HEALTHCARE SELF-STUDY SERIES Sponsored by N
PURCHASING EWS
November 2022 The self-study lesson on this central service topic was developed by 3M Health Care. The lessons are administered 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 (Certifi cation 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 LES- SON OR TEST TO CBSPD. For additional infor- mation regarding certifi cation, contact CBSPD - 148 Main Street, Suite C-1, Lebanon, NJ 08833 •
www.cbspd.net.
HSPA (Healthcare Sterile Processing Associa- tion,
https://myhspa.org) ) has pre-approved this in-service for 1.0 Continuing Education Credits for a period of three years, until October 17, 2025. The approval number for this lesson is STERIS-HPN 221710.
For more information, direct any questions to Healthcare Purchasing News (941) 259-0832.
LEARNING
OBJECTIVES 1. Discuss the four stages of endoscope processing
2. Identify opportunities for cross contamination during the cycle
3. List straightforward ways to prevent cross contamination when processing endoscopes
Sponsored by:
Cross out cross contamination in endoscope processing
by Heide Ames and Pam Boulet F
lexible endoscopes are among the most complex and indispensable medical devices used in healthcare. And yet, despite mounting evidence iden- tifying cross contamination opportunities during endoscope processing, many sterile processing and endoscopy departments dedicate little space to the proper cleaning, rinsing, and disinfection or sterilization of these lumened scopes. At the same time, regulatory and guidance organizations are taking a hard look at the details of this process and are updating best-practice recommendations. This is likely to lead to changes in processes, equipment and workfl ow space to enable compliant fl ex- ible endoscope processing.
Contamination level related to the stage of processing Endoscope processing roughly divides into fi ve stages. The fi rst stage consists of receipt, cleaning, and rinsing. Processing staff move soiled endoscopes from the decontamination holding area to the cleaning area. At this point in the clean- ing process, the endoscope has its highest level of contamination. The endoscope is leak tested and submerged in clean- ing solution as it is brushed and fl ushed. Once cleaned, the endoscope moves to a rinsing sink. Once again, the endoscope is submerged, and its channels are fl ushed per the manufacturer’s instructions to help ensure complete removal of cleaning solu- tion and soils.
Rinsed endoscopes move to the second
stage, the inspection. Despite cleaning and rinsing, pathogenic microorganisms are still on the endoscope. The endoscope is placed on an absorbent pad and is dried using a non-linting cloth. Lighted mag- nifi cation is used to examine the external surfaces, and a borescope may be used to view some of the internal channel surfaces that run through the endoscope. Once inspection is completed, the endoscope is moved to the high-level dis- infection or liquid chemical sterilization area, which is the third stage. High-level disinfection and sterilization start with an
38 November 2022 • HEALTHCARE PURCHASING NEWS •
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endoscope with a low level of contamina- tion and end with an endoscope virtually free of living pathogenic microorganisms. Both of these processes can be manual or automated. In a manual process, the endoscope is placed in high-level disin- fectant or sterilant solution for a specifi ed amount of time at a specifi ed temperature. Once the time has passed, the endoscope is removed and rinsed several times to remove the solution from the endoscope. For automated processes, the endoscope is placed within an automated reprocessor. The adaptors are connected to ensure fl ow of the solution though all channels of the endoscope. The automated reprocessor performs both the disinfection/steriliza- tion and rinsing steps. The fourth and fi nal stage of activities is drying and storage. At this stage, the endoscope has no pathogenic microorgan- isms and must be kept this way until used on a patient. Once at the drying area, a clean non-linting cloth is used to dry the external surface. All channels are purged with instrument quality or HEP-fi ltered air for 10 minutes or longer, until all chan- nels are dry. Once dry, the endoscope is transported to the storage cabinet where instrument quality or HEP-fi ltered air keeps the cabinet at a positive pressure as compared to the room environment. During this processing cycle, endo- scopes follow a path from highest to low- est contamination. Cross contamination frequently happens when an endoscope is exposed to contamination from an earlier stage.
Identifying sources of cross contamination The fi rst well-publicized source of cross contamination is inadequate cleaning and disinfection. Residual soils left by inad- equate cleaning protect microorganisms from subsequent high-level disinfection or liquid chemical sterilization processes. In addition, endoscope damage that goes undetected during inspection can harbor residual soils and biofi lms that also shield microorganisms. And when a properly
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