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missed residual soils on or in endoscopes are potential sources of contamination. Use a fresh clean towel to dry each endoscope. Change absorbent pads regularly to prevent potential biofilm formation and cross contamination between endoscopes. Lighted magnification used to inspect endoscopes can become contami- nated as staff manipulate the magnifier. Borescopes used to visu- alize the internal channels and ports can become contaminated as it touches the contaminated scopes. This is especially true when finding residual soil in an endoscope channel. Policies and procedures are needed for cleaning and disinfecting inspection equipment and surfaces. Transfer endoscopes that are ready for high level disinfection or liquid chemical sterilization through a pass-through window to the clean side. Avoid using doors between the decontamina- tion and clean sides, as they make it difficult to maintain positive pressure within the room and allow contaminated air to cross into the clean side. Also, segregate cleaned endoscopes from high level disinfected or liquid chemically sterilized endoscopes. Placing a disinfected endoscope on a surface that held a cleaned (but not disinfected or chemically sterilized) endoscope could transfer contamination from one scope to another.


Change PPE Be sure to change PPE between the decontamination and clean processing areas. PPE, such as gloves, become contaminated when handling clean but unprocessed endoscopes. Touching pro- cessing equipment or removing processed endoscopes with those contaminated gloves is an opportunity for cross contamination.


Replace manual disinfection/sterilization


Manual high-level disinfection and liquid chemical sterilization is discouraged by many organizations. Manual processing increases the chance of staff exposure to disinfectants and sterilants, and manual processes are more likely to create spills, splashes, and aerosols. As in the case of cleaning sinks, consider physical bar- riers between processing and drying areas.


Many standards indicate that automated high level disinfec- tion or liquid chemical sterilization systems are best practice. These systems do not have the same splash, spill and aerosol- ization cross contamination opportunities as a manual process. Pass-through automated systems allow loading of the cleaned endoscopes into the unit on the decontamination side of the wall and unloading of processed endoscope on the clean side of the wall. This unidirectional flow significantly reduces the possibil- ity of cross contamination by offering an efficient and complete separation of dirty and clean. It also helps support the negative and positive pressures of the rooms by allowing only one door of the reprocessor to be open at a time. Endoscopes must be dried prior to storage or terminal steriliza-


tion. Clean non-linting cloths dry surfaces and forced instrument or HEP-filtered air dries internal channels. Dry endoscopes are critical since any moisture that stays in the endoscope can become a breeding place for biofilm. Drying cabinets can help to dry surfaces, channels, or both. Using pass-through drying cabinets between decontamination and clean sides can help prevent contamination. Be sure to assess the drying cabinets ability to dry surfaces and channels completely. The clean room should be kept at a positive pressure as com- pared to the decontamination room, adjacent hallways, and other adacent rooms. This ensures that air flows out of the room to the adjacent areas and keeps microorganisms from entering and contaminating the processed endoscopes. As discussed, ANSI/ ASHRAE/ASHE Standard 170 Ventilation of Health Care Facili- ties provides guidance.


Figure 1 Pass thru automated systems give separation between loading of the cleaned endoscopes in decontamination and unloading of processed endoscopes on the clean side of the wall.


Attention to detail protects patients Guidance for many healthcare processes is based on evidence and designed to offer practices that help reduce avoidable patient infections. The physical separation of dirty and clean processing environments is a globally recognized infection prevention best practice. Add to that some simple department practices that focus on the cleanliness of surfaces, PPE and processing equipment will help reduce the risk of recontamination and help to ensure patient-ready endoscopes for every procedure. HPN


Heide Ames, BS, CCSVPis a product manager with 29 years of healthcare and laboratory experience in various roles including as a researcher, author, instructor, tutor and presenter for numerous top- ics including: biology, microbiology, sterilization validations, medical device processing, sterility assurance uses and applications, and process failure investigations.


Pam Boulet BSN, RN, CGRN, CFER is a clinical education specialist manager with more than 27 years of GI and healthcare experience. She previously served as the center director at New Orleans Endoscopy and as a gastroenterology nurse at several facilities. Pam holds a Bachelor of Science degree in Nursing from Louisiana State University in New rleans and is a ertified astroenterology egistered rse  and ertified leible ndoscope eprocessor  e is an active member of the Magnolia SGNA.


References:


1. American Society for Gastrointestinal Endoscopy. (2014) Guidelines for safety in the gastrointestinal endoscopy unit. Gastrointestinal Endoscopy 79(3): 363-372 http://dx.doi. org/10.1016/j.gie.2013.12.015


2. ASHRAE. (2021) ANSI/ASHRAE/ASHE Standard 170-2021 Ventilation of Health Care Facili- ties. Corners, Georgia. ASHRAE


3. Association for the Advancement of Medical Instrumentation. (2021). ANSI/AAMI ST91:2021 Flexible and semi-rigid endoscope processing health care facilities. Arlington, VA: ANSI/AAMI.


4. Johnston, E. R., Habib-Bein, N., Dueker, J. M., Quiroz, B., Corsaro, E., Ambrogio, M., King- sley, M., Papachristou, G. I., Kreiss, C., & Khalid, A. (2019). Risk of bacterial exposure to the endoscopist’s face during endoscopy. Gastrointestinal Endoscopy, 89(4), 818–824. https:// doi.org/10.1016/j.gie.2018.10.034


5. Ofstead, C.L., Heymann, O.L., Quick, M.R., Eiland, J.E., & Wetzler, H.P. (2018). Residual moisture & waterborne pathogens inside flexible endoscopes. American Journal of Infection Control, 46(6), 689-696.


6. Vertes, A., Hitchins, V., & Phillips, K.S. (2012). Analytical Challenges of Microbial Biofilms on Medical Devices. Analytical Chemistry, 84, 3858-3866. dx.doi.org/10.1021/ac2029997


40 November 2022 • HEALTHCARE PURCHASING NEWS • hpnonline.com


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