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As a follow-up to a report from the Centers for Disease Control and Prevention (CDC) that found transmission of infections by bronchoscopes inadequately reprocessed by automated endoscope reprocessors (AERs), the Food and Drug Administration (FDA) and the CDC have issued a public health advisory on reprocessing of endoscopes. (For more information on the initial CDC report, see Same-Day Surgery, September 1999, p. 104.)
Some health care providers are using AERs to reprocess endoscopes that should not be processed in AERs, the advisory reports. "This practice may have resulted in damaged endoscopes and also raises questions about whether such processing results in an endoscope that is properly prepared for patient contact," the report states.
The advisory recommends that health care facilities do the following:
• Ensure all staff who handle soiled endoscopes comply with the manufacturer’s instructions for cleaning the device. Staff should flush all endoscopes immediately following the procedure, meticulously remove any debris or residuals collected in or on the endoscope, perform leak tests, and visually inspect the endoscope to ensure that it is in proper working order, in accordance with the endoscope manufacturer’s recommendations, the advisory says. "These steps are critical regardless of whether your facility manually reprocesses endoscopes or uses an AER."
• Check with your devices’ manufacturers to determine whether your endoscopes can be reprocessed in an AER. Also, check with the manufacturer to determine whether your endoscopes require that specific steps be taken before being reprocessed in an AER. Not all endoscopes can be reliably reprocessed in an AER, the advisory points out. "For example, the elevator- wire-channel of most duodenoscopes cannot be accessed by the AER and requires manual reprocessing. If not specifically indicated in the AER labeling, it is advisable to ask the AER manufacturer if the endoscope you are using has been tested with their system."
• Compare the reprocessing instructions provided by the endoscope and AER manufacturers and resolve any conflicting recommendations. "We encourage you to work with the AER manufacturers’ technical staff to clarify conflicting information," the advisory says.
• In the absence of specific technical instructions on automated reprocessing for each model of endoscope used in your facility, be sure to follow the endoscope manufacturer’s manual reprocessing instructions, as well as the recommendations of the manufacturer of the chemical germicides used at your facility.
• Regardless of whether you manually reprocess your endoscope or use an AER, consider incorporating a final drying step in your reprocessing protocol.
• Check to be sure that your facility’s instructions for preparing endoscopes for patient contact are appropriate and your staff are adhering to these instructions.
• Provide comprehensive and intensive training for all staff assigned to reprocessing endoscopes to ensure that they understand the importance of proper reprocessing of all endoscopes used in your facility.
• Implement a comprehensive quality control program.