Endoscopy's Dirty Little Secret
Last week, AAMI published an article on ECRI's listing of the Top 10 Technology Threats of 2018. As one might expect, cybersecurity took the top spot, but hazard number two was endoscope reprocessing.
Confronted with this news, one might logically assume that reprocessing departments are redoubling their efforts to follow established procedures and reduce this threat. While that is very likely the case in most places, the fact that endoscopy reprocessing has been a high ranking hazard on eight of the last 10 previous editions suggests that part of the problem may be with the established procedures themselves.
There are seven steps involved in reprocessing endoscopes, including: pre-cleaning in the patient procedure room, transport to a decontamination or reprocessing room, manual cleaning, a disinfection cycle (often with an automated endoscope reprocessor), alcohol rinsing, drying, and storage.
The AAMI list of threats focused on two main areas of concern: insufficient removal of biological debris and other foreign materials during the pre-cleaning stage and moisture trapped in instrument channels during storage.
Regarding storage, Case Medical has addressed the issue of dry vs. wet loads in many blog posts including this one. Regarding pre-cleaning, Case Medical has identified a common pre-cleaning procedure that may be contributing to the recurring threat endoscopy reprocessing poses in the AAMI ranking.
Currently, one of the most widely used pre-cleaning products is a packet containing a sponge soaking in a detergent solution. Standard pre-cleaning protocol is to wipe the endoscope with the sponge, three times from top to bottom, then flush the instrument with the liquid remaining in the bag. The problem is, after the first pass, the sponge is contaminated with all of the debris and fluids which are effectively reapplied to the instrument on passes two and three.
To address this situation, Case Medical has innovated a new pre-cleaning packet for endoscopes that replaces the sponge with, single use, non-woven disposable Penta Wipes® surface cleaning wipes, pre-moistened with our EPA Safer Choice awarded PentaZyme® Multi-Enzymatic Cleaning Solution. Each packet contains three Penta Wipes in accordance with the protocol. Each case contains 12 packets as well as 12 250ml bottles of PentaZyme solution for flushing.
By replacing three strokes with a dirty sponge with three single-use wipes, and providing a flushing solution in a separate sealed bottle, reprocessing departments can make significant progress toward removing endoscope reprocessing from the 2019 list of hazards.