By Carol Stevens, BSN, RN, CGRN
Each year, more than 34 million gastrointestinal endoscopic procedures are performed.1 During these procedures, the flexible endoscopes that are used come in contact with mucous membranes in areas of the body that are not considered sterile.2 In the absence of defective equipment, every reported case of nosocomial infection associated with a contaminated GI endoscope has been linked to a specific breach or violation of at least one of several requisite reprocessing steps. To ensure patient safety, flexible endoscopes must undergo a thorough cleaning and high-level disinfection process between uses.
In many facilities, this process has meant a manual, time-consuming method. Endoscopes reprocessed appropriately—in accordance with reprocessing and infection-control guidelines—pose virtually no risk of transmitting patient-borne or environmental microorganisms.3 However, numerous studies of manual reprocessing indicate there is widespread difficulty in achieving recommended standards for manual cleaning, and great variability in the manual cleaning performed.
Challenges to Manual Cleaning
The first and most important step in removing microbial burden from an endoscope is manual cleaning. Failure to perform good manual cleaning can result in inadequate disinfection, and may be a significant contributor to challenges with the current standard of care.4-5, 9-13 Proper and consistent results require invariable adherence to a complex protocol.
Flexible endoscope reprocessing has been shown to have a narrow margin of safety. In fact, any slight deviation from the recommended reprocessing protocol can lead to the survival of microorganisms and an increased risk of infection.14 Although adherence to infection-control protocol is required to maintain a safe environment,6 data show that manual cleaning practices vary from one facility to another. In fact, one survey found that only 43 percent of centers were compliant with national guidelines.15
Another factor that creates challenges in the manual reprocessing of endoscopes is the effect it may have on healthcare workers. For example, the physical demands required by manual cleaning can result in repetitive strain injuries.16 Additionally, the need to handle a high volume of endoscopes with quick turnaround to avoid procedural delays can place significant stress on staff, 17 increasing the potential for human error.