and valves. Damaged channels may impede microbial exposure to
high-level disinfection.
• Process. With as many as 150 manual steps — and fail points
along the way — how many steps will your tech complete … and
complete correctly? Leak test, disassemble scope completely, brush
all endoscope channels and components, immerse scope and com-
ponents in detergent. Flush endoscope with detergent, rinse endo-
scope with water, purge endoscope with air, load and complete auto-
mated cycle for high-level disinfection, flush endoscope with alcohol,
use forced air to dry endoscope and wipe down external surfaces
before hanging to dry.
The margin of safety with endoscope reprocessing is said to be so
small that perfection is required. Perfection? That's a bet not worth
making and a risk not worth taking — not when we know that the use
of a contaminated endoscope may lead to patient-to-patient transmis-
sion of pathogens with a subsequent risk of infection.
"If the margin of safety is so small that perfection is required, then
the design is too complex and the process is too unforgiving to be
practical in a real-world setting," says noted epidemiologist William A.
Rutala, PhD, MPH, CIC, a research professor of medicine at the
University of North Carolina at Chapel Hill.
Revamped reprocessing
Sterilization is just one way we've overhauled our scope reprocessing
process in recent years. Here's what else we've done.
• Ergonomic equipment. We made a huge investment in ergonomic
equipment for our reprocessing techs, including height-adjustable
sinks, automated instrument flushers, instrumentation tables in the
clean room and easy-to-push case carts. In the 2½ years before I came
on board, our 25 central sterile employees suffered 50 work-related
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