You can brush and flush with precision, for just the right amount of time and with just the right amount of touch, and still there's no guarantee that you'll deliver an endoscope free of bacteria and bioburden. Such is the lot of the reprocessing tech and the degree of difficulty of the manual clean, a rather thankless chore that requires amazing stamina and attention to detail.
The job recently got a lot more daunting with the publication of a study that found that rigorous, by-the-book cleaning of flexible endoscopes before disinfection doesn't ensure that scopes are free of contamination, particularly when the scopes have scratches and dents that could harbor blood, tissue and bacteria. The study, published in the February American Journal of Infection Control (osmag.net/C8WRex), raised the frightening possibility that you can't count on current reprocessing practices to consistently decontaminate your scopes even if, and it's a mighty big if, your techs meticulously follow reprocessing guidelines and don't take shortcuts.
"The study was kind of chilling, but I was not shocked by it," says Chris Lavanchy, the engineering director of ECRI Institute's Health Devices Group. "Many people have long been suspicious that the manual cleaning process is not 100% reliable."
Twelve of the 20 reprocessed scopes examined during the 7-month study tested positive for microbial growth, indicating a failure of the disinfection process, despite being disinfected using the current guidelines. Researchers found that all 20 endoscopes had visual irregularities, such as fluid, discoloration and debris in the channels. The finding of residual fluid was significant because any bacteria present will flourish in a moist environment and lead to the development of biofilm which can be difficult or impossible to remove, says lead study author Cori Ofstead, MSPH, an epidemiologist and president and CEO of Ofstead & Associates in St. Paul, Minn.
"If the scope's not clean, it can't be disinfected or sterilized. If the scope is damaged, it can't be disinfected or sterilized," says Ms. Ofstead.
In implicating the critical point-of-use precleaning and cleaning steps that precede the disinfection cycle as the weak links in the reprocessing chain, the study hammers home the point that you can't disinfect a dirty scope.
"Ever tried to wash a plate that has a bit of dried egg on it?" asks Mr. Lavanchy in a fitting dishwashing analogy. "There's so much emphasis on the disinfection process that we often overlook the cleaning step. But if you don't clean properly, you can't ensure that you can effectively disinfect a device."