Advances in surgery have yielded a new breed of complex instruments that require special attention when they are being disinfected and reprocessed. An item of particular importance—and one that’s received some less-than-stellar media attention lately—is the flexible endoscope, a camera-equipped medical device that is used for diagnosis or treatment by inserting it directly into an organ.
I was recently asked to serve on the FDA panel of medical device experts, which convened in response to a series of national bacterial outbreaks associated with these scopes. Used in approximately half a million procedures in the U.S. annually, there have been eight hospital outbreaks of antibiotic-resistant bacteria linked to these devices since 2013.
While other devices are susceptible to blood contamination, endoscopes—by design and function—can trap blood, tissue, and other types of biological soil. Long, narrow channels and state-of-the art electronics in the scopes call for additional knowledge, skill, and focus during the multistep routine for reprocessing. Here are a few high-level contamination prevention tips that are basic enough to be used by your sterile processing department right away.
- Have the right tools handy. Keep the manufacturer’s instructions for use, all cleaning materials, and needed equipment readily available in all of the reprocessing areas. It is one simple yet gigantic step toward ensuring that devices are cleaned properly. Not only must staff be aware that similar scopes have significantly different instructions for use, but their cleaning and sterilization processes are specific about time lapsed and device location. Remove the potential for compromised equipment or process substitutions.
- Prioritize, train, monitor, repeat. Reprocessing medical devices, especially instruments as intricate as endoscopes, requires diligent oversight. It’s up to department managers to make certain that staff members perform their duties in compliance with federal, facility, and manufacturer standards. Establish and regularly schedule formal training for new employees as well as ongoing education about new devices, equipment use, changes in instructions for use, and facility policies.
- Don’t skimp on or skip any steps; focus on the task at hand. Manual cleaning that occurs prior to any manual or automated disinfection or sterilization steps is particularly important to scope reprocessing. Focus on the task at hand and verify that the cleaning process was fully successful before moving on to the high-level disinfection of the scope. Human error has a lot to do with the occurrence of patient infections caused by these scopes. Proper cleaning and maintenance of sterile processing materials, such as brushes and washing equipment, can also decrease contamination. Remember—if it’s not clean, it’s not sterilized.
- Post clear, attainable instructions, protocols, standards, and policies. Standards matter. Create accountability by developing a formal reprocessing program—it is essential to understanding the current state of your department and where improvements need to be made. In conjunction with formal onboarding and continuous training regimens, there should be a general consensus on how clean is clean and no room left for anyone to say, “I didn’t know.”
- Get your team certified. Certification requirements have been surfacing in states across the country. Certification ensures that staff members are fully apprised of the latest infection control techniques, have a fundamental knowledge of microbiology, and understand the critical support role sterile processing provides in clinical areas, such as the OR, endoscopy centers, diagnostic radiology centers, and ambulatory surgery facilities.
While sterile processing necessitates thorough evaluations and the ability to adjust to industry changes, there are a plethora of existing measures to help ensure better patient care at your facility today. Educate staff about how and why reprocessing is critical to delivering quality patient care—it’s a great place to start.