Endoscopy has revolutionized the field of medicine, allowing for minimally invasive procedures and accurate diagnosis. However, the proper reprocessing of endoscopes is critical to ensure patient safety and prevent healthcare-associated infections (HAI).
What are the essential steps involved in endoscope reprocessing?
Are there any challenges to face in this crucial process?
Let’s shed light to the endoscope reprocessing process and answer these questions together.
Step 1: Use on patients
An endoscope is a flexible tube with a light and camera attached to it, sending real-time high-definition videos of the patient’s inner body on a color TV monitor in the clinic/hospital.
They can be used in nonsurgical procedures, by inserting the scope through the patient’s mouth or via his/her bottom.
Endoscopes are increasingly used in place of traditional surgical procedures as they are less invasive, less time consuming, and less painful.
These instruments operate inside the body, so they need to undergo a careful reprocessing process before using them again on the next patient.
Step 2: Bedside cleaning
After its use on the patient, an endoscope starts its reprocessing process.
The first step in endoscope reprocessing is bedside cleaning. This involves removing gross contaminants, such as blood, tissue, and other debris, from the endoscope’s surfaces and internal channels. Bedside cleaning starts immediately after the endoscope is used. It is important to emphasize that bedside cleaning is not sufficient for high-level disinfection or sterilization, but it is a crucial initial step to facilitate effective subsequent cleaning.
Step 3: Leakage Testing
After bedside treatment, endoscopes shall be safely transported to the reprocessing room where they undergo a leakage test to identify any potential damage or defect. Leakage testing necessarily needs to be performed prior to manual cleaning and it ensures that the endoscope is intact and that no fluids can leak into areas that are difficult to access during subsequent cleaning and disinfection steps.
The test must be performed meticulously to detect even the smallest leaks that may compromise the correct endoscope functioning as well as the following disinfection process. Failure to identify and address leaks can result in serious endoscopes damages and in their ineffective disinfection, posing a risk to patients.
Step 4: Manual Cleaning
Manual cleaning is a critical step that involves thorough cleaning of the endoscope’s external surfaces, channels, and accessories. This is typically performed using single-shot detergents, single-use brushes, and flushing devices to remove all organic and inorganic residues, including biofilm, that might remain after pre-cleaning. Detergent solutions applied for manual cleaning should not be reused. Due to their complex design and narrow channels, endoscopes are intricate instruments that are challenging to clean manually. The presence of crevices, joints, and delicate components requires meticulous attention to detail. Inadequate cleaning can leave behind residual contaminants, leading to cross-contamination and potentially compromising patient safety.
One of the primary challenges during manual cleaning is time constraints. Healthcare professionals must perform this step promptly to prevent biofilm formation, which can harbor harmful microorganisms. However, the rush to complete the pre-cleaning process may lead to incomplete removal of contaminants, potentially compromising patient safety.
Bedside cleaning and manual cleaning steps are the most important steps in endoscope reprocessing: it is indeed impossible to effectively disinfect or even sterilize an inadequately cleaned instrument. Our device supporting the manual cleaning process and performing the leakage testing procedure automatically, EPW 100 S, is equipped with a user-friendly HMI. It allows a no-touch instrument and operator identification through an integrated barcode reader or RFID system.
EPW 100 S can be equipped with an integrated printer and it can communicate with SteelcoData tracking software to enable full traceability of the process.
After the brushing phase, it guarantees an automatic washing, rinsing, and purging phase of every single channel, thus safeguarding operators’ health and eliminating the risk of strain-injuries.
Step 5: High-level Disinfection or Sterilization
After manual cleaning, which can be supported by automatic devices like EPW 100 S, endoscopes must undergo high-level disinfection in AERs (Automatic Endoscope Reprocessors) or sterilization, depending on the specific procedure and guidelines. High-level disinfection inactivates a broad spectrum of microorganisms, while terminal sterilization ensures the complete elimination of all microorganisms, including bacterial spores, and can only be maintained when instruments are protected in sterile barrier systems (SBS).
Steelco AERs can also perform liquid chemical sterilization processes, which ensure higher results in comparison to simple high level disinfection cycles, even without granting sterility over time due to the absence of an SBS. This is the preferred choice when having to treat particularly critical endoscopes.
Compatibility between the endoscope and the disinfection/sterilization process must be ensured, and type tests must be carried out by every endoscope washer manufacturer to verify the efficacy of the chosen method.
The requirements set forth in the ISO 15883-4, indeed, consider all endoscope washers as closed systems that should only work with the set of chemistry that has been fully type tested and validated by the AER manufacturer.
Failure to select the correct method or properly validate the process can result in endoscope damages and ineffective disinfection, thus compromising patient safety.
To support operators in endoscope reprocessing processes, our EW series of automated endoscope reprocessors best ensure efficiency, infection control, and cost-effective operations thanks to dedicated workflow solutions, full integration with our SteelcoData Ares traceability software, not to mention RFID no-touch processes and the unique OCS – One-Time Connection System technology, which allows to speed up the reprocessing steps and at the same time reduce the risk of errors and cross-contamination.
Step 6: Drying and Storage
The final step involves thorough drying and proper storage of the disinfected endoscope. Effective drying is crucial to prevent the growth of moisture-loving microorganisms, and appropriate storage prevents recontamination before the next use. Our selection of drying and storage cabinets allows the drying and storage of flexible endoscopes, protecting reprocessed endoscopes from the risk of contamination by maintaining their microbiological integrity up to 840 hours.
In conclusion, overcoming challenges such as time constraints, complex designs, and compatibility issues is crucial for safe and effective endoscope reprocessing. Ongoing research, improved technology, education, and adherence to guidelines are essential to ensure patient safety and maintain the integrity of healthcare facilities.