area. They've also updated disinfection instructions to require the use
of a special disposable brush designed specifically to clean the eleva-
tor channel. But the onus ultimately rests with reprocessing techs,
who must take time to meticulously brush the elevator mechanism, a
process that includes raising and lowering the mechanism to allow for
brushing of both sides.
After its outbreak, Virginia Mason took its reprocessing efforts a
step farther. The hospital now places every reprocessed duodeno-
scope in quarantine for 48 hours; only after culturing indicates no
harmful bacteria remain in the instruments can quarantined scopes be
used again.
The scope redesigns and new reprocessing directives have presum-
ably mitigated much of the cleaning problems that led to the out-
breaks. Infection preventionists and reprocessing techs have a better
understanding of the reprocessing process. On the other hand, the
complex design of duodenoscopes means some parts of the scope are
extremely difficult to assess and effective cleaning of all areas may
not be possible. In addition, national standards on scope reprocessing
vary on their guidance on how to deal with these challenges.
Problems associated with duodenoscopes aren't caused by the people
doing the cleaning; they're the result of the complex design of the
scopes, and that hasn't changed.
Why not sterilize?
Part of the positive that has come out of the CRE outbreaks is that facili-
ty leaders are much more involved in efforts to ensure flexible endo-
scopes, and especially high-risk duodenoscopes, are properly cleaned.
There's more of a willingness to adopt technologies for validating scope
cleaning that have not been used as aggressively as they could have
been in the past.
1 1 8 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • A P R I L 2 0 1 7
