Avoid Endoscope-Related Infections Come to ASCA 2018 to learn how BY LAURA SCHNEIDER RN, CASC


The ECRI Institute has listed endoscope reprocessing on its “Top 10 Health Technol- ogy Hazards” list for the last eight years, and endoscope-


related infections have been in the news frequently during this time. According to William Rutala, director of the Statewide Program for Infection Control and Epide- miology at the University of North Caro- lina School of Medicine, “There are more outbreaks from the use of endoscopes than any other medical device due to the complexity of the instrument and micro- bial contamination.”


During my presentation, “Develop an Education and Competency Program for Endoscope Reprocessors,” at ASCA 2018 in Boston, Massachusetts, April 11–14, I will discuss resources available to develop a standardized endoscope reprocessing education program for ori- entation, ongoing education and valida- tion of annual competencies. Despite the large number and vari- ety of GI endoscopic procedures per- formed in the US, documented instances of infectious complications remain rare for several reasons, including inade- quate surveillance, undiscovered and unreported breaches, and asymptomatic infections. Effective June 2014, however, the Centers for Medicare & Medicaid Services (CMS) began requiring accred- iting organizations to report infection control breaches to public health authori- ties. Surveyors from the Accreditation Association for Ambulatory Health Care (AAAHC) now inform the AAAHC office of any identified breach to verify that it is a reportable event. The AAAHC office notifies the relevant public health authority of any such reportable event. The financial consequences of an endoscope-related incident are high. The total estimated business cost per incident of endoscope-related infection is between $2 million and $20 million.


6 To avoid an endoscope incident at


your ASC, make sure that your scope reprocessing practices are based on manufacturers’ instructions for use. Train your staff in all areas of scope reprocessing with ongoing education, and audit scope reprocessing practices frequently to ensure compliance. Some of the important steps that I


have identified to emphasize in an endo- scope reprocessing education program: ■■


Review the manufacturer’s instruc-


tions for use (IFU) and all educa- tion available for the equipment and products that your facility uses. This includes instruction manuals for all endoscope models used, automated endoscope


reprocessor (AER) and


flushing pump, and IFUs for enzy- matic detergents, high-level disin- fectants (HLD) and test strips. Some endoscope manufacturer websites also provide helpful videos. This informa- tion is vital in developing a customized education plan specific to your facility.


■ ■


Endoscope flushing aids are com- monly used to simplify channel flush- ing and avoid wrist and hand injuries that frequently occur with repeated manual flushing. Most flushing aids require daily calibration and dis- infection. It is helpful to develop a generic check list on all steps to use the flushing aid device.


■■


Follow the precise instructions for each chemical used with endoscopes. Know the recommended dilution ratio of your brand of enzymatic cleaner. Enzymatic cleaners are not like dishwashing liquid


ASC FOCUS MARCH 2018 | www.ascfocus.org ■ ■


and you must follow the specific instruc- tions for the product you are using. To do this, you need to know how many gallons are in the sink when cleaning a scope. A formula to calculate the num- ber of gallons in a sink is (W x L x D) ÷ 231. Measure and multiply the width and length of the sink by the depth of the water. For example, if your sink is 12-by-12 inches and the water is 8 inches deep, multiply 12 x 12 x 8 = 1152 cubic inches. Then, divide by 231 (a gallon is equal to 231 cubic inches). The amount of water needed in the sink is 4.99 gal- lons. If the enzymatic instructions state to add 1 ounce for each gallon, you can add 5 ounces of enzymatic cleaner to the sink for each scope washed. If you pre- fer, you can use a gallon container to fill your sink to the required level and count the gallons as you fill the sink.


If the instructions require your HLD at > 68 degrees Fahrenheit, you need to verify and document that the tem- perature is > 68 degrees Fahrenheit for each use. If the temperature is below 68 degrees Fahrenheit, you may need to use a heating device. Many facilities use a heating pad or aquarium heater to maintain the required temperature. The HLD must have contact with all inter- nal and external surfaces of an endo- scope for the required amount of time. Test the HLD for the minimum effec- tive concentration (MEC) before each use. The HLD may pass the MEC tests in the morning but fail in the afternoon. By testing MEC before each use, you will identify exactly when it fails. Fail- ing to check MEC prior to each use is one of the common deficiencies during endoscope reprocessing.


I will discuss and share more tips dur- ing my presentation. See you there.


Laura Schneider RN, CASC, is a se n- ior director of clinical services at Am- surg in Dallas, Texas. Write her at laura.schneider@amsurg.com.


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