HEALTHCARE
PURCHASING EWSN SELF-STUDY SERIES
September 2021 The self-study lesson on this central service topic was developed by STERIS. The lessons are admin- istered by Endeavor Healthcare Media.
Earn CEUs After careful study of the lesson, complete the examination at the end of this section. Mail the completed test and scoring fee to Healthcare Purchasing News for grading. We will notify you if you have a passing score of 70% or higher, and you will receive a certifi cate of completion within 30 days. Previous lessons are available at
www.hpnonline.com.
Certifi cation The CBSPD (Certification Board for Sterile Processing and Distribution) has pre-approved this in-service for one (1) contact hour for a period of fi ve (5) years from the date of original publication. Successful
completion of the lesson and post-test must be documented by facility management and those records maintained by the individual until recertifi cation is required. DO NOT SEND LESSON OR TEST TO CBSPD. For additional information regarding certifi cation, contact CBSPD - 148 Main Street, Suite C-1, Lebanon, NJ 08833 •
www.cbspd.net.
IAHCSMM (International Association of Health- care Central Service Materiel Management)
has pre-approved this in-service for 1.0 Continu- ing Education Credits for a period of three years, until August 5, 2024. The approval number for this lesson is STERIS-HPN 210508. For more information, direct any questions to Healthcare Purchasing News (941) 259-0832.
LEARNING OBJECTIVES
1. List the types of soils found in endoscope procedures
2. Identify the key properties of cleaning chemistries effective against endoscopic soils
3. Create a checklist for evaluating endoscopy cleaning chemistries
Sponsored by:
The perfect solution
Understanding, assessing and selecting endoscope cleaning chemistries by Ann Kneipp and Nancy Kaiser
ndoscope reprocessing is time- consuming and complex, and it involves a two-step process. It begins with thorough cleaning – removing soil from a contaminated reusable device – and is followed by a disinfection or ster- ilization process. While there are a variety of guidelines and recommendations that address the importance of cleaning, they all say essentially the same thing: if it isn’t clean, it cannot be properly disinfected or sterilized.
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The right cleaning chemistry is criti- cal for successful endoscope cleaning. However, not all chemistries are equal. Some formulations can leave residual soils, some can damage endoscope com- ponent materials, and some require more scrubbing, which can cause scratches and other damage. Soiled and damaged surfaces can harbor microorganisms and promote biofi lm, which in turn prevents proper rinsing of the cleaning chemistry and ultimately reduces the effectiveness of disinfection or sterilization processes. With the safety of patients riding on thorough scope cleaning, how do you determine the right cleaning chemistry for your endoscopy practice?
Types of endoscopy soils To determine the most appropriate clean- ing chemistry for endoscope reprocessing, we must understand the procedures being performed and the types of soils that may be present after these procedures. Soils found on endoscopic devices come from a variety of sources. For many fl exible endoscopes, the most common source is the gastrointestinal (GI) tract. For example, patients prepare for endoscopy by taking “fl ush cocktails” to rid the tract of as much “debris” as pos- sible and allow for clear viewing. These products leave residuals such as propyl- ene glycol and sodium phosphate behind that can deposit on endoscopes. In cases
36 September 2021 • HEALTHCARE PURCHASING NEWS •
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where patient prep was incomplete or prep was not performed at all (as in emer- gency procedures), the fecal matter in the tract includes numerous types of soil, including bile, bilirubin (broken down red blood cells), mucus, undigested food and large amounts of bacteria. If polyps were removed, whole blood and membrane tissue may also be present.
Substances introduced during the pro-
cedure will also deposit on endoscopes and require removal. For example, petro- leum jelly is often applied as a lubricant for patient comfort, and contrast dyes are instilled in the GI tract during chro- moendoscopy to help identify suspect tissues. The practice of using simethicone (the antifoaming agent found in gas relief products) to reduce the amount and size of mucus bubbles and improve visualiza- tion has created a new cleaning challenge. Simethicone is especially hard to remove because it’s not soluble in water or alcohol. To understand how to remove various endoscopic soils, we need to categorize them into two general categories: organic and inorganic. Organic soils include pro- tein, lipids/fats and carbohydrates. Proteins are found in every type of tis-
sue and fl uid in the human body, so they are present on endoscopes after every type of procedure. Proteins are large, insoluble molecules with extremely com- plex multi-layered structures. These struc- tures allow the molecules to function and protect them from breaking down, which makes proteins especially hard to remove. Lipids are fatty, waxy and oily com- pounds that the body uses to build cell membranes and store energy. By their nature they are insoluble in water. The saturated and unsaturated fats present in the GI tract occur naturally in patients’ bodies and are also introduced through their diets. Synthetic lipids (i.e., olestra) used as fat substitutes in “light” foods may also be deposited on endoscopes
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