OR Manager - September 2019 - 15

Patient safety
Bronchoscopes
Continued from page 13
that had been used over the weekend.
They never knew where or when they
had been used, or whether they were
precleaned.
For the most part, Ofstead notes,
bronchoscopes were being reprocessed
by nurses, medical assistants, respiratory
therapists, and anesthesia personnel
who did not have adequate reprocessing
training or competency testing.
Many of these clinical personnel did
not reprocess bronchoscopes frequently
and found it challenging to remember
the steps each time.
The turnaround time for bronchoscopes
reprocessed in central sterile or
the endoscopy unit was 41 minutes at
the fastest site and almost 2 hours at
another site when HLD was used.
" By cutting corners, they could get
the reprocessing down to about 40 minutes,
but it became clear to us that at
least an hour and a half was needed to
do everything properly, " she says.
Costs
The other key takeaway from the
study, Ofstead says, was that inventory
management drove the cost, and
the cost of acquiring, maintaining, and
reprocessing reusable bronchoscopes
was higher than they thought it would
be, at $280 to $800 per procedure
(sidebar above).
This was driven by the fact that these
facilities had many more bronchoscopes
than they needed for the number of procedures
they were doing. Most of the
bronchoscopes were used less than
once a week. One site was only using
each bronchoscope 16 times a year.
" This is very expensive, " Ofstead
says, " considering they pay $30,000
to buy a bronchoscope and several
thousand dollars a year for maintenance,
and they don't use it. "
This made the single-use bronchoscopes
look more appealing at $220
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to $315 per bronchoscope, particularly
if the sites have low procedural volume
and staff are using them for a lot
of after-hour procedures.
Another finding of the cost study was
that when bronchoscopes were sterilized,
the reprocessing turnaround time
was 46 minutes longer than with HLD,
which required 41 to 109 minutes.
Sterilization also requires machines
that are more expensive than AERs,
plus additional supplies, such as sterilization
trays, wraps, dust covers,
sterilant, and chemical and biological
indicators.
Recommendations for future
best practices
" It seems clear, " Ofstead says, " that
more than any other type of endoscope,
we need to do something to improve
personnel competence, inventory
management, reprocessing effectiveness,
and storage of bronchoscopes. "
Ofstead recommends having a
couple of complex reusable bronchoscopes
needed by pulmonologists for
advanced procedures, and using single-use
bronchoscopes for the rest of
the procedures whenever possible,
particularly when they're done after
hours or in remote units that may not
be able to ensure timely reprocessing.
She strongly recommends that if a
facility decides on reusable bronchoscopes,
they should be reprocessed
and inspected by central sterile and
not clinical personnel.
And finally, Ofstead recommends
having experts perform periodic audits
and provide consultation to ensure
that regulations and standards are followed.
✥
-Judith M. Mathias, MA, RN
References
Mathias J. Dirty scopes persist despite
cleaning protocol compliance. OR
Manager. 2016;32(11):1, 10-11.
Mathias J. Greater vigilance needed to
combat ureteroscope contamination.
OR Manager. 2017;33(12):1, 8-11.
Continued on page 16
OR Manager | September 2019 15
Total cost per use for reusable bronchoscopes

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OR Manager - September 2019

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