Endoscope Processing Horror Stories Could Have Been Preventable

Sterile processing for endoscopic equipment is one of the biggest concerns when it comes to infection control. A recent study presented at the 40th Annual Conference of the Association for Professionals in Infection Control and Epidemiology found that approximately 15 percent of endoscopes were above the 200 relative light unit ATP threshold.

It's no wonder that this is the case, as the process itself is incredibly involved. Sterile processing is already an exact science, and increasing equipment complexity exacerbates the difficulty of the task. Small parts, teeth, hinges and numerous inconspicuous debris-trapping spaces, make endoscope cleaning a job full of pitfalls to success.

Recent news in the world of endoscopic processing only confirms the challenge of the task. A study in the September issue of the American Journal of Infection Control revealed that endoscope reprocessing lapses have been recorded in all parts of the process. What's more, the majority of such lapses lasted at least several months, sometimes remaining undiscovered for years. 

The study authors observed that because endoscope processing research is not often featured in peer-reviewed journals, there exists perception that such processing is not especially problematic. To correct this misconception, the researchers suggested an increase in research for perfecting reporting requirements and evidence-based policies for endscope reprocessing.

When lapses occur, so do horror stories like that from Natividad Medical Center in Salinas, Calif., where nearly 900 endoscopy patients had to be notified of potential contamination due to improperly cleaned equipment, when a routine safety check at the hospital turned up several cleaning lapses over an 18-month period. Natividad ended up offering affected patients free HIV, hepatitis B and hepatitis C testing and retraining its staff.

A similar event occured at Neosho Memorial Regional Medical Center in Chanute, Kan., when that hospital experienced problems in the disinfection procedure for a certain type of endoscope used for colonoscopies. Neosho also offered free tests for HIV, hepatitis B and hepatitis C for patients tested between Jan. 3 and July 3 at no cost until Jan. 3, 2014.

While these stories highlight the seriousness of an infection control lapse, the good news is that having perfectly sterile endoscopes is a realistic goal for any healthcare setting, especially with proper administrative support. Marcia Patrick, RN, an infection control and teaching consultant for APIC with 30 years of experience in hospital and ambulatory care infection control, shared how hospital management can improve sterile processing of endoscopes.

1. Have realistic processing expectations. "Probably the biggest problem we see is technicians taking too little time to process endoscopes," says Ms. Patrick. This may happen when administrators require a turnover time for equipment that is physically impossible according to the manufacturer's cleaning specifications. "Administrative support cannot require equipment turned over in 15 minutes when it has a 12 minute soak time," says Ms. Patrick, indicating that such policies lead to improper sterile processing in the rush to meet deadline. The time required for sterile processing is highly variable and depends on the particular equipment and chemicals in question. The trick here is for administrators to check in with processing team management and come to an appropriate agreement on processing turnover time so no one is expecting miracles.

2. Evaluate the process periodically. The complexity of the endoscope cleaning process demands a robust monitoring system. Do technicians have the proper equipment to do their jobs? The proper training? Are they handling equipment according to manufacturer guidelines for each product? Is there a robust quality control system in place? Getting an efficient and effective sterile processing system in place takes many steps, a lot of work and a significant time commitment. It's easy for something to slip between the cracks after this system is established without regular thorough systemic evaluation.

3. Triple check that policies match equipment. To combat equipment complexity's negative effects on sterilization, it is critical that written policies and procedures reflect design features for all endoscopes processed. Different design plans have different cleaning procedures. Another consideration with endoscope design is to try and order the same type of scope every time new equipment is up for order. If possible, allow the infection control department to have input in new equipment ordering; while ordering a new style of scopes may be cheaper on the front end, proper cleaning of a style with which technicians are not familiar requires many more man hours for training and use.

4. Make sure technicians have access to required cleaning equipment. There are some essential tools for sterilization quality control. These may include, but are not limited to, timers and thermometers for ensuring proper soak times and temperatures, working dipsticks for checking detergent effectiveness and logbooks for proper documentation of each step of the process to facilitate quality control in case of a failure in sterile processing. Administrators should check with processing managers to see if they are missing any auxiliary equipment that might improve the cleaning process.

5. Keep the right tools for the job on hand. There is no room for shortcuts. For reusable pieces of equipment, such as brushes, allow only one use. If cleaning equipment is in less-than-prime condition, replace it immediately. Using cleaning equipment for longer than it's designed is not a safe or acceptable way to cut costs. In addition, have the right tools for your hospital needs. If a hospital has high volume scope usage, having enough scopes to handle expected patient volumes builds cushioning time into the cleaning process, eliminating undue time pressures and ensuring a safer experience for the patient.

6. Invest in comprehensive training and recertification processes. Every technician must have access to comprehensive training to ensure competency in endoscope processing. "You want to avoid the situation where the 'good person' takes a day off, and the fill-in technician isn't properly educated. This can cause lapses," says Ms. Patrick. Even when all technicians are competent, it is important to support the sterile processing program with reevaluations and supervisors that ensure consistent, top-notch processing every time.

Ms. Patrick emphasizes that with proper attention to each step of the process and proper oversight, endoscope cleaning should be 100-percent achievable. "There isn't a magic solution or process for endoscopes: They must be thoroughly cleaned and disinfected with adequate time for processing and comprehensive training. And remember, there isn't any room for shortcuts," she says.

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