manager and supervisor and the four of them read through all their findings, dis- cuss whether changes in scope processing should be made, and if so, where they need to update their protocols and practices. “If we find a potential change that must be made, we start testing out the change ourselves to determine if we need new equipment or supplies,” Buskol explained. “Then our manager presents our findings to the hospital executive team so they provide the resources for us to adapt processes to implement changes, order the necessary supplies and equipment, and develop the documentation behind why we should be doing it.”
Putting planning into practice Sanford Hospital Sioux Falls SP team’s work to stay ahead has been demonstrated in their scope aeration, drying, storage and transport processes, which align with ANSI/AAMI ST91:2021, Flexible and semi-rigid endo- scope processing in health care facilities.
Aeration and Drying
ANSI/AAMI ST91:2021 emphasizes how the channels of high-level disinfected endo- scopes must be dry before storage to help prevent bacterial growth and the formation of biofilm. The standards cite the preference for methods that employ active drying of endoscopes with filtered air, noting how some storage cabinets can be used to both secure processed scopes and circulate air through them.
Sanford Hospital Sioux Falls has a scope drying cabinet in its SP department, and alongside it Buskol and her team have devel- oped tools to guide technicians on best prac- tices for using it.
“We provide users documentation on every scope that we receive in our area as to what size tubing and connectors it requires. That way, team members know exactly what to use for each specific scope when hooking it up in the cabinet for the 10-minute dry cycle.”
Inspection and testing ANSI/AAMI ST91:2021 noted that if a drying cabinet is not used, dryness can be checked by using dryness indicators. The Sanford Hospital Sioux Falls SP team covers all its bases by using these indicators to test following the drying cycle.
“Each day we perform a test on all our scopes to ensure they are dry, and we have our calibration set up correctly,” said Buskol. “This is done by putting colored paper made for the purpose on the distal end of the scope,
Borescope
STERILE PROCESSING Per ANSI/AAMI ST91:2021 visual inspec-
which reveals whether there is any resid- ual moisture.”
tion recommendations, the team employs lighted magnification and borescopes to inspect processed endoscopes. Starting with just one borescope used for cannu- lated orthopedic instrumentation, the fleet has now grown into 10 borescopes located in decontamination, the scope room and every assembly station.
Dri-Scope Cabinet Hookup
As with every step of scope processing, reinforcing best practices is critical in the inspection process. Because there can be confusion among technicians as to which scopes should be inspected with lighted magnification versus borescope, Buskol has developed a guidance document that technicians can easily access and understand. She commented:
“Some bronchoscopes and nasopharyn-
geal scopes have very small lumens, and our borescopes go down to just 2mm inside. We want to avoid someone trying to force a borescope down a lumen when it may not fit because they will harm the scope. To clear up any confusion, we’ve developed a list of all our scopes, their part/model num- bers, what size brushes and swabs should be used and whether inspection should be performed with lighted magnification or a borescope.”
Storage
ANSI/AAMI ST91:2021 emphasizes the importance of proper scope storage in both protecting scopes from contamination and damage, and identifying those that are “patient ready” as opposed to those that have not been processed with liquid chem- ical sterilants (LCSs) or high-level disinfec- tants (HLDs).
Sanford Hospital Sioux Falls employs a two-cabinet process for storage, with one dry scope cabinet in the SP department and the other in the operating room (OR) clean core, as Buskol explained: “That way, we always keep them hang- ing and aerating to ensure they stay clean and dry. Furthermore, with the two-cabinet process, everyone knows where the scopes are stored, as opposed to storing them in a cart that could end up somewhere they can’t easily find them.”
Cabinet kept in the OR
Transport “Scope transportation was our biggest, most difficult process,” said Buskol. “Because we are in the basement with the OR two floors above us, we had to map out all the touchpoints in the transport process
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