CS CONNECTION Tools for the job
Lee Ann Purtell, Owner, Capital Medical Resources, offers the following list of visual inspection tools that can “enhance” the inspection process when visual inspection may be challenging, or even impossible. • Insulation testers for validating the integrity of laparoscopic insulation that may not be seen with the naked eye (visual inspection alone is NOT adequate). Insula- tion testing should be done after every use. If defects are found, the device should be removed from service and repaired to prevent patient burns.
McGan Insulation Tester used to detect defects in laparoscopic insulation
these steps resulted in a clean and sterile instrument.
“We’ve found that IFUs frequently do
not adequately address cleaning proce- dures. SPD leaders must ask themselves ‘How do we validate that our cleaning and disinfection processes are effective?’ Additionally, ‘Is it enough that we follow the IFU…should we do more to verify that the process we utilize to decontaminate and then sterilize is effective?’ I believe the answer to that question is a resound- ing ‘yes’. We must validate our processes, even when those processes are part of the IFU. We must leave nothing to chance.”
Invest in people
“Tools are very valuable, but they rely on the competencies of the technician,” said Agoston. “This is where many fall short, as we have witnessed technicians who do not use the tools or test correctly. The complexity of instrumentation, combined with typical high turnover in SPD, makes ensuring that every set is visually inspected at all stages of prepa- ration a very difficult job. Training and competency assessments are absolutely necessary.”
According to Agoston, 30 to 40 percent
of a typical hospital’s surgery volume is comprised of minimally invasive sur- gery (MIS) procedures, with orthopedic procedures using implants representing another approximately 25 to 30 percent. “Thus, approximately 60 percent of all surgical cases are performed using com- plex instruments,” notes Agoston. “It is
generally accepted that for a technician to become competent with non-complex instruments (basic stainless steel hand- held instruments) across all specialties is at minimum a 12-month process. The advanced skills required for complex instrument processing (robotics, fleible endoscopes, MIS instruments, power tools and complex orthopedic instruments) have a much longer learning curve.” To help ensure the effective and safe processing of minimally invasive equip- ment, Purtell recommends healthcare facilities consider having dedicated CS/ SPD endoscopy technicians who are trained and specialize in MIS instrumen- tation, such as rigid and fleible scopes, laparoscopic instruments, powered surgi- cal devices, etc.
“Having a dedicated area equipped
with a variety of inspection tools is also worthwhile to round out a well-equipped testing station,” she added.
Agoston notes how SpecialtyCare offers
CSSD full staffing solutions, includ- ing specialists with the skills required to prevent common problems associated with MIS instruments, video equipment and robotics. “Our specialists support instrument reprocessing, OR set up, troubleshooting and take down,” said Agoston. “We can also provide the MIS instruments and video equipment. Through our services we ensure that these cases are not delayed due to instrument availability, function or safety and that they go well for the nurses, surgeons and patients.” HPN
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• Lumen inspection for looking inside small channels not visible to the naked eye on flexible scopes, shaver handpieces, suction tubes, etc. Use to validate the effectiveness of cleaning and detect damage and comply with manufacturers’ instructions for use (IFU).
• EndoScan rigid scope internal optic scanner to look “inside” rigid scopes to visually detect moisture, chipped/broken lenses, debris, etc.
• EndoLume or Lux Meter for measuring light output on scopes, light sources and light cords (visual inspection may not be adequate).
• Endoscope leak testers for testing and checking for leaks in flexible endoscopes.
• Magnifiers and USB microscopes for up-close inspection and documentation.
• Video tower, wireless camera or test- ing consoles (or access to) for image and functional testing of scopes and powered surgical devices.
• Adenosine triphosphate (ATP) or other biological detection to measure the amount of organic materials in surfaces not visible to the eye.
“The purpose is so CS and Endoscopy techni- cians can confidently validate the cleaning process, detect defects and comply with IFUs,” said Purtell. “Doing so helps reduce end-user complaints and aids in staff educa- tion/training, departmental communication, patient-care follow-up and repair vendor interaction.”
References
1. [1] The Direct Medical Costs of HAIs in US hospitals and the benefits of prevention, R. Douglas Scott II, 2009) 2. N Engl Jrnl of Med 2012, 366:1354-1356, April 2012
3. Quality Control: Stopping infections before they happen through safer endoscope reprocessing, FDA, January 9, 2020,
https://www.fda.gov/science-research/fda-grand-rounds/ quality-control-stopping-infections-they-happen-through-safer- endoscope-reprocessing-01092020
4. Quality Control: Stopping infections before they happen through safer endoscope reprocessing, FDA, January 9, 2020,
https://www.fda.gov/science-research/fda-grand-rounds/ quality-control-stopping-infections-they-happen-through-safer- endoscope-reprocessing-01092020
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