One of the country’s most­ respected medical product testing laboratories has placed endoscope and surgical device reprocessing among the top health technology hazards facing hospitals and patients today.

In the ECRI Institute’s report “2015 Top 10 Health Technology Hazards”, inadequate endoscope reprocessing ranks as the 4th most hazardous medical technology issue, behind only alarm hazards, data integrity, and IV line mixups. The hazards were selected by industry professionals weighing the following factors:

  • Severity ­ What is the likelihood that serious injury or death could result?
  • Breadth ­ If the hazard occurs, what is the likelihood that it may spread to affect more people?
  • Frequency ­ How often does it occur?
  • Insidiousness ­ How difficult is the problem to recognize? Can the problem lead to more errors before it is identified?
  • Profile ­ Is the problem likely to receive significant publicity?
  • Preventability ­ Can actions be taken now to prevent or minimize the risk?
    As evidenced by recent outbreaks of CRE bacteria, endoscope reprocessing issues meet and exceed all of these criteria.

Why Is Improper Reprocessing of Endoscopes So Dangerous?

The institute found that while the incidence of improper reprocessing is likely low, the consequences of failures are extremely severe. When reprocessing is not preformed properly performed, deadly pathogens can be spread to subsequent patients leading to hospital­ acquired infections and larger outbreaks.

The study found that most commonly overlook or inconsistently performed step in reprocessing is the initial cleaning of devices and instruments. This step is critical, as organic matter or other contaminants and bacteria that are not removed may make sterilization impossible.

Endoscopes ­duodenoscopes included ­ were found to be particularly challenging due to the narrow and difficult to reach channels in the devices. On endoscopes particularly, debris that is left in channels may dry to create impenetrable plaque or form a biofilm that can prevent germicidal agents from killing bacteria.

These devices also have very complex multi­step reprocessing protocols ­often specific and different from model to model ­ that must be followed exactly to ensure sterilization.

ECRI Endoscope Reprocessing Recommendations for Healthcare Providers

In their report, the ECRI Institute provided several recommendations for healthcare facilities to ensure that instruments and devices are properly and thoroughly sterilized

  • ­ Emphasize to staff and end users that devices must be cleaned before they can be sterilized
  •  Provide adequate space, resources and equipment for the reprocessing function
  • ­ Confirm that an appropriate reprocessing protocol is available and correct for all relevant instrument models including any loner devices that may be in use.
  • ­ Provide thorough training on cleaning and reprocessing and periodically repeat training to keep ensure staff is performing procedures properly.
  • ­ Monitor staff’s adherence to protocols and quality of instrument cleaning.
  • ­ Verify that protocols address and document all reprocessing steps
  • ­ Periodically review protocols to make sure that they are up to date and clear, accurate, and comprehensive.
  • ­ Establish mechanisms to ensure that procedures are routinely updated and all personal are notified of any change in reprocessing protocols.
  • ­ When purchasing new instruments and devices, seek input from reprocessing staff to ensure your facility has the time, equipment and resources to maintain proper reprocessing protocols for each new device.

You can download the rest of the report here.