In the real estate industry, the key to success is location, location, location. For thorough endoscope reprocessing, the key is pre-cleaning, pre-cleaning and ...... Pre-cleaning.
Pre-cleaning helps prevent the accumulation of potentially infectious bioburden and biofilm on the endoscope." Bioburden" is a mixture of blood, tissue, mucus, feces and other body materials left on the internal and external surfaces of the endoscope after surgery.
According to ANSI/AAMI ST79:2017, bioburden is defined as "viable microbial populations on products and/or sterile barrier systems" and it is measured as "the total count of bacterial and fungal colony-forming units (CFU) per item."
Biofilms are clumps of microorganisms and organic materials that adhere tightly to almost all moist solid surfaces, soft organic tissues, and liquid-air interfaces. Microorganisms form a structure protected by a polysaccharide "shield" that resists cleaning efforts.
Endoscope Cleaning Foam
Biofilms prevent thorough disinfection or sterilization and, if not removed, pose patient safety risks, such as toxic reactions and potential infection transmission.
The endoscope design makes these devices vulnerable to bioburden and biofilm development. The long, thin channels and tubes within the endoscope capture and retain bioburden and promote biofilm development.
Pre-cleaning inhibits the formation of bacterial biofilms, which can begin to form within minutes. This is why "bedside" pre-cleaning in the operating room is so important to ensure thorough reprocessing.
The following steps for pre-cleaning endoscopes are based on the recommendations of the Society of Gastroenterology Nurses (SGNA) and the International Association of Healthcare Central Service Materials Management (IAHCSMM).
Everyone involved in pre-cleaning should wear appropriate personal protective equipment (PPE).
Begin pre-cleaning immediately after the procedure. Wipe the insertion tube with a sponge moistened with enzyme detergent to remove as much soil as possible.
Endoscope Cleaning Foam
Aspirate the enzyme detergent through the access system of the speculum.
Clear the air and water channels and the lumen (light channel) according to the manufacturer's instructions for use (IFU). Use sterile water. Do not use salt water as it may cause corrosion.
Remove reusable removable parts, such as air/water valves, suction valves, and biopsy port covers, and soak them in a detergent solution. Whenever possible, use disposable valves to minimize patient risk so that manual cleaning and reprocessing of reusable valves is not required.
While the guidelines and manufacturer IFUs do not always agree on best practices for reprocessing, they all emphasize the importance of spot cleaning as the first step to successful reprocessing of flexible endoscopes.
The primary purpose of using spot cleaning (often referred to as "bedside cleaning") is to prepare the endoscope for transport and further reprocessing and to prevent biofilm formation. Biofilms are thin layers of microorganisms in an extracellular polymer matrix that adhere to the surface and resist common cleaning methods.
The general steps for point-of-use cleaning of flexible endoscopes include.
1. Wiping the exterior of the insertion tube with a clean, lint-free cloth using a freshly prepared detergent solution, or endoscope cleaning foam.
2. Aspirate the cleaning solution through the endoscope suction channel.
3. Flush the air, water and other passages with the detergent solution, followed by a final air flush.
4. Visually inspect the endoscope for damage.
5. Maintain a moist environment during transport of the soiled endoscope to the reprocessing area, which should be in a closed container clearly marked with the biohazard symbol.
Tech Talk Tip: Pretreatment foams and sprays can be used to maintain a moist environment and prevent organic debris from drying and hardening on the exterior and interior of the endoscope.
