Flexible endoscopes are complicated instruments. There are lots of moving parts, small cracks and crevices, countless opportunities for bacteria to hide and grow. Because of this, national organizations stress the importance of careful and comprehensive manual reprocessing. Yet, inadequate endoscope reprocessing remains a top healthcare issue as reported by the ECRI Institute. So what gives?
If you ask anyone who uses these devices regularly, they will agree that no steps should be skipped during manual reprocessing, especially things like brushing, flushing and forced air drying. However, whether you reprocess with high level disinfection (HLD) or sterilize using an automated endoscope reprocessor (AER), human factors and neglect to adhere to protocols remain the main cause of endoscopy-related infections.
Missed Steps Risk Lives
Endoscope Reprocessing Methods: A Prospective Study on the Impact of Human Factors and Automation (Ofstead, 2010) observed five separate healthcare facilities to see just how much of a problem the “human factors” are in reprocessing. The findings were, simply put, disconcerting. The article noted 12 steps that were considered “most important” in the manual reprocessing and recorded whether those steps were completed. Ofstead reported that two or more steps were completely skipped in 44.9% of all manual reprocessing. Specific steps that were most frequently skipped were brushing the working channel and drying with forced air. Even though staff members interviewed acknowledged that brushing and forced air drying were two of the most important steps in reprocessing, only 43% of scopes were brushed properly and 45% received forced air drying. That means, in over half of observed cases, bio-burden inside the working channel was not fully removed. Without forced air drying, the majority of the scopes likely had portions that were still wet. Moisture in dark places, combined with bio-burden residue is a perfect equation for an impending infection.
But the rest of them followed protocols perfectly, right? Unfortunately, no. Ofstead found that personnel followed all 12 listed steps 1.4% of the time! That’s only 12 steps; that doesn’t take into account the dozens of other “sub-steps” that are included in most recommended protocols. That means that there is more than a 98% chance that, when the scope is grabbed for the next procedure, it’s insufficiently cleaned and may be harboring dangerous pathogens that could spread to the next patient.
Why Is This Happening?
Why are these steps and protocols being followed so sporadically? The most common reasons shared for not completing the reprocessing steps or skipping some altogether, according to staff members interviewed by Ofstead, were:
- Steps were difficult to complete (specifically brushing the working channel)
- Posture required for reprocessing caused pain or discomfort for those performing the cleaning
- Pressure to complete the reprocessing quicker so that there would be no need to wait for later procedures
- Exposure to HLD chemicals was irritating to the respiratory system
What Can We Do?
How can we get around this massive problem? Some suggest that AER sterilization is a better option than HLD. However, the effectiveness of sterilization is limited by the thoroughness of manual cleaning before placing the endoscope into the machine. After all, generally speaking, AERs can’t get in there and scrub the working channels!
A much easier and more efficient alternative is the use of a PrimeSight™ Flexible Endoscope with the single-use EndoSheath® Protective Barrier. The EndoSheath works as a microbial barrier between the patient and the endoscope, preventing the permeation of microbes as small as 27 nanometers. There has never had a reported case of cross-contamination with the use of EndoSheath. The scope is never exposed directly to biological material, meaning no bio-burden on the surface of the scope, meaning much easier cleaning and no high level disinfection process between procedures.
The working channel still needs to be scrubbed, you say? Luckily, that is not the case. The PrimeSight Endoscope has no working channel. Instead, the single-use EndoSheath Barrier contains the working channel. When you dispose of the EndoSheath at the end of the case, you discard the dirty working channel and all the biological material it might contain. Simply remove the scope, perform a visual inspection for moisture or residue, wipe the entire scope with an instrument grade detergent, rinse, wipe with alcohol and dry. You are ready for your next procedure in 10 minutes or less. The use of EndoSheath eliminates the need for high level disinfection between procedures, minimizes the human factor in turning a room, and makes turn-around more efficient.
For more information on this topic, please review part 1 of our Webinar Series: Path to Sterile Endoscopy with Judie Bringhurst, MSN, RN, CIC and sign up to join us for the rest of the series.