STERILE PROCESSING “Both the ANSI/AAMI ST91 and AORN’s Flexible Endoscope
Processing Guideline provide guidance in the processing of flexible endoscopes, and they emphasize the importance of training and edu- cation for personnel to process a safe endoscope for patient care,” said Klacik. “Still, there are dif- ferences between the two documents.” “AORN’s guideline recommends using an automated process for HLD instead of a manual process because automated processes may be more efficient and consistent and may reduce personnel exposure to high-level disinfectants. ANSI/AAMI ST91 provides detailed guidance on how to manually perform high-level disinfection on flexible endoscopes, as well as properly use automatic endoscope reprocessors (AER) and liquid chemical sterilant processing sys- tems (LCSP),” Klacik added.
Susan Klacik
What impact will these changes have on CSSD teams? Wood acknowledged how some of the guideline changes will “take time to work out the kinks,” especially those around cleaning verification testing and borescope inspection. “Leaders should conduct a gap analysis to determine what
changes are needed, and then form a team to evaluate feasibility, conduct a trial, and develop an implementation plan,” said Wood. “Cleaning verification testing and borescope inspection may be challenging with regards to identification and interpretation of findings, so a clear protocol and competency verification will be essential.”
“Start small with your highest risk endoscopes (e.g., broncho- scopes, ureteroscopes, duodenoscopes) and limiting the frequency of inspection,” Wood added. “As your team becomes before pro- ficient, you can expand your program. Remember Rome wasn’t built in a day!” Veronica Holder, CRCST, CHL, Certified Registered Sterile Processing Technician II/Certified Healthcare Leader, believes two of the greatest challenges to compliance are lack of training and equipment. “Technicians want to do what is correct and work within the guidelines, but it can be very challenging,” said Holder. “Most of the time the Endo suite functions like its own community, performing procedures and processing scopes in a small decontamination room. When work- ing in CSSD you may hear about HLD but are not trained on it because it happens outside of the department. Processing of instruments and devices should all take place in the CSSD, and technicians should be trained on all techniques, but that is not the reality today.” “It is not up to the SPD technician, supervisor or department to purchase endoscope drying cabinets or boroscopes, it is the facil- ity’s decision whether to allocate resources to these purchases,” Holder added. “Perhaps it is a financial reason preventing the acquisition of this equipment. If the facility doesn’t come into alignment with AAMI or AORN guidelines on endoscope pro- cessing equipment, that leaves the technician to do the best they can with what they have. You can only do what the facility allows you to do, and that gets frustrating.”
Veronica Holder
Which changes will be the most impactful on the CSSD?
When asked which of the four major practice changes will have the greatest impact on CSSD teams with regards to endoscope reprocessing workflows, here were the responses from the others interviewed on the topic.
Ron Banach, Dir. of Clinical Education & Training, Ruhof “Cleaning verification tests will have the greatest impact on CSSD teams with regards to endoscope reprocessing workflows as they provide objective methods for verifying endoscope cleanliness. Of the types of cleaning verification systems available, ATP (ade- nosine triphosphate) testing stands out as the best way to verify cleanliness and measure micro- bial contamination. ATP is the universal energy molecule found in all human, animal, plant, bac- terial, yeast, and mold cells. Product residues, including blood, bioburden and microbial contamination contain ATP.
Ron Banach
“ATP testing is both reliable and quick – providing results in just 15 seconds—and is also easy to use. After manual cleaning at the sink, the endoscope’s surfaces and channels are swabbed to collect ATP, after which the test swab is placed in a handheld luminometer to measure the level of ATP collected. The results will immediately determine if the effectiveness of the cleaning process is acceptable, and the endoscope can then move on to HLD or sterilization. “Beyond endoscope reprocessing, an ATP contamination system can be used throughout your healthcare facility for verifying the efficacy of cleaning protocols for all surfaces and surgical instruments. For the crucial detection of contamination and an uninterrupted cleaning regimen there is no better testing program than one that utilizes an ATP testing system.”
Christian Escobar, Director of Marketing, Endoscopy, Ambu “Regarding the new AORN guidelines, there is a lot for CSSD and point-of-care endoscopy managers to con- sider. Out of the four key AORN recommenda- tions, the extended use of boroscopes might pose the biggest workflow impact.
“Since reusable endoscopes are used across a wide variety of settings and the interior channel wear, tear and damage can present in very sub- jective ways, the time it takes to perform this vital reprocessing efficacy step could take longer than expected, creating workflow challenges in busy settings. I expect implementing all the recommendations for reusable endoscopes will be daunting, though there are clear reasons to do so. “For CSSD leadership, it’s important to take into account both short- and long-term planning for solving the demand crunch and complexity challenge. This will provide relief for staff and an ideal compliance solution for infection prevention and quality.”
Christian Escobar
Crit Fisher, CST, FAST, Director, On-site Service & Operations, KARL STORZ Endoscopy-America “The AORN recommendations all are important in their own rights. They center around ensuring that the scope is adequately cleaned and repro- cessed so that is safe for use on the next patient. The difficulty is that all manufactures have their own IFUs. These IFUs are what govern the use and the reprocessing of these critical medical devices. In all the [recommendations], time is the critical com- ponent. How much time, and in some cases, financial invest- ment in inspection/testing equipment is needed to meet the recommendations.”
Crit Fisher
Angela Lewellyn, CRCST, CER, CHL, LPN, Director of Develop- ment & Research, Advantage Support Services “All four AORN recommendations will impact endoscope repro- cessors, leaders and management in that they will have to
26 February 2023 • HEALTHCARE PURCHASING NEWS •
hpnonline.com
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