STERILE PROCESSING
document a full competency and document each of the processes recommended is being performed. The ‘Lack of Oversight’ is one of the accreditation findings that we at Advantage Support Services have observed when we have been privileged to pre- pare departments for accreditation. That being said, the management team should oversee edu- cation and ensure processes are being performed periodically by self-assessing the procedures being performed.”
Angela Lewellyn
Suneil Mandava, Founder & CEO, Mobile Aspects “The biggest impact of all the new AORN recommendations will be on drying processed endoscopes. Hospitals are facing higher and higher volumes of patients. Therefore, scopes have to be reprocessed and ready for the next case even faster. We have sev- eral hospitals that utilize our scope tracking and drying systems scopes a day.”
to reprocess over 100
“Drying the channels of scopes, as recom- mended by AORN and AAMI, adds time to the reprocessing time of the scope. This will increase frustrations with physicians and staff. Hospitals must find a way to meet these new guidelines, while minimizing time. Solutions, such as our iRIScope Channel Drying systems, meet the 10-minute drying time guidelines of several agencies without adding a minute more for high volume centers.”
Suneil Mandava
What role should the CSSD play in pre-purchase evaluation of flexible endoscopes? To Holder’s point that many CSSDs do not have the required equipment to comply with the AORN guidelines, perhaps those departments responsible for reprocessing flexible endoscopes should have a say on the procurement of these complex devices. Another key change in AORN’s guideline is related to the pre-purchase evaluation of single-use and reusable, flexible endo- scopes, including the role of the CSSD team. When asked what role the CSSD team should play in this evaluation process, here were the responses from individuals interviewed on the topic.
Escobar
“One area ripe for impact is the inclusion of single-use endoscopes in the pre-purchase planning section of the guidelines. This is perhaps the first time that CSSD and endoscopy management have guidance on how to strategically handle the expansion of endoscopy use without increasing labor and complexity for CSSD staff.
“Consider outpatient clinics, on campus and off, where recom- mendations call for scope handling and transportation to be highly documented and CSSD reprocessing routines can’t be replicated. Single-use is an ideal solution for workflow, readiness, and alle- viating the pressure on CSSD to turn around equipment quickly.”
Fisher
“While there are some CSSD teams that are involved in the evaluation process, many departments learn about the clinical choices after the fact. A single use solution may assist in the costs and difficulties of reprocessing re-usable scopes, but it will put pressures on PAR levels and supply chain management.”
Klacik “AORN recommends that before the purchase of flexible endo- scopes, equipment or supplies that will be used for processing, an interdisciplinary team be convened to develop a standardized
process for product evaluation and selection. Having the correct people on the interdisciplinary team is essential, and this revised guideline suggests key stakeholders, including Sterile Processing professionals, to participate on this team. “This recommendation also provides a list of what to evaluate during product reviews, and specific criteria are identified to review flexible endoscopes, AERs, storage cabinets, borescopes, cleaning solutions, and detergents. “In regard to purchasing flexible endoscope processing equip-
ment, ANSI/AAMI ST91 includes an Annex, ‘Purchase consider- ations in selecting AERs and LCSPS.’ AORN has also added a new recommendation on purchasing decisions surrounding single-use or reusable flexible endoscopes and accessories; this revised guide- line provides criteria to review when making these decisions.”
Lewellyn
“The CSSD contributes valuable information to the pre-purchasing process of reusable endoscopes. They will ask questions about the item that other team members may not consider. Not only will they request the manufacturer’s IFU that will provide the decontamination, assembling, inspection, and sterilization/HLD information, they will also ask if the sterilization department has the equipment to reprocess the endoscope. “The equipment to consider upon purchasing a new is instru-
ment is the sterilizer, AER, HLD equipment, a drying cabinet and others. But, just as necessary, they will request information about the inspection tools needed to properly clean and inspect the instrument during the decontamination and assembling tasks of processing. Some may be the correct brushes, the expected usage of those brushes, and if they will be able to have access to those inspection tools consistently. “They will also need to consider if the department has the staff capacity to reprocess the brushes if they are not disposable. The staff in CSSD is usually pushed to complete the volume of instrument volume they currently have, so adding another task of reprocessing brushes could be daunting. Those reusable brushes should also be added to the in-service when initiating the new reusable endoscope. The collective team must consider the residual duties specified by the tool. Not only will they have to reprocess consistently, but they must also keep track of the number of times it was processed by documenting the reprocessing task according to the brush manufacturer’s IFU.”
Mandava “CSSD is very important in this process. CSSD should be looking at both single use and reusable flexible endoscopes. For reusable, they should be reviewing the IFUs from the manufacturers to properly clean the scopes. Additionally, they should be evaluating whether they have appropriate documentation processes and systems to meet regulatory guidelines. If there is a delta, they should be contacting industry experts, such as at Mobile Aspects, to review the gap analysis and help them close the gap. For sin- gle-use items, CSSD should be evaluating how those items should be ordered, stored and documented for regulatory purposes.”
What resources are available to help CSSD teams? As Holder and Wood indicated, it is unreasonable to believe these changes can happen overnight. When asked what resources are available to help CSSD teams implement the new guidelines, Fisher and Mandava offered these suggestions.
Banach
“Using Ruhof’s new ATP Complete 2, the next generation of con- tamination monitoring technology, CSSD teams can be confident
28 February 2023 • HEALTHCARE PURCHASING NEWS •
hpnonline.com
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