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Archive June 2016 XVII, No. 6

Are Your Flexible Endoscopes Really Clean?

5 reprocessing recommendations.

Sharon Van Wicklin, MSN, RN, CNOR, CRNFA, CPSN, PLNC


visual inspection CLOSE INSPECTION Visual inspection alone — even with magnification — is not sufficient to determine the cleanliness of flexible endoscopes.

Are your flexible endoscopes truly clean? It's a question many facility leaders have asked since the deadly "superbug" outbreaks were linked to dirty duodenoscopes. Here are tips gleaned from new AORN recommendations to help ensure your scopes are in tip-top shape for patient use.

1 Record when cleaning begins
Biofilm can start to form in the lumens of endoscopes just a few minutes after use, so it makes sense to record the times the endoscopy ends and cleaning in sterile processing begins. This doesn't need to be a complicated process — it can be as simple as writing the time the endoscopy was completed on a whiteboard in the processing area. Your processing and procedural personnel will need to determine the best way to communicate this information, whether it's through an electronic system or simply passed along while transporting the dirty scope. This may seem like a simple idea, but time really does matter. Each manufacturer has a specified time within which routine processing should be completed. Some manufacturers even require that processing be completed within an hour of the finished procedure. Recording the time the procedure was completed gives personnel the ability to determine how long the endoscope has been awaiting processing, establish priority order and determine if the manufacturer's recommendations are possible.

2 Mechanically clean
Rather than soaking the scope and its accessories after the manual clean, use an automated endoscope reprocessor (AER) to clean scopes (when compatible with the manufacturer's IFUs). Why this change? As we've seen with the recent outbreaks, procedures for manual scope processing may be inadequate or inconsistent. They often vary from one facility to another, and sometimes even within the same facility. Mechanical processors reduce this variability and also reduce the potential for breaches in recommended processing protocols due to human error and noncompliance. The evidence backs the change, too. Using an AER will ensure a scope is exposed to the disinfectant for the necessary length of time. Mechanical processing also thoroughly rinses disinfectants, reducing the potential for patient injury associated with residual chemicals remaining in scopes. While mechanical processing may require an initial capital investment, the consistency associated with it may minimize potential damage and the need to repair pricey scopes.

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