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Hopefully, updated national guidelines will soon require facilities to
monitor the reprocessing of each endoscope to confirm proper manu-
al cleaning has been completed before high-level disinfection, and to
hold improperly cleaned scopes back from use until they're
reprocessed correctly.
Surgical instruments are typically steam sterilized, so there's robust-
ness to the entire process. The infection risks might be lower, but
biofilm buildup on instruments is even too much for steam sterilizers
to treat. Instrumentation used in orthopedic surgery — bone reamers
and complex instruments with several moving parts that can't be dis-
mantled — is particularly problematic to clean.
Automatic instrument washers help improve the efficacy of instru-
ment decontamination, but they don't take the place of expert manual
cleaning. The AAMI suggests you check the operation of automatic
washers weekly if not daily, although monitors designed for automat-
ed washers simply document that cleaning was done to instrument
manufacturers' directives, not necessarily that infection risks were
eliminated.
Is proper cleaning enough?
The impact of failing to remove biofilm from instruments and endo-
scopes on patient safety is clear, but here are a few real-life examples
to emphasize the stakes you're dealing with.
A recent Morbidity and Mortality Weekly Report (
tinyurl.com/pusk92q
)
published by the CDC on endoscopic retrograde cholangiopancreatogra-
phy documented the spread of a new New Delhi metallo-β-lactamase
strain in 9 patients in northeastern Illinois. Federal investigators discov-
ered that 8 of the patients were treated at the same hospital and
obtained cultures from the flexible endoscopes used on 5 of the patients
after the scopes were cleaned and high-level disinfected. NDM-produc-
C E N T R A L S T E R I L E
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