The Society of Gastroenterology Nurses and Associates (SGNA) Inc. of Chicago, recently published revised infection prevention standards pertaining to flexible endoscopes, which should be a reminder to surgery centers that they need to assess their own practices and make changes as needed.
“The flexible endoscope is in the spotlight,” notes Susan Klacik, CRCST, CIT, FCS, president of Klacik Consulting in Canfield, OH. “There is a lot of good and new information on these endoscopes. All the research is coming out with evidence showing there’s a lot of work we need to do. So be aware of new standards.”
In the last couple of years, SGNA has joined other organizations in issuing new standards, including the Association for the Advancement of Medical Instrumentation (AAMI)
SGNA’s 31-page standards, published this fall, are called the “Standards of Infection Prevention in Reprocessing Flexible Gastrointestinal Endoscopes.” They outline nine steps in endoscope reprocessing, from pre-cleaning to visual inspection to storage.1 ‘
Earlier in 2016, the Association of periOperative Registered Nurses (AORN) of Denver, published “Guideline for Cleaning and Processing Flexible Endoscopes and Endoscope Accessories.”
Also, AAMI published “ST91: 2015, Comprehensive guide to flexible and semi-rigid endoscope processing in healthcare facilities,” addresses national concern about infections caused by carbapenem-resistant Enterobacteriaceae (CRE) from coast-to-coast.
Surgery centers need to continually emphasize infection control prevention.1
Research shows that for staff to achieve competency in cleaning flexible endoscopes, training is crucial, Klacik says.
“They must have documented competency to process these scopes, which are challenging to clean,” she says. “They are a good breeding ground for bacteria.”
Some of the new standards talk about adding a new step to the reprocessing of flexible endoscopes to verify the scope is cleaned before subjecting it to the high-level disinfection or sterilization step. This step is to use a magnifying glass on the external part of the scope and a cleaning verification method to measure the levels of organic soil and microbial contamination for external scope and internal channels, Klacik says.
“Another hot topic is the storage time,” she says. “Previously, AORN’s best practices were to have a five-day storage; now they’ve changed that and are recommending performing a risk assessment to see how long scopes can be stored in each facility before they become contaminated.”
The time it takes for a stored endoscope to become contaminated can vary based on how it’s stored, how it’s been handled, and other variables, she adds.
To conduct a risk assessment, refer to the AAMI ST91 standards, which have a table for risk assessment, Klacik suggests. “The risk assessment says, according to this we look at several variables, such as the patient population, frequency of use, and testing protocols.”
Surgery centers should put the risk assessment’s findings in their policies so if the assessment determines that the endoscopes could hang safely for five days, then the policy should limit it to five days of storage.
“Each site determines its own expiration date of flexible endoscopes, and this concurs with AORN, who also says to do a risk assessment,” Klacik says.
Prior to use with a patient, the scope needs to be visually inspected to make certain it’s visibly clean and ready for the patient. The visual inspection should ensure there are no cracks, discoloration, and retained debris. If it’s not clean, then manual cleaning steps need to be taken.1
“Inspecting the scope before use and finding an unclean scope requires the scope to undergo complete reprocessing, including disinfection or sterilization,” Klacik says.
When reprocessing the devices, sites should follow the manufacturer’s instructions, including how many flushes are necessary, the type of brush to use, and all of the critical steps, she notes. “They have to be documented each time they’re processed, and it’s important the scope is traceable to each patient.”
Also, depending on the surgery center’s size, there might be one staff member dedicated to reprocessing the scopes and documenting the reprocessing. Some places have automatic endoscope processors.
“The best practice is an automated endoscope reprocessor that we call an AER,” Klacik says. “When you and I process scopes, we do it differently, and the way I process one at 8 a.m. is different than 2 p.m. Processing automation is much more standardized and consistent.”
The latest guidelines also address how the scopes should be transported after use. “They need to be contained in a leak-proof, puncture-proof container alone,” Klacik says. “They must have lids and have to be identified as biohazardous.”
After the scopes have been cleaned, they should be transported from being cleaned to storage and then to patient use in a manner to prevent contamination, thus they should be covered, Klacik adds.
- Herrin A, Loyola M, Bocian S et al. Standards of infection prevention in reprocessing flexible gastrointestinal endoscopes. Gastroenterol Nurs. 2016;39(5):404-418.