SELF-STUDY SERIES


Devices should be manually dried before placing them into a drying cabinet, follow- ing each device’s IFU.


Devices enter the prep-and-pack area through the pass-through drying cabinet or the washer-disinfectors. At this point, items should be inspected for residual moisture under magnification. It may also be necessary to use a borescope or moisture-sensitive paper to check lumens. In this area, staff will need access to instru- ment air and lint-free towels.


In GI departments, scopes should be dried before placing them into an AER or HLD soak because residual water could dilute the AER or HLD chemis- tries and make them less effective. Even more importantly, the device should be thoroughly dried after AER, HLD or LCS processing is complete and before storage. A recent study by Ofstead et al. (2018) showed that residual uid remained in nearly 50% of scopes and could be con- tributing to infections in patients because over 70% of the wet scopes were con- taminated with organisms after processing and storage. Therefore, residual water may contribute to cross-contamination of scopes. Kovaleva (2017) wrote that a wet endoscope environment contributed to the replication of gram-negative organisms and that residual moisture created an ideal environment for growth.


Consequences of inadequate drying In addition to contributing to bacterial proliferation and impeding sterilization and disinfection processes, poor device drying can also be a major contributor to damage and degradation of external and internal device surfaces. Damage can include discoloration, corrosion, rust and pitting. Moisture and debris are notori- ously known to hide in tight areas, such as box locks, jaws, lumens and crevices of devices so thorough drying and magnified inspection needs to be performed to find moisture before it can cause damage or biofilm formation.


Biofilm is a slime-enclosed commu-


nity of bacterial colonies that can form anywhere on a moist surface. Some examples of surfaces that can form bio- film are water pipes wet device surfaces and wet internal and concave surfaces of lumened or cannulated devices, such as endoscopes, suction tips, shavers or drill bits. According to Dancer et al (2012), coagulase-negative staphylococci (CoNS) and Bacillus species found in biofilms on


Sponsored by


devices were responsible for surgical site infections (SSIs). Also, in a recent review article by Alfa and Singh in Gastrointestinal Endoscopy, inadequate manual cleaning and drying storage failures led to biofilm build-up in endoscope channels, causing bacterial replication. The results of several studies show that inadequate cleaning and drying of endoscopes prior to storage are associated with a high risk for contamina- tion, causing healthcare associated infec- tions (HAIs). This risk has led to some healthcare facilities including a borescope in their work instructions to visualize the internal channels of lumened/cannulated devices and check for cleanliness and residual moisture before moving on to the next step of sterilization prep and pack, HLD or placement in a storage cabinet for drying.


Support for an optimal drying program


Medical device drying is an extremely important infection-prevention function in the reprocessing loop. Evidence-based research has reinforced the risks, and stan- dards support its importance. To ensure patient safety, facilities should establish a quality management system (QMS) for monitoring device drying. The QMS needs to identify risks by assessing current practices in order to identify and mitigate potential sources of residual moisture (and therefore potential contamination) that can contribute to SSIs. Documented practices should be based on manufac- turers’ IFU, hospital standard procedures and industry standards and guidelines, and should be monitored continuously as part of the QMS. In addition, ongoing employee education, training and compe- tency testing need to be provided to help reduce contaminated device events due to ineffective cleaning and drying. Once a drying QMS is in place, consistent, effec- tive drying protocols can be achieved, and patient safety is enhanced. HPN


Tamara Behm, MSN, RN, CIC, FAPIC, CER is a clini- cal education specialist for STERIS Corporation, with 14 years of clinical nursing leadership and healthcare experience. She has held


various roles as a director of ICU, ICU nurse, infection prevention director, infection preven- tion consultant, mentor, adjunct professor, presenter, author and mock surveyor. She is an expert in infection prevention, CMS and


42 September 2020 • HEALTHCARE PURCHASING NEWS • hpnonline.com


other regulatory requirements and process improvement. She is a member of APIC, SHEA, AORN, IAHCSMM, SGNA, ASQ and AAMI.


Pamela Carter, BSN, RN, CNOR, AGTS, CRCST, is a clinical education specialist for STERIS Corporation. She provides customer educa- tion, clinical support and device reprocessing trouble- shooting expertise. She also performs medical device audits/assessments based


upon regulatory guidelines and infection prevention practices to help promote patient saety he is a certied perioperatie reis- tered nurse with over 27 years of experience in nursing management, perioperative and sterile processing education, infection preven- tion and quality systems. In addition, Pamela has written articles for HPN, AORN and the periOperative Nursing Clinic and is an active member of AAMI, AORN, APIC, ASCA, ASQ, IAHCSMM, and SGNA.


References:


1. Alfa MJ, & Singh H. Impact of wet storage and other factors on biofilm formation and contamination of patient ready endo- scopes: a narrative review. Gastrointestinal Endoscopy. 2019; doi: 10.1016/j.gie.2019.08.043


2. ANSI/AAMI ST91: 2015. Flexible and semi-rigid endoscope reprocessing in health care facilities. Arlington, VA: Association for the Advancement of Medical Instrumentation.


3. ANSI/AAMI ST79: 2017. Comprehensive guide to steam ster- ilization and sterility assurance in healthcare facilities. Arlington, VA: Association for the Advancement of Medical Instrumentation.


4. ANSI/AAMI ST58:2013. Chemical sterilization and high-level disinfection in health care facilities. Arlington, VA: Association for the Advancement of Medical Instrumentation.


5. ANSI/AAMI ST41: 2008/(R)2012 Ethylene oxide sterilization in health care facilities: safety and effectiveness. Arlington, VA: Association for the Advancement of Medical Instrumentation


6. Association of periOperative Registered Nurses. 2020. Guide- lines for Perioperative Practice. Processing Flexible Endoscopes.


7. Dancer SJ, Stewart D, Coulombe C, Gregori A, Virdi M. Surgi- cal site infections linked to contaminated surgical instruments. Journal of Hospital Infection. 2012; 81(2012): 231-38. doi: 10.1016/j.jhin.2012.04.023


8. Evangelista S, Guimaraes NR, Garcia NB, dosSantos SG, deOliveira AC. Effectiveness manual versus automated cleaning on staphylococcus epidermidis biofilm removal from the surface of surgical instruments. American Journal of Infection Control. 2019; 48(2020): 267-74. doi: 10.1016/j.ajic.2019.08.024


9. Instrument Society of America. Quality standard for instrument air. ANSI/ISA 7-0-01-1996. New York: ISA, 1996.


10. Kovaleva, J. (2017) Endoscope drying and its pitfalls. Journal of Hospital Infection. 97; 319-328.


11. Lopes LK, Costa DM, Tipple AF, Watanabe E, et al. Complex design of surgical instruments as barrier for cleaning effective- ness, favouring biofilm formation. Journal of Hospital Infection. 2018; 103(2019): 53-60. doi: 10.1016/j.jhin.2018.11.001


12. Nation Fire Protection Association. Health care facilities code. NFPA 99. Quincy (MA): NFPA, 2012.


13. Ofstead CL, Heyman OL, Quick MR, et al. Residual Moisture and Waterborne Pathogens Inside Flexible Endoscopes: Evidence from a Multisite Study of Endoscope Drying Effectiveness. Ameri- can Journal Infection Control. 2018; 46(6): 689-96.


14. Perumpail RB, Marya NB, McGinty BL, Muthusamy, VR. Endoscope reprocessing: Comparison of drying effectiveness and microbial levels with an automated drying and storage cabinet with forced filtered air and a standard storage cabinet. American Journal Infection Control. 2019; 47(9): 1083-89. doi: 10.1016/j.ajic.2019.02.016


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