Methods for Endoscope Reprocessing

Ensuring patient safety during cystocopy: risk assessment of device reprocessing through healthcare failure mode and effects analysis

INTRODUCTION

Flexible cystoscopy is a widely performed urological procedure, with millions conducted annually. However, cystoscope contamination rates are relatively high, ranging from 2 to 21%, and infections may go undetected. Proper reprocessing of cystoscopes is a critical step in ensuring the safe use of these devices, which underscores the importance of studying it more thoroughly. The aim of this article is to describe the stages of cystoscope reprocessing in the Urology Department of a tertiary Hospital, identifying the potential failures of the system before they occur, quantifying its risks and recommending improvement actions to enhance overall safety and efficiency.

MATERIAL AND METHODS

This qualitative study was conducted using the Failure Mode and Effects Analysis methodology in different phases. First, data on structure, equipment and work processes were collected through direct observation and staff interviews. Then, processes and sub-processes were described along with their possible failures and underlying causes. Risks of this potential failures (failure modes) were quantified using the Risk Priority Number (RPN), calculated as the product of their frequency, severity and detectability. Improvement actions to mitigate failures with the highest NRP were proposed based on expert consensus and literature review.

KEY FINDINGS AND LIMITATIONS

9 processes and 11 sub-processes were identified, along with 16 failure modes. The key failure modes, those with an RPN > 100 included incorrect manual high-level disinfection, incorrect cleaning due to lack of brushing and lack of traceability. These failures were primarily caused by insufficient staff training, short intervals between procedures, and inadequate infrastructure. To address these issues, expert recommendations included providing comprehensive training for staff, improving reprocessing infrastructure by optimizing room layout, and ensuring an adequate supply of cystoscopes to reduce time constraints. Additionally, prioritizing automatic high-level disinfection and implementing a traceability system were proposed to enhance process reliability and patient safety.

CONCLUSION

Inadequate organizational structure and equipment can compromise patient safety during high-care activities. After analyzing cystoscope reprocessing at our center, three critical failure modes (NPR > 100) were identified: lack of traceability, improper cleaning due to insufficient brushing, and improper manual high-level disinfection (HLD). To address these issues, we proposed actions including improve staff training, increase the cystoscope supply, and enhance the unit's infrastructure. These findings may guide other healthcare professionals in improving reprocessing safety.

Harmonized technical standard test methods for quality evaluation of medical fluorescence endoscopic imaging systems

Fluorescence endoscopy technology utilizes a light source of a specific wavelength to excite the fluorescence signals of biological tissues. This capability is extremely valuable for the early detection and precise diagnosis of pathological changes. Identifying a suitable experimental approach and metric for objectively and quantitatively assessing the imaging quality of fluorescence endoscopy is imperative to enhance the image evaluation criteria of fluorescence imaging technology. In this study, we propose a new set of standards for fluorescence endoscopy technology to evaluate the optical performance and image quality of fluorescence imaging objectively and quantitatively. This comprehensive set of standards encompasses fluorescence test models and imaging quality assessment protocols to ensure that the performance of fluorescence endoscopy systems meets the required standards. In addition, it aims to enhance the accuracy and uniformity of the results by standardizing testing procedures. The formulation of pivotal metrics and testing methodologies is anticipated to facilitate direct quantitative comparisons of the performance of fluorescence endoscopy devices. This advancement is expected to foster the harmonization of clinical and preclinical evaluations using fluorescence endoscopy imaging systems, thereby improving diagnostic precision and efficiency.

Point of Use Treatment for Medical Devices: From Bedside to Battlefield

INTRODUCTION

Point of use (POU) treatment is a critical first step of medical device reprocessing. Reusable instruments and flexible endoscopes require a minimum of terminal sterilization or high-level disinfection, neither of which can be guaranteed if POU is performed incorrectly. Compliance considerations for POU include hospital accreditation readiness, unique austere surgical mission requirements, and the transition of future conflict towards Large Scale Combat Operations. This integrative review aims to describe POU for reusable instruments and endoscopes, and extrapolate implications for Military Health System policies and future considerations.

MATERIALS AND METHODS

The authors performed an integrative review and comprehensive literature search in PubMed and CINAHL with the keywords "point of use," "point of use cleaning," "POU," "instrument," "high-level disinfection," "endoscope," and "clean." Articles were limited to "English" and "human" from 2017 to 2023. The authors also performed a thorough review of the Defense Health Agency and service-specific doctrine, as well as national guidelines regarding POU adherence.

RESULTS

The literature review yielded 18 articles that discussed the transport and reprocessing of reusable medical devices. Regulatory standards and national guidelines were used to supplement the literature. Seventeen evidence-based criteria were extrapolated from the literature to generate two step-by-step guides for the POU treatment of endoscopes and reusable instruments (Tables I and II). Despite increased morbidity and mortality rates linked to inadequate device reprocessing, compliance with POU procedures remains low. Barriers to practice included complex POU processes, intricately designed surgical instruments and endoscopes, lack of healthcare worker (HCW) knowledge and competency, and inadequate or ambiguously written policies. Training, competency assessments, and clearly written policies and procedures can be cost-effective, evidence-based, and feasible solutions.

CONCLUSION

Completing POU treatment is critical to a successful surgical mission in both the hospital and austere environment. Implications to practice include implementing evidence-based POU programs that improve patient outcomes and readiness while decreasing costs.

Evaluation of the prevention effect of high-quality nursing quality control in disinfection supply center on nosocomial infection

To explore the application effect of high-quality nursing quality control in disinfection supply center. The control group consisted of 1850 medical devices managed using the conventional quality control mode from January 2021 to December 2021, while the observation group consisted of 1900 medical devices managed using the high-quality nursing quality control mode from January 2022 to December 2022. The qualified rates of equipment cleaning, sterilization, and packaging were analyzed in both the observation and control groups. The occurrence of nosocomial infections in 2021 and 2022 were compared, and the changes in the Beck-Srivaatava stress scale index (BSSI) and Symptom Checklist-90 scores of the staff before and after implementing the high-quality nursing quality control mode were analyzed. The qualified rate of equipment cleaning, sterilization, and packaging in the observation group were 99.08%, 99.73%, and 99.78%, respectively, which were significantly higher than those in the control group (P < .05). The incidence of nosocomial infections in interventional and surgical cases in 2022 was 0.79%, which was significantly lower than that in 2021 (P < .05). The BSSI score of female staff was (68.76 ± 7.81) points, which was higher than that of male staff (P < .05). After the implementation of the high-quality nursing quality control mode, the BSSI score of the staff was (47.76 ± 9.12) points, which was significantly lower than that before implementation (P < .05). After the implementation of the high-quality nursing quality control mode, the staff's Symptom Checklist-90 scores for somatization, compulsion, interpersonal sensitivity, depression, hostility, and paranoia were (1.28 ± 0.29), (1.53 ± 0.24), (1.50 ± 0.21), (1.46 ± 0.32), (1.44 ± 0.26), and (1.38 ± 0.30) points, respectively, showing a decrease compared to before implementation (P < .05). The high-quality nursing quality control mode has great application value in the disinfection supply center. It can effectively improve the qualified rates of equipment cleaning, sterilization, and packaging, prevent nosocomial infections and improve the working pressure and psychological health of staff.

A Single-Blind Study Testing the Preparation Accuracy of Bedside Precleaning Solutions Used for Flexible Endoscopes

Endoscopy-related pathogen transmission may occur if microorganisms are spread from patient to patient by contaminated equipment. Effective and safe endoscope reprocessing includes bedside precleaning, mechanical cleaning, high-level disinfection, storage, and drying. The aim of this research study was to observe and report on the variation in practice regarding the use of detergent for bedside precleaning of flexible gastrointestinal endoscopes. Endoscopy nurses working in the endoscopy unit at the Princess Alexandra Hospital, Australia, prepared four samples of detergent solution as per normal routine. Twenty-nine nurses participated providing in total 116 samples. There was a significant variation in detergent concentration. The detergent concentration variated between 2.00 and 288.20 ml/L ( M = 34.55, SD = 39.21). Two samples revealed lower concentrations than required. More than 25% of the samples contained at least a 10 times higher concentration than required (>40 ml/L). Current practice of bedside precleaning of gastrointestinal endoscopes was not deemed safe or cost-effective as it did not guarantee an adequate concentration of detergent. More precise methods to establish the required concentration of the bedside precleaning solution were introduced to improve practice.

A narrative review on current duodenoscope reprocessing techniques and novel developments

Duodenoscopy-associated infections occur worldwide despite strict adherence to reprocessing standards. The exact scope of the problem remains unknown because a standardized sampling protocol and uniform sampling techniques are lacking. The currently available multi-society protocol for microbial culturing by the Centers for Disease Control and Prevention, the United States Food and Drug Administration (FDA) and the American Society for Microbiology, published in 2018 is too laborious for broad clinical implementation. A more practical sampling protocol would result in increased accessibility and widespread implementation. This will aid to reduce the prevalence of duodenoscope contamination. To reduce the risk of duodenoscopy-associated pathogen transmission the FDA advised four supplemental reprocessing measures. These measures include double high-level disinfection, microbiological culturing and quarantine, ethylene oxide gas sterilization and liquid chemical sterilization. When the supplemental measures were advised in 2015 data evaluating their efficacy were sparse. Over the past five years data regarding the supplemental measures have become available that place the efficacy of the supplemental measures into context. As expected the advised supplemental measures have resulted in increased costs and reprocessing time. Unfortunately, it has also become clear that the efficacy of the supplemental measures falls short and that duodenoscope contamination remains a problem. There is a lot of research into new reprocessing methods and technical applications trying to solve the problem of duodenoscope contamination. Several promising developments such as single-use duodenoscopes, electrolyzed acidic water, and vaporized hydrogen peroxide plasma are already applied in a clinical setting.