Endoscopy is on every Sterile Processing (SP) and Operating Room (OR) department’s mind as a priority to develop a continuous quality process. Those processes seem to be ever-changing for the endoscopy and SP technicians processing them, intending to increase the level of care given to the endoscopes during the reprocessing stages. Most of us have been directed to the manufacturer’s instructions for use (MIFU) for each type of scope. The endoscopy technician should have easy access to the MIFUs. Each should provide clear and detailed instructions on proper cleaning and disinfecting the endoscope.

AAMI provides the standard ST 91 ANSI/AAMI ST 91: 2021: Flexible and semi-rigid endoscope processing in healthcare facilities to help direct users and department leaders in the development stages to comply with standards. The objective of ST91 “is to provide comprehensive guidance to achieve best practice for each stage of processing flexible endoscopes as well for competency and education of staff... The updated standard provides new guidelines for precleaning, leak-testing, cleaning, packaging (where indicated), storage, high-level disinfecting, and/or sterilizing of flexible gastrointestinal (GI) endoscopes; flexible bronchoscopes; flexible ear, nose, and throat endoscopes; flexible surgical endoscopes (e.g., flexible ureteroscopes); and semi-rigid operative endoscopes (e.g., choledochoscopes) in health care facilities.” Your department can gain access to the standard here.

AORN recently released its newly revised “Guideline for Processing Flexible Endoscopes.” The Association of periOperative Registered Nurses (AORN) provides recommendations for the cleaning, disinfection, and sterilization of endoscopes in their "Guideline for Processing Flexible Endoscopes" and "Guideline for Cleaning, Disinfection, and Sterilization of Flexible Endoscopes.”

SP and the OR departments may already have the AORN guidelines. Still, they may not currently have access to the new recommendations that provide guidance for hand-over communication to decontamination personnel, borescope inspection, cleaning verification tests, and drying processed endoscopes. If not, both departments can access them via the following sites: "Guideline for Processing Flexible Endoscopes" and "Guideline for Cleaning, Disinfection, and Sterilization of Flexible Endoscopes."

AORN HandOver Process

AORN has redefined the handover processes regarding how the Operating Room/Endoscopy nurse communicates to the SP/processing area decontamination technician. The communication should be direct from one healthcare professional to another to make all aware of the time the point-of-use treatment was completed and if it needs additional cleaning. Overall, clear and concise communication is vital to ensure that the endoscopes are appropriately cleaned, disinfected, and sterilized before they are used again. This can help to minimize the risk of infection and ensure patient safety.

Additional resources from AAMI ST91 recommendations have provided a time limit for the time the endoscope should be transported after the initial point-of-use treatment. It also states tasks to perform when transporting to the decontamination area if the endoscope is not transported in the allotted time or if the point-of-use treatment was not performed. As we all know the importance of understanding why we do what we do, AAMI and AORN provide rationales for each recommendation or standard. The rationale provided for not performing point-of-use treatment for endoscopes is that it can lead to several risks, including the spread of infection and the contamination of the endoscope with microorganisms. Without proper treatment, the endoscope can become a source of infection for patients, potentially leading to serious illness or even death. Additionally, the endoscope may become damaged or rendered ineffective if it is not correctly cleaned and disinfected. This can result in costly repairs or replacements and lost time and productivity. Overall, not performing point-of-use treatment for endoscopes can have serious consequences for patients and healthcare facilities.

• Communication is key. Communicating point-of-use treatment to endoscopy technicians is essential in ensuring that the instruments are properly cleaned and sterilized before they are used on patients. The following are some key points to overall processing to consider when communicating this information:
• Provide clear instructions: The endoscopy technician should be given clear and detailed instructions on how to properly clean and disinfect the endoscope.
• Emphasize the importance of safety: The endoscopy technician should be reminded of the importance of maintaining a safe and sterile environment for patients and proper cleaning and disinfection to prevent infections.
• Address any concerns: The endoscopy technician should be encouraged to ask questions or raise concerns about the cleaning and disinfection process, and any issues should be addressed promptly.
• Provide ongoing training: The endoscopy technician should be provided with ongoing training and education on the latest techniques, protocols, and regulations for cleaning and disinfecting endoscopes.
• Monitor the process: The endoscopy technician should be monitored regularly to ensure that the cleaning and disinfection process is performed correctly and to make any necessary adjustments.
• Keep records: It is essential to keep records of the cleaning and disinfection process, including the date, time, and personnel involved, to ensure that the instruments are properly maintained and to facilitate quality control.

Borescope Inspection Recommendations

AORN recommends using a clean borescope to visually inspect accessible channels of flexible endoscopes before sterilization or HLD. Borescopes allow for visual inspection of internal channels and may identify damage or debris that would otherwise be undetected. 

It's important to note that endoscopic borescope inspection should be performed by trained and licensed healthcare professionals, following the appropriate guidelines and sterilization protocols to minimize the risk of infection and ensure patient safety.

Cleaning Verification Tests

AORN recommends using cleaning verification tests to verify the manual cleaning of flexible endoscopes before sterilization or HLD. Cleaning verification testing, such as with ATP, protein, carbohydrate, or hemoglobin, is recommended to provide an objective method for verifying cleanliness.

Cleaning verification for surgical instruments refers to the process of confirming that a surgical instrument has been properly cleaned and is free from contaminants. Verification is an essential step in the sterilization process, as it helps to ensure that the instruments are safe to use on patients and do not pose a risk of infection. It's important to note that the cleaning verification process should be performed by adequately trained personnel, following the appropriate guidelines and protocols to ensure that the instruments are safe for patient use.

Drying Processed Endoscopes

It's important to perform the drying process carefully and thoroughly to ensure no moisture is left inside the endoscope. This can lead to bacterial growth and increase the risk of infection. Again, education is key. The drying process should be performed by properly trained personnel, following the appropriate guidelines and protocols to ensure that the endoscope is safe for use on patients. 

The AORN recommendation is to dry all accessible channels of HLD-processed flexible endoscopes per the manufacturer’s IFU with pressure-regulated instrument air or HEPA-filtered air for a minimum of 10 minutes or until no visible moisture remains.

In Conclusion

As we audit our current processes at each touch point, AAMI and AORN provide clear guidance to help us all. Although ever-changing, these organizations help us keep our staff and patients safe. They have provided updates for proper cleaning, disinfection, and maintaining flexible endoscopes. These guidelines ensure that healthcare facilities can provide the highest level of patient safety by preventing the spread of infection and ensuring the proper functioning of these medical devices. Healthcare professionals need to stay informed and follow these updates to ensure compliance with infection control standards and best practices. Happy processing!

References:

Guideline for Processing Flexible Endoscopes: https://www.aorn.org/guidelines/guideline-for-processing-flexible-endoscopes

Guideline for Cleaning, Disinfection, and Sterilization of Flexible Endoscopes https://www.aorn.org/guidelines/guideline-for-clea...

ANSI/AAMI ST 91: 2021: Flexible and semi-rigid endoscope processing in health care facilities https://www.aami.org/st91