Understanding every step of endoscope reprocessing – and meticulously following and documenting those steps – are critical to overcoming the equipment-related and human factors that can lead to poor compliance.

That’s especially true as hospitals and infection control specialists emphasize strict adherence to manufacturers’ reprocessing guidelines – and yet reports persist of biological contamination of bronchoscopes, colonoscopes, gastroscopes and cystoscopes.

That challenge was underscored with the discovery of mobile colistin resistance (mcr-1) transmission by a duodenoscope despite “no identifiable breaches in reprocessing or infection control practices,” according to Nancy Schlossberg, a nurse and program director of John Muir Health in Walnut Creek, California, who presented at the 2019 Society of Gastroenterology Nurses and Associates (SGNA) Annual Course.

“By meticulously following [and documenting] all steps in processing an endoscope, its components and accessories, you dramatically improve patient safety,” Schlossberg said, according to this report. “Remember, you never know when you will be on the other end of that scope.”

We’ve written before about how flexible endoscopes are notoriously difficult to clean and disinfect, given their long narrow channels and delicate nature. Manufacturers offer varying guidelines for cleaning, disinfecting and reprocessing scopes, and industry guidelines for reprocessing endoscopes include more than 100 steps. The process can take more than two hours to complete.

Schlossberg emphasized that the pre-cleaning process needs to start at the point of use in the procedure room, and it’s especially important that nurses and technicians follow the manufacturer’s instructions for use (IFU) for each endoscope model. In fact, the key phrase to remember when it comes to reprocessing is “follow the manufacturer’s IFU,” Schlossberg said.

That means undertaking pre-cleaning, leak testing and manual cleaning in the specific timeframes outlined in the scope’s IFU. That helps reduce harmful buildup of organic materials that can blunt the effectiveness of high-level disinfection and sterilization. And to prevent human error, all technicians should be certified and follow the proper protocols for hand hygiene and protective equipment.

Click here for a deeper dive into Schlossberg’s recommendations.

Evidence-based guidelines from SGNA, AORN, the FDA, the CDC and the American National Standards Institute/AAMI, among others, should be closely tracked. Keep an eye out for updates when new alerts are issued.

For the first time in almost a decade, the ECRI Institute, in its annual ranking of the top health technology hazards, shifted its focus from the threat posed by improperly cleaning endoscopes to the risk of recontamination due to the improper handling of an endoscope after it has been cleaned.

Mishandling flexible endoscopes after disinfection, leading to patient infections, came in at No. 5 on the list.