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Archive August 2018 XIX, No. 8

Is That Scope Clean? Verify It

Now you can confirm that reprocessed scopes have no residual contamination or damage that could harbor future microbes.

Weston "Hank" Balch

Weston "Hank" Balch, CRCST, CIS, CHL


MISSED A SPOT Small-diameter borescopes let you see inside of a device to visually verify cleanliness before high-level disinfection or terminal sterilization. Some models can take photos and short videos for documentation purposes.

Tflexible endoscope certainly looks clean. As well it should. The reprocessing tech leak tested the scope, flushed and brushed the internal channels, and ran it through the automated endoscope reprocessor for the proper cycle. After an alcohol purge and air drying, it’s now back in the procedure room, ready to use on the next patient. Or is it?

Look closely at the scope’s distal tip. Closer. Closer still. There’s bioburden right there. Still don’t see it? What about the nicks, chips and discoloration? You probably can’t see those either. That’s because residual debris and damage that can harbor future microbes are often invisible to the naked eye. But more and more sterile processing departments are using cleaning verification tools such as handheld lighted magnifiers, tabletop microscopes and borescopes that let them examine and test areas that are difficult or impossible for the human eye to see into directly. Could your facility benefit from greater magnification, X-ray vision and high-tech microbial monitoring during visual inspections?

Standardizing a manual process

Of all the types of medical device reprocessing, flexible scope cleaning is one of the most manually intensive. Unfortunately, with manual processes can come variability, which is the chief threat to repeatable quality outcomes. This variability is often tied to human factors involved in everything from bedside cleaning and speed of transport to the reprocessing room to how techs manipulate their cleaning brushes and how closely they visually inspect the distal tip before disinfection.

The first key to creating a thorough scope cleaning verification program is to develop a standard cleaning process and defined verification program at the facility level. Because people are not machines, you must provide as much structure as possible to technicians regarding how they should clean and conduct cleaning verification testing. Never let individual preference trump standard facility practice. Regardless of the type of verification tests you use, you can develop standard cleaning and verification procedures in conjunction with manufacturers’ instructions for use, industry recommendations such as AAMI ST91:2015 ( and department policies. For any quality assurance program to work, staff must be both competent and consistent in their application of the verification methods and documentation protocols.

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