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5%.
Many facilities also rely on automated washers, whether they're integrated into
automated endoscope reprocessors (AERs) or ultrasonic washers designed for
lumened instruments. For the vast majority of these washers, you can purchase
additional attachments that connect to lumened devices and force water and
detergent through their channels. Though the purchase of the attachments is an
added cost, it's well worth the expense. Without these attachments, there's no
guarantee that cleaning fluid is being flushed through lumened devices with
enough pressure to hit all of the internal surfaces. Some techs place the devices
in various positions within automated washers to force fluid through the chan-
nels, but that practice isn't nearly as effective as purchasing the attachments that
are designed specifically to flush channels properly.
4. Verify complete cleaning
Though cleaning verification is becoming more common, it remains the single
biggest missed opportunity in proper instrument reprocessing. If your techs are
cleaning dozens of lumened instruments each day, consider investing in a
borescope that can look inside channels for missed debris. A borescope can cost
several thousand dollars, and busy processing departments often need more than
one to keep up with the heavy volume, but the scope easily pays for itself if it pre-
vents just a single infection. In addition to a borescope, you should also consider
keeping lighted magnification devices on hand that techs can use to inspect
instruments after cleaning.
For a more precise look at your cleaning processes, use chemical cleaning veri-
fication tests to routinely check for traces of missed bioburden. These tests fea-
ture indicators that are pulled through the lumen to test for the presence of resid-
ual soil. They come in different formats and are available for nearly all lumened
instruments, including endoscopes. Some of the most common tests measure
levels of protein, hemoglobin or adenosine triphosphate (ATP). Keep in mind
