OR Manager - September 2019 - 13

Patient safety
high levels of ATP, indicating that there
was organic soil in the bronchoscope
storage areas.
Inadequate staffing and reprocessing
increase chances of contamination.
One site had good reprocessing practices,
and it also had the lowest contamination
levels. Ofstead says this site
was among the best she and her team
have seen in the US.
However, even at this site, one step
was not consistently done well: bedside
precleaning. " This step was not consistently
done and not done using the
same supplies and method, and this
is something OR managers need to be
aware of, " Ofstead says.
The other steps that weren't done
well at the site with the best practices
were lighted magnification and borescope
inspections by central sterile personnel
and visual inspections by personnel
in the units where the bronchoscopes
were used.
" All you had to do was look at these
scopes, and you could see they were
torn up and should be sent out for repair, "
Ofstead says. " Even though all of
the guidelines say you are supposed to
be doing visual inspections every step
along the way, they are not being done. "
In the other two hospitals, the reprocessing
was " astonishingly bad, "
Ofstead says. " They didn't just skip one
or two steps, they did virtually nothing
in accordance with the guidelines or the
IFUs [instructions for use]. "
Quality standards were widely ignored,
which was even more troubling,
she says, because the perioperative
services managers were aware this
was happening.
The managers were aware of inadequate
staffing and inadequate reprocessing,
and at one site, the manager
knew the cleaning cycle on the AER had
been disabled to save time. " It may
have saved them 20 minutes, but it
cost them because they had highly contaminated
scopes, " she says.
Ofstead notes that this hospital has
taken action to fix its processes, but
she doubts this would have happened
www.ormanager.com
had her team not confronted its leaders
with their findings.
In a meeting with the hospital's executives,
Ofstead and her team recommended
that they shift to sterilization
of the bronchoscopes, retrain all personnel,
and only use single-use bronchoscopes
until they could turn their
program around.
They already had some single-use
bronchoscopes in their emergency department
(ED), and the pulmonologists
were open to using them, but they had
never used them in the ICU or OR before,
she says.
Cost study finds multiple
problems at smaller sites
To answer questions about costs for
single-use, HLD, and sterilization of
bronchoscopes, Ofstead and her team
conducted a cost study in four additional
smaller sites. They also wanted
to know if their findings in the three
large tertiary hospitals would be the
same in the four smaller sites.
The researchers sought to learn
when and where in these smaller hospitals
bronchoscopes were used, where
they were stored, and who was responsible
for reprocessing them as well as
the costs of personnel time and acquiring,
maintaining, and repairing bronchoscopes.
Ofstead
says one of the things they
learned was that bronchoscopes are
used 24/7 all over the hospital and
that the storage areas were dependent
on what unit the bronchoscopes were
being used in.
" I thought personnel went to central
sterile to get them, but that is not the
case. They generally keep at least a
couple of them in each unit, and one
hospital had them on every crash cart, "
she says. " It made sense, " she adds,
" but they were stored horizontally in a
bag, which was concerning. "
Ofstead and her team designed
some worksheets for the four new sites
on which staff had to list what brand
and model of bronchoscopes they had,
how many they had, and where they
were stored.
All four sites had trouble locating
their bronchoscopes. This was due in
part to one or two bronchoscopes being
kept in multiple departments, like the
ED, the OR, and the ICU for emergency
use, she says.
Bronchoscopes were frequently not
returned to the central sterile department
for reprocessing immediately
after procedures. When staff looked
for bronchoscopes, they found them on
carts or still in the procedure rooms,
having not been reprocessed for several
days.
One site reported having four bronchoscopes
in their endoscopy unit. A
month later they found a fifth one that
they did not know was stored in another
unit.
A few months after finding the fifth
bronchoscope, staff at
this hospital
found two more bronchoscopes in the
OR that were not on the central sterile
inventory. At that time, the infection
preventionists discovered that the bronchoscopes
were not being properly reprocessed
between uses.
" The key thing here is that the bronchoscopes
at these sites were used
all over the hospital, and they were not
being reprocessed by staff who were
trained and certified in endoscope reprocessing
or by central sterile personnel, "
Ofstead says.
In addition, central sterile personnel
told Ofstead that on Monday mornings,
they often found dirty bronchoscopes
Continued on page 15
OR Manager | September 2019 13
http://www.ormanager.com
OR Manager - September 2019

Table of Contents for the Digital Edition of OR Manager - September 2019
