physicians as well as patients and a careful quality study any time there's an issue could identify new opportunities to close gaps in the reprocessing protocol and make sure staff members are cleaning appropriately each time.

4. Less-effective cleaning brush use. Some cleaning brushes are more effective than others at clearing up blockages. Conduct research to evaluate which brushes and methods work best and then invest in equipment to adequately clean the endoscope every time. Pull-through cleaning devices, such as the Pull Thru® from Medivators, are proven superior to normal channel brushes. They can significantly reduce the time required to manually clean the lumen and improve overall efficiency.

5. Inappropriate endoscope storage. Storage is a huge issue for endoscopes, especially if staff members store contaminated scopes with clean scopes. The AJIC study noted an instance where a colonoscopy was hung in a cabinet, despite being unlabeled, with clean endoscopes. Another issue highlighted was improper staff training and documentation in the storage area.

Contaminating a whole cabinet of endoscopes is hazardous. However, new technology tracking reprocessing can also track storage methods and prevent contamination. The ENDORA system has already averted at least one potential disaster when a staff member attempted to hang a dirty scope in storage.

This article is sponsored by Medivators.

More articles on gastroenterology:
Defining the ideal GI physician partner

9 gastroenterologists in the news

Cost-effectiveness & quality: 5 recent studies on colonoscopy

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