Archive April 2017 XVIII, No. 4

Endoscope Reprocessing Gone Wrong

Recent outbreaks shine light on the dirty truth about the scope cleaning practices at facilities across the country.

Frank Myers, MA, CIC, FAPIC

difficult-to-clean duodenoscopes BY DESIGN Difficult-to-clean duodenoscopes have been linked to several deadly outbreaks of antibiotic-resistant bacteria.

The ceaseless wave of endoscope reprocessing mishaps making headlines across the country has hammered home the point that you can't reprocess a dirty scope. Proper manual cleaning is a challenge under normal circumstances, but nearly impossible when you pressure reprocessing techs to hurry up because a patient is waiting for his procedure to begin, or if you expect techs to get scopes cleaned, disinfected and back in a procedure room in less than an hour.

Scope techs essentially work blindfolded — Here's a brush, now remove the bioburden that you can't see inside the scope. They're told to brush a scope's internal channels until the brush they're using appears clean. Techs must rotate brushes 360 degrees as they clean scopes' internal channels, but I haven't seen that attention to detail in many of the GI clinics I've visited. When I've asked reprocessing techs how many times they brush a scope's channels during manual cleaning, some tell me they run the brush through just once. Why do we allow that inexcusable shortcut? Assuming cleaning practices are eh, good enough is never good enough when it comes to endoscope reprocessing.

Are aging technicians who need glasses to read endoscope cleaning directions really able to notice every little speck on a brush's bristles? Relying on the visual inspection of a channel brush to confirm the cleanliness of a scope increases the potential for human error. That's why your reprocessing area should be outfitted with adequate lighting and magnifying glasses staff can use to confirm brushes are in fact as clean as they appear at first glance. It should also have a clear flow from dirty to clean and adequate workspace for techs to clean scopes properly.

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