Decontamination
with staff in the reprocessing area, then errors can occur. The countdown is on once the procedure is complete but how is 60-minutes between procedure room and decontamination department monitored? If the time of the pre-clean is recorded, where is this information available? As most endoscopes are transported in trays and carts, with liner bags it is difficult to show the time of pre-clean while in the transport system. Another issue to consider is how several endoscopes arriving in the decontamination department on the same cart are prioritised if there are no visual indicators showing the time of the pre-clean.
Studies have shown infections due to delayed reprocessing There are reports of infection outbreaks which link directly to delayed reprocessing of endoscopes, one study in France in 2010 records a nosocomial outbreak which was partially attributed to delayed reprocessing.13 A further study on an outbreak of Pseudomonas aeruginosa infections outlined inferior reprocessing of bronchoscopes and non-adherence to guidelines. The study showed that bronchoscopes were reused multiple times between procedures without cleaning. Cleaning and disinfection were unsuccessful with the most probable cause being the drying of biofilm between uses of the endoscope.14
Although endoscope infection rates
are reported as low, the correct rate of transmission may be unknown due to lack of inspection or the absence of clinical symptoms. In a report by Kovaleva, in 2013, insufficient decontamination procedure and equipment malfunction were the two leading causes of post endoscopic infections. More than 91% of the infections could be preventable if quality control systems were improved.15
What’s the Solution? The time between device use and cleaning and reprocessing is crucial, but a fundamental question that should be assessed is, when should the timer begin? Does the time limit begin immediately after procedure, or when the pre-cleaning commences? According to Olympus, the 60-minute timer should begin as soon as the endoscope is removed from the patient, and pre-cleaning is carried out. Once the insertion tube is removed, biofilm is exposed to external air and begins to dry and harden. In circumstances when the endoscope is removed from the patient but set aside for
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use later in the procedure, pre-cleaning should be performed in the usual way, immediately after removal from the patient. The endoscope can then be set aside on a sterile drape but should be inspected periodically to ensure it is not allowed to dry.10 Another important consideration is how the
process should be mandated. Communication is vital in providing the much-needed information between the procedure room staff and the pre-clean, and the decontamination staff in the reprocessing area. While some facilities favour modern technology systems, smaller units may prefer a more simplistic and less expensive approach. The timing information helps staff to prioritise endoscope reprocessing based on the amount of time that has elapsed since the pre- clean and determine if the delayed reprocessing protocol is required.
Endoscopy facilities are continually
challenged to provide timely care with limited resources and ever-increasing screening numbers. Endoscope manufacturers and industry need to be working together to create innovative solutions to improve time management and patient safety. Time indicators could be an ideal way of
improving workflow management in busy units. Using simple time indicator labels allows staff to clearly see which endoscopes need to be reprocessed first. Time indicator labelling provides a clear visual aid without the need for tracking devices or additional equipment. Efficiency is increased by allowing the staff to quickly prioritise endoscope reprocessing. The ToteTimer by Meditech Endoscopy is a
new endoscope transport system that uses this method, by combining a tamper proof
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