Ensuring the efficacy of endoscopes is paramount in preventing healthcare-associated infections. This process involves rigorous testing to verify that cleaning and disinfection protocols effectively eliminate contaminants. Key aspects of this testing include verifying cleaning procedures, detecting residual proteins or microbes and evaluating the effectiveness of drying and storage practices. Through meticulous assessment, healthcare facilities can safeguard patient health and uphold the highest standards of hygiene. Not knowing which guidelines or standards to follow can lead to inefficiencies, confusion or missed steps.
The Association for the Advancement of Medical Instrumentation 91 (AAMI ST91) is a comprehensive standard for the reprocessing of flexible and semi-rigid endoscopes in healthcare facilities. AAMI ST91 accentuates the critical importance of quality assurance and verification in the reprocessing of endoscopes. This standard requires healthcare facilities to implement strong programs that ensure the efficacy of both mechanical and manual cleaning steps. Significant components of these programs include verification tests, particularly for high-risk endoscopes, and regular monitoring of reprocessing procedures.
AAMI ST91 Compared to Other Guidelines
Let’s explore AAMI ST91 versus the Society of Gastroenterology Nurses and Associates (SGNA). AAMI ST91 provides detailed guidelines on every step of the reprocessing procedure, including precleaning, leak testing, manual cleaning, rinsing, visual inspection, high-level disinfection, drying and storage. SGNA standards also cover these steps but may not be as detailed in certain areas. ST91 emphasizes verification tests and regular monitoring of reprocessing procedures, particularly for high-risk endoscopes. SGNA standards also recommend verification but may not mandate it as strictly.
Next, let’s compare and contrast AAMI ST91 with standards from the Association of Perioperative Registered Nurses (AORN). AAMI ST91 places significant emphasis on high-risk endoscopes, such as duodenoscopes, bronchoscopes and ureteroscopes, requiring stringent cleaning and verification procedures. AORN guidelines also address high-risk endoscopes but may have different recommendations for specific procedures. AAMI ST91 recommends using lighted magnification and borescopes for visual inspection, which is a more specific requirement than AORN guidelines.
Now let’s take a look at AAMI ST91 versus the Centers for Disease Control and Prevention (CDC). AAMI ST91 and CDC guidelines stress the importance of comprehensive quality-assurance programs. However, AAMI ST91 provides more detailed instructions on the implementation and verification of these programs. AAMI ST91 mandates competency training for personnel involved in endoscope reprocessing, aligning closely with CDC guidelines that also emphasize training but may not specify the same level of detail.
AAMI ST91 is renowned for its detailed and specific guidelines, particularly in the areas of verification and monitoring processes. Its emphasis on high-risk endoscopes and the use of advanced inspection tools, such as borescopes, distinguishes it from other standards. Overall, AAMI ST91 is recognized for its thorough approach to ensuring the efficacy of endoscope reprocessing, making it a critical standard for healthcare facilities aiming to prevent healthcare-associated infections.
Visual inspection is an essential step in reprocessing flexible endoscopes, ensuring these complex instruments are thoroughly cleaned and safe for patient use. This process involves examining the endoscope and its accessories for any residual debris, damage or defects that could compromise the effectiveness of subsequent cleaning and disinfection steps. Identifying issues such as leaks or retained debris early on helps prevent cross contamination and reduces the risk of healthcare-associated infections. Additionally, visual inspections can uncover wear and tear or other damage that might necessitate repairs, thereby extending the lifespan of the endoscope and maintaining its functionality.
By incorporating routine visual inspections into the reprocessing protocol, healthcare facilities can uphold high standards of hygiene and patient safety. The use of lighted magnification and borescopes significantly enhances visual inspections, allowing for detailed examination in areas that are challenging to see with the naked eye. There are even borescopes on the market such as Watchdog AI with an artificial intelligence program to aid in the detection of defects and soil inside the endoscopes.
Various innovative products have been developed to enhance the cleaning process. For instance, the revolutionary UltraZonic ENDO semi-automated pre-cleaning machine excels in removing contaminants from flexible endoscopes. This advanced technology performs leak testing, pre-cleaning, first flush, brushing, final flushing and rinsing for multiple endoscopes simultaneously. A Belgium-based, high-tech R&D and manufacturing company specializing in infection-control technologies, UltraZonic has established a global distribution network, making its innovative solutions accessible worldwide.
Take a Little Time
A potential misstep—but an important one—is to leak test the endoscopes after each use. Leak testing flexible endoscopes identifies the endoscopes’ waterproof integrity to ensure patient safety. This process detects damage to the external surfaces and internal channels that could lead to fluid invasion during procedures. If fluids penetrate the endoscope, it can compromise the device’s functionality and lead to cross contamination, presenting significant infection risks to patients.
Furthermore, leak testing helps prevent costly repairs by identifying potential issues early, thereby extending the lifespan of the endoscope. By regularly performing leak tests, healthcare facilities can ensure that their endoscopes remain in optimal condition, safeguarding both equipment and patient health.
Another example that supports cleaning efficacy is the novel double-headed disposable brush, which has shown superior cleaning performance compared to conventional brushes, particularly in reducing bacterial presence in endoscope channels. This brush is especially important for complex endoscopes, such as duodenoscopes and bronchoscopes, which have intricate channels and lumens that are challenging to clean thoroughly. The double-headed design allows for more effective scrubbing and removal of biofilms and residual debris, ensuring that these high-risk endoscopes are properly sanitized and safe for patient use. Given the complexity of these devices, using advanced cleaning tools like the double-headed brush supports high standards of cleaning and infection prevention.
Using high-quality detergents made for cleaning endoscopes is essential in healthcare settings to ensure the thorough cleaning and disinfection of medical instruments, including flexible endoscopes. Medivators’ cleaning solutions, for example, are specifically formulated to effectively eliminate biofilms, which are often resistant to standard detergents. Biofilms can harbor harmful pathogens, making them a significant risk factor for healthcare-associated infections. High-quality detergents are designed to break down these resilient biofilms, ensuring that endoscopes are properly sanitized.
Moreover, these detergents can remove tough organic residues, such as blood and bodily fluids, which can contain infectious agents. The use of advanced cleaning solutions helps maintain the integrity of the endoscopes while ensuring they are free from contaminants. This is particularly important for complex endoscopes like duodenoscopes and bronchoscopes that are known to have cleaning challenges. By using high-quality detergents, healthcare facilities can adhere to stringent infection-control standards, minimize the risk of cross contamination, and safeguard patient health. Choosing the right detergent makes a stark difference in cleaning capability.
Once the endoscope is manually cleaned, verifying the cleanliness of the inside channel of an endoscope should be performed. Protein residue testing—via Scope-Check, ChannelCheck and EndoCheck—plays a vital role in this process by detecting residual proteins on the endoscope surface and within its channels. These tests help confirm that the cleaning procedures have effectively removed the organic matter that can harbor harmful pathogens.
Microbial testing, including microbial cultures and bioburden tests, assesses the effectiveness of disinfection and sterilization by checking for the presence of microbes after processing. These tests are excellent ways to verify that the endoscope is free from microbial contamination, ensuring it is safe for patients. Utilizing these verification tests enables healthcare facilities to ensure rigorous cleanliness standards, minimize infection risks and enhance patient safety.
Dry-testing flexible endoscopes after processing verifies that all channels are thoroughly dried, as residual moisture can create an environment conducive to microbial growth. Studies have demonstrated that methods such as alcohol flushes and hanging endoscopes in cabinets may not adequately dry channels. Even with compressed-air drying, some channels can remain moist, posing a risk of contamination. Effective drying is essential to prevent the proliferation of waterborne pathogens and environmental contaminants, which can compromise patient safety. Implementing rigorous dry-testing protocols provides an optimal way to ensure flexible endoscopes are completely dry after processing.
Adhering to best practices in endoscope cleaning efficacy is essential for ensuring patient safety and preventing healthcare-associated infections. Implementing rigorous cleaning, verification and monitoring protocols allows healthcare facilities to effectively eliminate contaminants and reduce the risk of cross contamination. Advanced tools and techniques, such as lighted magnification, borescopes and high-quality detergents, enhance the thoroughness of the cleaning process. Regular competency training for personnel and adherence to standards like AAMI ST91 help ensure that reprocessing procedures are consistently performed to the highest standards. Following these best practices is the optimal way to safeguard patient health and maintain the integrity of medical devices.
