When it comes to medical devices, cleanliness is a top priority. That's a given. What many healthcare facilities don't always realize is that even with a solid set of procedures in place, they still may be failing to properly clean, disinfect and sterilize certain instruments.
This is particularly true for endoscopes. In recent years, the need to improve how we sterilize and reprocess patient-ready endoscopes has been the focus of increased attention. The problem has become so pronounced that for the past several years, ECRI, an independent nonprofit that researches ways to improve patient care, has listed endoscopic reprocessing as one of the top technology hazards in healthcare.
“Human Factors in Endoscopy and Technologies that Can Help” was the third topic in the webinar series about the Path to Sterile Endoscopy. The webinar was presented by Judy Bringhurst, infection preventionist and safety officer for the University of North Carolina Hospitals in Chapel Hill, North Carolina, and discussed the recognized need for improving the sterility of patient-ready endoscopes and some associated human factors related to endoscope reprocessing. The following are some key points from the webinar.
Standardization Issues in Instrument Reprocessing
Across the medical field, practitioners agree that standardization is the key to implementing a consistent and repeatable process for effectively reprocessing endoscopes. However, products used in crucial steps do not have standard instructions for use. For example:
- There are many enzymatic detergents available. However, different detergents require different amounts of water than others and have different intended uses.
- The chemicals required for a high-level disinfection (HLD) vary depending on the manufacturer’s recommendation.
- Depending on what model of endoscope is being reprocessed, and what kind of soaking chemical is used, the instrument may have to be soaked for eight, 10 or 20 minutes.
These are only a few of the obstacles that stand in the way to implementing a broad, standardized set of guidelines that would both increase compliance and decrease the risk of cross-contamination.
The point is that even if we were in an ideal situation where reprocessing was fully standardized, and there was one type of detergent, a clear set of steps to follow for HLD reprocessing and a standardized soak time, etc., this would not eliminate the risks involved with reprocessing endoscopes. The truth is, numerous human factors prevent endoscopes from being properly reprocessed, and because of this, even strict guidelines and tighter standardization have major shortcomings.
The Human Factor
First, let’s start off with one of the most shocking findings. In a watershed study, researchers observed that when using manual cleaning methods with automated high-level disinfection, only 1.4 percent of endoscopes are reprocessed properly. Far from following the suggested process, the same study showed that in 44.9 percent of all manual reprocessing, two or more steps were completely skipped.
This wasn’t just because of laziness. The two steps that were most frequently skipped were brushing the working channel and drying the instrument with air. The reason for this is that brushing the working channel can be both uncomfortable and painful for those doing the cleaning, which often involves HLD chemicals that are irritating to the respiratory system. Couple this with the pressure to complete the reprocessing quickly for subsequent procedures, and you start to see that, even with a standardized method for reprocessing, a large portion of endoscopes will continue to be inadequately reprocessed and cross-contamination will remain a problem.
Technologies to Mediate These Issues
The ever-present human factors, along with the current lack of standardization, can make it look like we are in an unwinnable situation. Despite our best efforts, will we always have to live with a degree of acceptable risk?
As you have probably surmised, eliminating that risk can be a huge undertaking. But recent developments in medical technology have made it possible to eliminate the many complications and variables involved in manual reprocessing.
EndoSheath protective barriers are a single-use microbial barrier that slides onto an endoscope and creates a protective wall between the patient and the endoscope. It can prevent microbes as small as 27 nanometers from permeating the barrier. And since the scope is never directly exposed to biological material, cleaning is easy and there is no need for HLD reprocessing between cases.
In an industry that lacks broad standardization and whose reprocessing procedures are inherently risky, EndoSheath represents a technological advantage that can bring us closer to a solution where endoscopes are sterile for each patient and the risk of cross-contamination is eliminated.
Learn More: Webinar on Demand
To learn more about sterilization in endoscopy, watch the webinar on Human Factors in Endoscopy and Technologies that Can Help.