Who Develops Endoscope Reprocessing Standards?

The field of endoscope reprocessing is experiencing ongoing changes as the healthcare industry strives to reduce infectious outbreaks associated with improper cleaning procedures. Best practices for GI scope reprocessing continue to evolve, driven by new research and technological advancements. These guidelines, which cover the entire reprocessing workflow, are regularly updated to incorporate the latest findings. The goal is to equip healthcare facilities with the most effective methods for ensuring patient safety and minimizing infection risks related to endoscope use.

Several key organizations have contributed to developing comprehensive guidelines for GI scope reprocessing. These influential stakeholders include:

• Healthcare Infection Control Practices Advisory Committee (HICPAC)
• American Society for Gastrointestinal Endoscopy (ASGE)
• Society of Gastroenterology Nurses and Associates (SGNA)
• Association for Professionals in Infection Control and Epidemiology (APIC)
• European Society of Gastrointestinal Endoscopy (ESGE)
• Association for the Advancement of Medical Instrumentation (AAMI)
• Association of Perioperative Registered Nurses (AORN)

Though each organization may have its own nuanced approach, there is a consensus on core principles for effective GI scope reprocessing. These shared fundamentals include:

1. Comprehensive staff training programs
2. Implementing rigorous high-level disinfection (HLD) protocols
3. Ensuring thorough air drying of scopes post-cleaning
4. Strict adherence to manufacturer-specific guidelines for endoscope storage

Despite variations in specific recommendations, these key elements form the foundation of best practices across the industry, reflecting a unified commitment to patient safety and infection prevention.

Whose Guidelines Should We Follow?

The ASGE Quality Assurance in Endoscopy Committee encourages endoscopy units to take a comprehensive approach. They recommend that facilities examine guidelines from various sources and collaborate with regulatory authorities to ensure the implementation of standards that are most suitable for their specific operational context and requirements.

How Adherence to SGNA Scope Cleaning Guidelines Impacts Safety of Patients and Staff?

Endoscopes, with their small lumens used for investigating the gastrointestinal tract, are prone to accumulating body fluids and tissue. The reprocessing of these instruments involves a complex, hands-on procedure that can expose staff to infectious organisms and chemical cleaners at various stages.

To mitigate these risks, proper reprocessing protocols must mandate the use of appropriate personal protective equipment (PPE) during all phases of endoscope cleaning. Additionally, these guidelines emphasize strict adherence to each reprocessing step to safeguard both staff and patients.

The SGNA has developed a detailed set of endoscope reprocessing steps, each playing a vital role in preventing the spread of infections. Strict adherence to these protocols is crucial for patient safety, as any lapse in following the outlined procedures could potentially expose patients to infection risks. Examining these steps provides insight into their collective importance in maintaining a safe environment for endoscopic procedures.

What Steps Are Involved in Endoscope Reprocessing?

• Pre-cleaning: This initial step involves pre-rinsing and wiping in the procedure room to wash off body fluids and tissues clinging to the scope. It prevents the early formation of biofilm—a sticky bacterial substance that’s challenging to remove.
• Leak Testing: This step identifies damaged scopes that should be removed from use. Undetected scratches or nicks make these areas harder to clean and can harbor microorganisms, increasing infection risk for the next patient.
• Manual Cleaning: Performed immediately after leak testing, this involves washing, brushing, and flushing all endoscope surfaces with a detergent solution as per the manufacturer’s instructions for use (IFU). Inadequate cleaning can leave microorganisms behind.
• Rinsing Before Visual Inspection: Reduces the number of organisms on the scope, minimizing the risk that detergent presence will obscure areas of concern.
• Visual Inspection: Utilizes magnification and possibly cameras under good lighting to identify organic matter or damaged areas. Both can potentially retain pathogens.

These steps are critical before the endoscope undergoes HLD. SGNA emphasizes that rigorous cleaning before HLD is essential to minimize retained pathogens.

• High-Level Disinfection (HLD): Whether done manually or using an automated endoscope reprocessor (AER), HLD is the standard for GI scope reprocessing. Using incorrect detergents, temperatures, or timings can damage scope parts or result in ineffective reprocessing.
• Second Rinse: After HLD, this step removes detergents and alcohol, protecting patients from chemical exposure.
• Drying: Crucial for preventing infections, as retained moisture may allow remaining bacteria to proliferate and develop into biofilm.
• Storage: Once dry, scopes should be stored in a clean, dry environment. While specific guidelines for storage cabinets are not established, some organizations prefer cabinets with clean or HEPA-filtered air under pressure.

The SGNA recommends storing processed scopes for up to 7 days, following the manufacturer’s Instructions for Use (IFU) and industry guidelines. They also advise facilities to implement a tracking system for endoscopes, allowing tracing of scopes to specific patients, procedures, and reprocessing technicians to quickly identify potential infection sources if needed. Implementing such a system is crucial for maintaining the highest standards of patient safety and regulatory compliance.

Scope tracking is a critical component of the endoscope cleaning process, ensuring patient safety and regulatory compliance. ScopeCycle®, NewCura’s comprehensive solution, seamlessly integrates this crucial step into your workflow. By meticulously documenting each scope’s journey through reprocessing, ScopeCycle® enhances traceability, supports adherence to stringent guidelines, and ultimately improves patient safety. Elevate your practice’s efficiency and safety standards with NewCura’s ScopeCycle®. Contact us today to learn how ScopeCycle® can transform your endoscope management process.