Progress in patient safety has been a challenge in many areas of the hospital and many facilities have made significant changes in their practice of reprocessing endoscopes. With this said, guidelines and practice are in a continuous state of change. It is the responsibility of the hospital to make sure they do not become too satisfied with current practices.
As we establish a culture of safety with endoscope reprocessing, it is important to review 5 common mistakes with endoscope reprocessing:
Practice Inconsistency – The main cause of endoscopy associated infections is failure to adhere to reprocessing guidelines. There is a need to audit mundane task related to endoscope reprocessing. Pay particular attention to individuals who are crossed trained and may not do endoscope reprocessing on a regular basis. Guideline adherence and employee perceptions on practices can impact outcomes.
Workflow Design – Review ergonomic layouts of the reprocessing area as new staff is hired or additional staff is crossed trained. There have been reports of physical discomfort (i.e., back pain, decreased flexibility, numbness, or tingling) associated with the task and time spent reprocessing. Also, if new equipment is brought into the facility, such as endoscope storage cabinets, make sure the staff can reach the hooks to hang the scopes since newer cabinets are taller and designed with the most recent guidelines for storage.
Documentation – Data needs to be reviewed on a regular basis. Collecting manual data is a task that can be impacted by human error or simply not completed in full. Regular reviews of this data will be crucial to a culture of endoscope safety and the staff will notice how often it is reviewed. Automated data also need to be reviewed and discussed with staff on a routine basis.
Manufacture Recommendations – Guidelines for reprocessing new endoscopes should be adhered to. There are reports of incidents when new scopes are acquired, existing practices are grand-fathered. A thorough review of manufacture cleaning instructions by two separate individuals if possible, can identify any variance or complete change of practice.
Trust Conservatism – Challenge manufacture guidelines if necessary. Due to their complex design, duodenoscopes have been long recognized to be difficult to clean and many staff members expressed concern. Manufacturer recommended high-level disinfection protocols for duodenoscopes were considered inadequate resulting in national attention and reports. Another area is in regards to drying endoscopes, just because a manufacture of a disinfectant deemphasizes the importance of drying between uses or prior to storage, best practice is to continue to do so.
Even the best state of the art reprocessing workspaces and practices can benefit from periodic review and modifications. Change is all around in healthcare and it is in everyone’s best interest to share out thoughts to improve patient safety today and in the future.