The bad? "We audit at least once a year," says one respondent. "This
is done on a quarterly basis, or sooner if needed," says another. "We
do weekly culture audits on our scopes," says a third.
In other words, says Ms. Ofstead, audits and inspections aren't being
done nearly often enough. Consider that protocols for sterile instru-
ments call for audits to be done with every cycle, for chemical indica-
tors to be put into every tray or peel pouch, or for biological indica-
tors to be used every day or with every load. If audits and verification
tests are done less often, can you really be sure that endoscope repro-
cessing is effective?
"They need to begin doing these quality checks now, and they
should be done every day," says Ms. Ofstead.
Moreover, if you perform thorough inspections, you should expect
to occasionally see problems with scopes that require re-cleaning,
repairs, and more frequent maintenance. But don't blame your repro-
cessing techs, says Ms. Ofstead. After all, scopes used for messy and
bloody procedures are tough to clean, and if they aren't immediately
pre-cleaned in the OR, residue becomes virtually impossible to
remove.
Critical point
A panel of stakeholders assembled this past fall by the Association for
the Advancement of Medical Instrumentation (AAMI) recommended
that endoscopes used for therapeutic and diagnostic purposes be
reclassified as critical, not semicritical. If that happens, high-level dis-
infection would no longer be considered adequate.
But the group, which included Ms. Ofstead — in addition to repre-
sentatives from healthcare organizations, manufacturers, testing labs,
research groups, academia, and government, among others —
acknowledged that such a transition would be challenging, and would
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