Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.
Issue link: http://outpatientsurgery.uberflip.com/i/124399
H I G H - L E V E L D I S I N F E C T I O N inject 10ml of sterile, de-ionized water would then be cycled through the auto- through the channel, followed by a flush- mated endoscope reprocessor. In the ing of air. The water is then collected in a event of a failed test, we were prepared clean plastic bag secured at the distal tip. to run the scope through the AER, then from customers that its use in high con- Finally, a specially manufactured test strip send it back to the manufacturer for centrations made the removal of residue is dipped in the water. The test from the endoscope and water container strips are designed to identify difficult, even with strict adherence to the the presence of 3 residual manufacturer's reprocessing instructions. organic soils that often remain the speaker's advice. The letter their ELBOW GREASE The friction of manual cleaning is an all-important first step in the high-level disinfection of flexible endoscopes. research department sent me made no such prohibition regarding the use of simethicone. They'd received reports Because failing to remove this residue during the manual cleaning stage of reprocessing could adversely impact the end result, they recommended that those who used simethicone during endoscopy use the lowest practical concentration. Despite the mixed signals from the industry expert and the scope manufacturer, finding out whether our scopes had been thoroughly cleaned was important to our center because patient safety always comes first and we're very strict about the rules of proper reprocessing. We have to be confident in our practices and know we're doing things correctly. I wanted proof from a process, whether we were in the wrong or in the right. So I decided to run a quality improvement study to find out. 5 5 Collecting the data Once I'd planned the project, I presented it at a staff meeting. It wasn't complicated. When our physicians used simethicone in a scope, we'd check the water channel for residue after our routine manual cleaning. Not all of our endoscopists use simethicone in their cases, not all of those who do use it in every case, and all of them have varying case volumes. So we'd rely on the procedure room staff to let us know when the compound had been used, and a cleaning room tech would tag the scope to make sure it got checked. We have 3 techs working in the cleaning room, so it wasn't difficult to maintain a uniform process. The simethicone scopes would be manually cleaned, like every other scope, before we'd run the channel check test. A proper channel check involves using a syringe to SUPPLEMENT TO O U T PAT I E N T S U R G E R Y M A G A Z I N E | M AY 2013 in the lumens of surgical instruments after use: protein, hemoglobin and carbohydrates. (According to their manufacturer, the strips can help you determine how well you clean your instruments, "but are not a substitute for vigilance in observation of the state of surgical instruments.") In about 90 seconds, they deliver their results. After each channel check test, our techs would record the date, the pass-or-fail results, the scope number, doctor's name, the procedure it was used in and their initials in a logbook. The scope M AY 2013 | S U P P L E M E N T TO O U T PAT I E N T S U R G E R Y M A G A Z I N E 5 6