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The expert way to properly disinfect your GI scopes

Hospital Safety Insider, October 22, 2015

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In July, HCPro sponsored a 90-minute webinar, "Proper GI Scope Disinfection: How to Avoid Becoming a Statistic," that attempted to explain the complicated procedures and proper storage of the scopes and generated lots of questions from our participants. For more information, or to order the webinar on demand, visit the HCPro Marketplace.

Peggy Prinz Luebbert, MS, CIC, CHSP, CBSPD, has been an infection and prevention and healthcare safety professional for over 25 years. She is currently the infection preventionist at Nebraska Orthopedic Hospital and is owner of Healthcare Interventions, Inc. Terry Micheels, MSN, RN, CIC, is in charge of infection control at Methodist and Women's Hospitals in Omaha, Nebraska, and has worked in the field of infection control for 20 years.

 Q: How do you manage a scope that is brought into a patient's room and then not used?

 PPL: At that point, the contamination would be considered on the outside of the scope. Before you would place the scope back into its storage unit, it would be appropriate to wipe down the outside of the scope with a product that is approved by the manufacturer, and then it can be put back into circulation.

TM: You might have a couple different scopes in the room. Those scopes should be transported in a closed container with a lid to protect them from contamination. So in the event that that secondary scope that wasn't used was maintained in a clean environment within a scope storage case or a bin or a plastic bag, again, you could, just like Peg said, return it by wiping down the exterior portion and rehanging that.

 Q: How should I store the duodenal scopes if we are using ethylene oxide (ETO) to sterilize them?

TM: In the ANSI 2015 guidelines, the ST91 really addresses that very well. They outlined scope storage, whether it's considered high-level disinfected or if it's sterilized by ETO. Now the recommendations in the AAMI/ANSI guideline is that you would store that according to your sterility packaging. But I will tell you one of the challenges we found, because when you ETO-sterilize those scopes, they are coiled. Then the process for us takes about 18 hours by the time from beginning to end. So it sits coiled during that time in the package. Over time, if you leave it in that coiled state, the scope will create a memory, and you'll get curves in your scope. Those scopes have to be straight for safe use within your endoscopy suite and patient care, also to hang those scopes. They can't be touching.

To have a safe scope for a procedure, high-level disinfection is the minimum safety that you have to achieve. We will take those sterilized scopes out of the package and return them to the scope-storage cabinet. It's a HEPA-ventilated cabinet with closed doors to keep it clean. We don't get that memory, that curvature in the scope, and we get that straight, vertical, hanging scope.

Q: Have you heard that when utilizing ETO as part of the sterilization process of the scopes, that after a number of times they are sterilized in the ETO that the scopes begin to break down and/or weaken?

TM: That's the risk. But at our facility, I just challenged our endoscopy suite, both our service executive and our team leader and our staff, when we went back and looked at our risk assessment in July and really looked at whether we really are doing the right thing. At that time, we discussed that they were cleaning, they were high-level, and then they ETO. I said, "Would you consider high-level and not ETO if we validate cleanliness, or would you consider validating cleanliness and just ETO-ing?"

And their answer to me was no, they want to do it all. They thought if they eliminated that step, then they were concerned that the cleaning wouldn't get all of the debris out, and then we'd run the risk of having dirty channels over time.

You are right, they will begin to break down sooner and/or weaken. That is a concern of ours, and it's a cost. There is no right or wrong answer. You have to go back with your team and decide what's better for your facility.

Q: Is storing a scope in a cabinet versus hanging in an open area safer?

TM: Well, any scope that is high-level disinfected, you have to protect from recontamination. You have to ensure that you're in a dedicated clean room and that you protect that scope from recontamination. I would have to go back personally and go through the ANSI/AAMI guidelines to see if they specifically talk about a scope cabinet that is closed versus an open-area shelter or a cabinet that's not enclosed. The guidelines are very specific

This is an excerpt from the monthly hospital safety resource Briefings on Hospital Safety. Subscribers can read the rest of the article here. Non-subscribers can find out more about the journal, its benefits, and how to subscribe by clicking here.

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