Avoiding a dirty scope crisis: 5 steps to improve quality assurance with enhanced visual inspection

Recent incidents of bacterial infections in patients linked to dirty arthroscopic shavers and endoscopes have spurred dramatic change in device reprocessing and sterilization strategies. Yet many healthcare organizations' central processing departments have yet to follow suit, endangering both patients and hospital personnel.

Fortunately, advanced technology and intentional visual inspection practices can greatly improve hospitals' processing quality, Stephen Kovach, director of education at Healthmark Industries, said during a June 1 webinar sponsored by Healthmark Industries and hosted by Becker's Hospital Review.

A need for improvement
Device-related infections at premier healthcare institutions have become increasingly prevalent in the past few years. A report by the federal Food and Drug Administration found as many as 350 patients at 41 medical facilities worldwide were infected by or exposed to contaminated scopes between January 2010 and October 2015. In the U.S., notable infection incidents have occurred at RonaldReganUCLAMedicalCenter and CedarSinaiMedicalCenter, both based in Los Angeles, and VirginiaMasonMedicalCenter in Seattle, in the past three years.

Some scope- and shaver-related infections have occurred at hospitals where staff meticulously followed processing protocol. For particular instruments, such as some endoscopes, processing guidelines recommended by device manufactures have proved inadequate at eliminating infection-causing bacteria and residual organic contaminants, said Mr. Kovach. This has prompted infection control agencies to reform reprocessing recommendations as new surgical instruments prove harder to clean. Organizations such as the Association for the Advancement of Medical Instrumentation, the Association of periOperative Registered Nurses, the Society of Gastroenterology Nurses and Associates, and Instructions for Use now advise hospitals to enhance their visual inspection processes using advanced visual support technology and cleaning verification methods.

Still, many hospitals have yet to implement quality assurance practices that align with new industry guidelines, said Mr. Kovach. A 2014 survey by Healthmark Industries found only 7 percent of respondents said staff performed enhanced visual inspection methods in their healthcare facilities. As hospitals prepare to make the leap to quality-based reimbursement models, updating central processing practices should be a crucial priority for hospital quality assurance teams.

Best practices for enhanced visual inspection
"Enhanced visual inspection and cleaning verification methods are ways hospitals can build quality assurance into processing of flexible endoscopes," shavers and other reusable surgical devices, said Mary Ann Drosnock, manager of clinical education for endoscopy at Healthmark Industries. Mr. Kavech and Ms. Drosnock elaborated on the five key steps in enhanced visual inspection that align with AAMI, IFU, AORN and SGNA recommendations.

1. Visual inspection. Visual inspection involves using the unaided eye to inspect medical devices for defects in functionality, pitting, stains, residue and other imperfections during devices' processing cycles. If the device is dirty, personnel may manually re-clean the device at this point.

2. Magnification. Sterilization and central processing staff should employ magnification tools during inspection for added visual support. Simple devices, such as a magnifying glass, help staff discover organic contaminants or other defects on devices that are undetectable to the naked eye.

3. Enhanced visual support tools. Today's advanced technology enables personnel to examine medical devices in a more thorough and effective way. AAMI, AORN and IFU recommend using visual support technology to examine internal and difficult-to-see areas of surgical instruments. An investigation of a hospital's endoscope devices by research firm Ofstead & Associates found by using a boroscope to look inside reprocessed endoscopes, 71 percent of endoscopes failed the criteria for a patient-ready device. With advanced examination tools, such as flexible boroscopes and USB-enabled microscopes, central processing staff can examine contaminant-prone areas previously inaccessible to the naked eye.

4. Verification methods. When central processing personnel discover foreign contaminants, staff should employ methods to identify unknown contaminants or stains found on surgical devices. This enables staff to derive actionable insights into problematic processing procedures and implement revised, improved quality control methods. Staff can use flush, swab or ATP systems to perform identification tests. Verification methods to detect organic matter include protein, hemoglobin and carbohydrate tests.

5. Documentation. Processing staff should consistently document each step during reprocessing of reusable instruments. This is important for the hospital to show adherence to quality control protocol and record images or processing notes for teaching purposes. Some enhanced visual support tools even have documentation capabilities built in. For instance, USB-enabled microscopes allow staff to instantly record images during examinations for department records.

To download a record of the presentation slides, click here

To watch a recording of the webinar, click here


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