OR Manager - July 2018 - 8

Patient safety
Continued from page 7
that factors beyond reprocessing adherence
may affect outcomes.
" What is disturbing to me about our
findings is that these hospitals are part
of big systems that are Joint Commission
accredited, and they were asserting
that they were following guidelines, "
says Ofstead. " It reinforces for me the
value of doing real-world studies to see
what is actually happening in hospitals. "
At
all three sites, visual inspections
found endoscopes with multiple defects
were being used. Defects included
scratches, non-intact channel lining,
and damaged distal ends.
At one site, several endoscopes
were up to 15 years old, and the manufacturer
no longer provided maintenance.
At the other two sites, many endoscopes
were more than 3 years old,
and staff were hesitant to send them
out for repair because of cost concerns.
" Despite AORN, AAMI [Association
for the Advancement of Medical Instrumentation],
and SGNA [Society of Gastroenterology
Nurses and Associates]
all saying visual inspections with lighted
magnification should be done every
time a scope is used, visual inspections
are not being done, and we have only
been to one site that had magnification
stations, " Ofstead says. " These guidelines
are 2 years old now, and yet we
still aren't seeing them being followed. "
Sterilization vs HLD
In four endoscopes that were sterilized
at the site with reprocessing practices
that conformed to current guidelines,
ATP levels were low and no moisture or
microbial growth was found.
Though the sample size was too
small for statistical significance, rigorous
cleaning plus sterilization was more
successful than HLD.
" Sterilization may be the answer because
it is becoming clear to me that
so many scopes are used for surgery
8
OR Manager | July 2018
Fig 1. Retained fluid droplets found inside endoscope channels. (A) Gastroscope A-6;
(B) Colonoscope A-12; (C) Cystoscope A-4; (D) Gastroscope C-1; (E) Duodenoscope
C-10; and (F) EUS Radial Endoscope C-11.
Source. American Journal of Infection Control. Used with permission from the
Association for Professionals in Infection Control and Epidemiology [APIC].
so much of the time now that it is a
'no-brainer' that they should be sterile, "
says Ofstead.
The idea of HLD for endoscopes
came about in the 1960s when they
weren't being used for surgery, but it is
pretty rare to have a flexible endoscopy
without a biopsy today, and some gastroenterologists
are doing full-thickness
resections of tumors with gastroscopes
and colonoscopes, she says.
" More patients are having minimally
invasive procedures, and surgeons are
performing more complicated procedures
with endoscopes that are not
only not sterile, but they are not even
clean, " she says.
Single-use endoscopes such as bronchoscopes
and ureteroscopes might be
an alternative.
Lack of progress
The study underscores the lack of progress
by manufacturers, hospitals, and
regulators in reducing the infection risk
posed by endoscopes. " There has been
little improvement in the 10 years since
we have been looking into the quality
of endoscope reprocessing, " notes
Ofstead. " Some of the practices we
observed in this study seemed unbelievable,
and I am deeply troubled by this. "
Ofstead says she and her team have
alerted the Food and Drug Administration
and the Joint Commission about
their concerns regarding institutions
that have AERs with cycles that have
been disabled and drying cabinets with
HEPA-filter machinery that has been
turned off.
" To intentionally disable equipment
because the physicians were telling
them they needed faster
turnover
is
wrong, " she says, " and it should not
even be an option. "
Ofstead says it is only because she
and her team were in these hospitals
for a week that they noticed the endoscopes
were coming out of the AER
too fast because the cycles had been
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OR Manager - July 2018

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