TJC looking closely at endoscopy reprocessing
Joint Commission, other expert groups weighing in
With infections related to contaminated endoscopes a recurrent problem in health care, the Joint Commission and several other groups and associations are reiterating the importance of reprocessing procedures.
An emerging theme is safe practices in all settings and a desire for standardization of the guidelines issued by the different associations and expert groups. For example, the American Society for Gastrointestinal Endoscopy (ASGE) recently issued updated guidelines in part because the CMS and Joint Commission are taking a hard look at reprocessing practices.
"Over the past two years, surveyors have called into question accepted practices at many accredited endoscopy units seeking reaccreditation," the ASGE states.1 "Many of these issues relate to the Ambulatory Surgical Center Conditions for Coverage set forth by CMS and the lack of distinction between the sterile operating room and the endoscopy setting."
The Centers for Medicare and Medicaid Services Conditions has eliminated the distinction between a sterile operating room and a non-sterile procedure room, meaning GI endoscopy units are now held to the same standards as sterile operating rooms.
"We are doing flexible endoscope [procedures] in many different practice settings now, and in my opinion that is what the CMS and the Joint Commission surveyors are looking for — that you have standardization no matter where it is," says Rose Seavey MBA, BS, RN, CNOR, CRCST, CSPDT, president and CEO of Seavey Healthcare Consulting in Denver, CO.
Toward that end, the Association for the Advancement of Medical Instrumentation (AAMI) is working on a comprehensive guide to flexible endoscopes in health care facilities that may emerge as the gold standard for practice.
"So many guidelines are not that comprehensive, but this will be talking about the whole gamut of reprocessing," Seavey says.
For its part, the Joint Commission recently issued some basic guidance on endoscope reprocessing that emphasized vigilance, warning that "the long term effects of poor processes and an unsafe environment are severe. Working in partnership with infection control and clinical staff, environment of care professionals should ensure that these critical tools remain safe, clean, and ready for use every time."2
Recommending periodic environmental tours of reprocessing areas, the Joint Commission created a checklist that includes the following points:
• Is the reprocessing area sized appropriately in relation to the volume of equipment processed?
• Do staff put on personal protective equipment (PPE) before entering the area?
• Are staff wearing suitable PPE?
• Is there sufficient work space?
• Are cleaning supplies, storage areas, and other critical items clearly labeled?
• Is there an appropriate hand washing station?
• Is there an appropriate eyewash station?
• Are "dirty" areas physically separated from "clean" ones?
• Are there suitable storage areas for cleaned endoscopes? On visual inspection, do these areas look clean, free of debris and dry? If a cabinet serves as storage, does the cabinet have doors?
• Are endoscope storage containers dry and located off the ground"?
• What is the route from the processor to the cabinet? (The route should not cross through the soiled processing area.)
- American Society for Gastrointestinal Endoscopy. Guidelines for safety in the gastrointestinal endoscopy unit. Gastrointestinal Endoscopy 2014;3:363-372 http://bit.ly/1hPvo9K
- Joint Commission. Tips for improving endoscope reprocessing and preventing the risk of infection. Joint Commission Online April 9, 2014: http://bit.ly/1knPiNz