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Step 2: Monitor the process and correct your techs' errors. While the
complex designs of some endoscopes can resist or limit thorough
disinfection and have played a part in cross-contamination incidents,
many more outbreak investigations have cited such basic missteps as
delaying, overlooking or truncating mandated reprocessing steps —
in short, human error — and these can easily contribute to biofilm
formation.
For example, in the wake of an outbreak of multi-drug-resistant
Pseudomonas aeruginosa infection associated with contamination of
bronchoscopes and an endoscope washer-disinfecter at a French
teaching hospital, a 2010 study found that the pre-washing or mechan-
ical cleaning stage may have been delayed, and that the scope hadn't
been adequately dried before it was reused. When you expect repro-
cessing to be delayed, it may be advisable to soak the scope in a man-
ufacturer-approved enzymatic detergent until you can clean and disin-
fect it. However, a lack of recommendations or guidelines on the
effects that extended soaking has on scope integrity or internal or
external bioburden suggests that the better approach is to make every
effort to complete endoscope reprocessing in a timely manner.
Another investigation highlighted an AER's inability to achieve ade-
quate flushing pressures, pointing to a need to manually flush scopes.
Many cracks to fall through
Ultimately, any number of errors can occur in a busy practice, each
with potentially deadly implications. A recent study analyzed endo-
scope-reprocessing lapses nationwide that had been published in
medical literature, the news media and governmental reports between
January 2005 and June 2012. The study listed incidents in which
reprocessors and other scope handlers:
• didn't comply with established, published guidelines,
I N F E C T I O N P R E V E N T I O N
