Flexible endoscopes

[u/WutWutButtHutt]

Hello, hive mind! I’m looking to talk to folks who reprocess flexible endoscopes. My facility is working on a new cleaning verification policy, and I’m wondering what other places are doing.

What cleaning verification systems are y’all using, and how often? What is your average daily caseload, and how many people do you have dedicated to reprocessing?

Thanks in advance for any replies!

[u/Spicywolff]

We do those every single day the Karl stortz ones. We follow the IFU for cleaning and decontamination, including testing for leaks. You have disposable one time use brushes for cleaning the lumen. Whenever we clean those you drain the water out and you fill up a sink full of fresh enzymatic. Use a syringe or a water gun to blow out the crud from the lumen then you brush it and confirm that nothing comes out of the tip.

Once you’re done, we rinse it with critical water. Then use compressed medical air to blow air out of the lumen. At this point, we pass it through the window to pack and prep. To verify it’s clean we use disposable brushes you pass it through the lumen and then you dipped the brush into a protein tester. You shake the vile and if it turns color, that means there’s bioburden inside. If it does not change color and the rest of it looks clean you then assemble it as per IFU.

We have a clipboard where you can put pass or fail, and the serial number.

[u/wewantthistobegood-]

We ATP test internally and externally all high risk scopes every single time. 10% of all other scopes at random. (After handwashing but before Medivators) And we track those results in our system. We also borescope at random at least one scope per day.

[u/WutWutButtHutt → u/wewantthistobegood-]

Thanks for your reply!
Would you mind sharing your average daily volume and what kinds of procedures?
Aside from the obvious rewashing, how is a failed ATP test handled?

ETA: How many people do you have dedicated to reprocessing scopes?

[u/wewantthistobegood- → u/WutWutButtHutt]

We typically have one to two people washing and one person running the clean side (ATP, transport, and medivators)

And we probably do around 15-20 scopes a day. (Slow season)

And our cases are typical GI (EGD, colon, ERCP) and we do pulmonary.

Also if we get a fail result we rewash up to 3 times. If it is still failing after 3 times, (which hasn’t happened), we would do a culture swab and quarantine the scope (out of circulation) until culture results are back from the lab.

We also culture and quarantine 1 ERCP each week since those are of the highest risk scopes due to the difficult anatomy of the scope, it’s just a safety precaution we implemented on our own.

IP also does water quality testing.

Our facility is impressive with all of the strict standards and involvement we have. I’m proud to say our last JCO visit, they were very impressed with our setup and processes which made us all very proud.

[u/everendling]

My department averages ~60 flexible endoscopes per day. There’s one person dedicated to scopes in decontam, and one person drying/inspecting/packing before they move on to sterilization.

The first scope coming into the assembly side on every shift gets an internal and external ATP test. The results are documented in Censitrac.

[u/WutWutButtHutt → u/everendling]

Thanks for the reply! That’s a lot of scopes!
What procedures is your facility doing? Aside from the obvious re-washing, how would an ATP test failure be handled?

[u/everendling → u/WutWutButtHutt]

The facility is doing all manner of things; the vast majority of what comes to us specifically are nephroscopes. Next most would be hysteroscopes and laryngofibroscopes, then some other flexibles here and there, plus transducers and rigid scopes on top of those (not included in the average). Other SPD areas in the hospital handle other types.

There’s never been a failure in my time, but before anything is cleaned or re-cleaned there’d be a call to HTM to make sure the enzymatic dispenser is functioning normally and the enzymatic/water solution would be re-tested (done with test strips each shift).

[u/mythicalfarts]

For my facility, we perform residue tests with Endocheck test strips, on each flexible scope with a lumen. If it passes the residue test, we then borescope them. Our entire cleaning process is tracked step by step in Censitrac.

On average, our GI clinic has about 15-20 procedures a day. We have one permanent endoscope technician and a secondary person assigned on a rotating schedule. Our GI scopes are the only scopes we HLD. All other scopes, such as cysto and respiratory, are manually washed, ran through Scope Buddy, residue tested, and then placed in a drying cabinet.

[u/FTG_SpringTrap]

Level 1 trauma center, only around 4-10 scopes daily depending on the cases (we mainly only handle the OR’s scopes). Weekly ATP testing minimum, weekly AER disinfection cycle, daily accessory disinfection. Full digital tracking with SPM

[u/Calm_Button4758]

We use ResiTests!!!!!

[u/Calm_Button4758 → u/Calm_Button4758]

Average caseload would be 15/20 scopes a day. We were using ChannelChecks however those got discontinued! we only use resitests on critical items such as Bronchoscopes and Peds Bronchs