Endoscope reprocessing
despite the scope being used and reprocessed with high-level disinfection 17 times since the original colonoscopy.5 A further report by the FDA shows, that in the same month, a user facility reported that 42 patients had developed urinary tract infections (UTIs), as the facility was not dismantling and cleaning the scopes correctly.6
Why are scopes still dirty? Current pre-cleaning solutions are readily available in various forms with medical equipment manufacturers saturating the market with pre-clean kits which consist of a tray, pot, or disposable bag complete with detergent and sponge. All bedside cleaning kits are supplied with an instruction for use (IFU) sheet which details how the kit should be used; however, individual healthcare facilities also have their own training methods and tend to follow endoscope cleaning guidelines as per the manufacturer, meaning that the process is not yet standardised. There could be several reasons why endoscopes are linked to so many concerning reports on cleanliness and patient safety. Often a combination of several factors may contribute to a particular scope compromising patient safety, which is why there should be a focus on improving the quality of inspection and training methods to ensure that endoscopes are subject to the same protocols for every reprocessing cycle. A study by Ofsted et al raised concerns about the non-adherence to reprocessing guidelines. The study paid attention to the impact of human factors in the reprocessing cycle, and it revealed that 99% of the time, one or more of the reprocessing steps were skipped or completed incorrectly. In addition, 45% of the time, multiple steps were skipped.7 Although there is evidence to support human
errors in reprocessing practices, the report does not consider the interaction between the user
and the device design, and neither do they address the IFU, or training provided. Time pressures on overworked staff could contribute to reprocessing steps being missed or skipped, as workloads continue to increase. A lack of education about endoscopes themselves, their mechanical structure, how to clean each channel correctly, and insufficient training methods could also be reasons for discrepancies in the reprocessing process. The importance of reprocessing all the endoscope channels after each use of the endoscope, even if the channels were not used during the preceding patient procedure, is crucial. Particular attention should be given to the elevator wire channels, the balloon inflation channels, and the auxiliary water channel, which are often not covered in pre-cleaning IFUs. The channels of these models must be manually cleaned and disinfected according to manufacturers’ instructions. None of the reprocessing stages should be skipped or omitted.8
Pre-clean and be green? Pre-cleaning is essential for providing better patient outcomes, but with sustainability at the forefront of everyone’s minds, is it possible to provide a solution for patient safety without having a major impact on the environment? Consumable manufacturers and distributors
are under considerable pressure to deliver eco-friendly and affordable products for the healthcare system. Endoscopy is the third highest waste-emitting hospital department, behind theatre and anaesthetics, generating 3.09kg of waste per bed, per day.9 Clinical waste must be incinerated and not
recycled, which poses a particular challenge for endoscopy units in their quest to be as sustainable as possible. They can look to reduce their carbon footprint by using products made from sustainably sourced materials. Products such as the StageOne, a sustainably sourced pre-cleaning kit, have a fillable tray made from bagasse. An eco-friendly, organic material made from the by-product of sugar cane. The tray can be macerated if a facility is available, plus it is lightweight and stackable which reduces shipping charges. Manufacturers should be looking to use as many eco-friendly materials as possible in the production of endoscopy consumable products to ensure that health facilities can comply with sustainability guidelines.
Conclusion Pre-cleaning an endoscope is a crucial step in its reprocessing journey to ensure the efficacy of the cleaning process and to ensure patient safety. Endoscopy units should maintain that there is always a sufficient number of trained staff and the correct items of equipment to allow for thorough cleaning and disinfection
66
www.clinicalservicesjournal.com I June 2024
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84 |
Page 85 |
Page 86 |
Page 87 |
Page 88
