By Michelle Beaver
If only the process of scope cleaning were as easy as house cleaning: finding gumption and spare time on a Saturday. Sure, some house cleaning methods are easier than others (dusting vs. polishing, for instance) but the consequences of one choice over another are tiny. Say you forego sweeping and instead pick up clumps of dog hair and call it a day—the worst thing that will happen is a cross glance from your mother in law. Not so with scope cleaning, where the wrong methods, inattention to detail and incorrect information can lead to severe patient illness.
As most endoscopy technicians and technician managers know all too well, the consequences can be huge if scopes are not properly treated during the cleaning and/or decontamination and/or sterilization process. Multi-society guidelines on this topic are available for help, and they are indeed valuable resources. Conversational information from experts is too. For this reason, we've asked important questions of two leading endoscopy associations, the American Society for Gastrointestinal Endoscopy (ASGE), and the Society of Gastroenterology Nurses and Associates, Inc. (SGNA).
From ASGE we spoke with Bret T. Petersen, MD, FASGE, chairman of ASGE's Quality Assurance in Endoscopy Committee, and from SGNA we spoke with LeaRae Herron-Rice, MSM, BSN, RN, CGRN, SGNA board director, and administrative director at Indiana University Health-University Hospital. Their insightful responses are below.
ASGE's Bret T. Petersen
What are the biggest challenges to the scope cleaning/decontamination/sterilization process in the outpatient and inpatient settings?
In gastrointestinal endoscopy the standard for endoscope reprocessing is high-level disinfection (HLD). This standard is reliably met with conscientious performance of well-established reprocessing steps involving pre-cleaning at the bedside, cleaning, HLD employing appropriate contact times of well-established agents, rinsing, and drying. The HLD step is usually accomplished in automated endoscope reprocessing machines. The biggest challenge in this process is consistency in the repetition of all steps in a thorough sequential fashion. When this is done, experience suggests that the outcome is highly reliable and infection transmission does not occur.
Reprocessing is essentially the same in the inpatient setting. The major difference is performance of endoscopy in a variety of environments at widely varied hours of the day. Hence, the challenge of consistency of performance of all reprocessing steps is greater when procedures are performed after-hours in settings distant from the endoscopy suite, perhaps by personnel with varied concurrent demands and expectations.