Endoscope reprocessing
chemical compatibility with instruments and equipment to reduce the chances of damage. A standardised process would see a non- enzymatic detergent remove any organic traces - such as blood, protein, fat and saliva, found on and in flexible endoscopes. The chemistry should be compatible with all makes and manufacturers of flexible endoscopes and in line with their instructions for use, maximising their life. Increased efficiency in an endoscopy department can improve patient experience and reduce waiting lists. The technical and commercial challenge in departments is to ensure the highest efficacy with the lowest cost, but achieving this can be difficult when there are so many variables in the manual wash process - such as protein levels, water pressure, water temperature and water type damaging endoscopes, as well as overspending on chemicals. It is vital decision makers understand dosage and cost per dose, as often a product will need three, four or five times the amount per dose than recommended, which impacts on overall cost per dose. Another challenge is water variations. Water
hardness, treatment and trace elements can vary depending on the region and season, which can have an impact on chemical performance. Hard water is not the best for cleaning, as the calcium can cause stickiness and bioburdens can stick to the inside of the endoscope. Hard water areas need to use treated softened water. A standardised process, which considers these variables, may help to reduce this problem area. It is also widely accepted that you should
have foam when cleaning to ensure good performance, but there needs to be education around the impact of a foaming wash, especially in a sterile environment. Chemically, a non-foaming detergent is
better for the equipment and works to a higher performance than those with foaming agents.
increased demand, while every error is costing the NHS money dearly. When you’re waiting for a faulty endoscopy to be fixed, that is time, money and patients not being seen. With each endoscope costing in the region of £100,000 - which can be used multiple times in each treatment room in each UK hospital each day - just one being out of action with a leak or blockage or breakage is a delay to a patient and a longer waiting list.
Decontamination departments have evolved
When a foam based chemical is used it can be a challenge, as it can cause issues with standardising flow through automated flushing devices. Standardising endoscope decontamination
also moves away from enzymes, which can be aerated and cause sensitisation. A standardised process and chemical would not only ensure best performance across the board, it would help staff to identify with the chemistry allowing them to be aware of the COSHH implications. An automated flush would remove concerns
over manual handling - a technological flush movement not only improves quality of flushing and eradicates human error due to constant flow, it also reduces the risk of staff suffering with repetitive strain injury from repetitive hand movements when cleaning with a syringe. The challenge is change - it is hard to
introduce change, even when it is proven to be worthwhile. Experienced staff see mechanical processes as added time, when in fact mechanical decontamination takes the same time, or even less. There is a sense of perceiving the old process as being fine and that change is too much hassle, but it is about education and changing mindsets. Endoscopy departments are facing challenges around the backlog and
About the author
Daniel Collins has a background in the NHS and is currently the senior sales representative and technical lead at hygiene and decontamination specialist, Serchem. A British company, Serchem is a family business with more than 40 years’ experience of manufacturing hygiene and decontamination products used by global healthcare industries. Serchem serves more than 400 clients across more than 18 countries, and Daniel is technical lead on more than 20 chemical formulations.
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from a time when nurses were responsible for the cleaning techniques. These departments are a discipline in themselves, and training and awareness is of utmost importance. Departments take pride in their involvement in the patient journey. Our role is to work with departments to make
the process more efficient for both staff and patients. The Scopetech has been in use for 15 years, but it is long overdue to be installed in more hospitals. As the patient is ultimately at the forefront of all decision making, departments should welcome the efficiencies that come with introducing an automated flush. Many of the issues faced since decontamination departments were brought in, to take over the process more than 20 years ago, need not be problems faced in the department now, thanks to technological advancements. Ultimately, we can and should standardise what is a vital process. It is about patient safety and efficiency.
CSJ
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