STERILE PROCESSING
A•MAZE•ZING
of endoscope sterilization by Kara Nadeau
Illustration 234847783 © Mariia Simakova |
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T
he Association of periOperative Registered Nurses (AORN) recently released its newly revised Guideline for Processing Flexible Endoscopes, with recommendations for hand-over
communication to decontamination personnel, borescope inspec- tion, cleaning verifi cation tests, and drying processed endoscopes. HPN gathered insights from AORN, Central Sterile Supply Department (CSSD) professionals, endoscope manufactur- ers, and reprocessing solutions providers on how these new guidelines align with/differ from the ANSI/AAMI ST91:2021 Comprehensive guide to fl exible and semi-rigid endoscope pro- cessing in health care facilities, and their impact on CSSD teams.
Why the changes? Amber Wood, MSN, RN, CNOR, CIC, FAPIC, Senior Perioperative Practice Specialist at AORN and lead author for the AORN Guideline for Processing Flexible Endoscopes, comments on why AORN updated its fl exible endoscope pro- cessing guidelines:
“Flexible endoscope processing remains a critically important patient safety issue because there have been more outbreaks associated with these complex endoscopes than any other medical device. When the AORN Guideline for Processing Flexible Endoscopes came up for its 5-year revision cycle, we knew there were many important new published studies on the topic in addition to timing the update with the release of the updated ANSI/ AAMI ST91:2021.
Amber Wood
What are the changes? In an AORN Periop Today article, Wood said while there are many changes in the new guidelines, these four major practice changes can “help teams fall within the narrow margin for safety when processing fl exible endoscopes.” 1. Redefi ne hand-over communication: Refi ne the hand-over process from the transporter to decontamination personnel, recommending direct communication and documentation including the time the point-of-use treatment was completed
and whether the endoscope was exposed to factors during the procedure that may require additional cleaning.
2. Borescope inspection: Use a clean borescope to visually inspect accessible channels of fl exible endoscopes before sterilization or high-level disinfection (HLD). Borescopes allow for visual inspection of internal channels and may identify damage or debris that would otherwise be undetected.
3. Cleaning verifi cation tests: Use cleaning verifi cation tests to verify manual cleaning of fl exible endoscopes before steril- ization or HLD. Cleaning verifi cation testing such as with ATP, protein, carbohydrate, or hemoglobin is recommended to provide an objective method for verifying cleanliness.
4. Drying processed endoscopes: Dry all accessible channels of HLD-processed fl exible endoscopes in accordance with the manufacturer’s instructions for use (IFU) with pressure-reg- ulated instrument air or HEPA-fi ltered air for a minimum of 10 minutes or until no visible moisture remains.
How do the new guidelines compare to ANSI/ AAMI ST91:2021?
“There are many similarities, which will make it easier for sterile processing teams to implement recommendations into prac- tice,” Wood explained. “The main difference is that the AORN Guideline cites research that is critically appraised and systemati- cally reviewed, so you will see a ranking for the level of evidence and scores for each article in the reference list.” “For the major changes to practice, there is harmony, such as performing cleaning verifi cation testing, borescope inspection, and drying endoscopes after high-level disinfection for a minimum of 10 minutes with pressure-regulated instrument or HEPA-fi ltered air,” she added. “The AORN Guideline is unique in that is has a review of evidence comparing single-use and reusable fl exible endoscopes that will be very helpful when making evidence-based purchasing decisions.”
Susan Klacik, BS, CRCST, CIS, CHL, ACE, FCS, Clinical Educator for the Healthcare Sterile Processing Association (HSPA), compared and contrasted the ANSI/AAMI ST91 and AORN guidelines.
24 February 2023 • HEALTHCARE PURCHASING NEWS •
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Endoscope Care Navigating the complex cycle
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