Becker's ASC Review

73 Executive Briefing: GI reprocessing in ASCs Sponsored by A mbulatory surgery centers are considered high-quality sites of care, and many centers with gastroenterology conduct their own endoscope reprocessing. They have small staffs with checks-and-balances to make sure everyone does their job correctly. But in reality, people become distracted or have memory lapses and crucial steps in endoscope reprocess- ing are easily overlooked. More recalls than ever are reported in the peer review journals now due to issues with endoscope reprocessing. There were 30,000 patient recalls due to reprocessing lapses from 2005 to 2012, according to recent literature, and that's unacceptable. The lapses might be due to missed steps, distraction or other issues at the ASC, and if the scopes aren't cleaned they won't be disin- fected properly. In 2008, a Centers for Medicare and Medicaid Services inves- tigation of 68 ASCs where nearly half performed endoscopy yielded unfortunate results: 39 facilities had infection control deficiencies warranting citation and 19 facilities failed to prop- erly reprocess instruments. An observational study that was published in Gastroenterology Nursing in 2010 found only 48 percent of the 183 endoscopes were properly processed. Non- adherence hit 99 percent when the centers used manual meth- ods to clean endoscopes. Unclean endoscopes have several negative implications. First and foremost, patients may experience infections or serious inju- ry. Those complications require additional treatment, hospital ad- missions and extra resources to correct a preventable issue. One of the most common complications from inappropriate endoscope reprocessing is Pseudomonas, which can have a huge economic impact on treatment. Another potential complication is Clostridium difficile, costing around $9,000 to $11,000 on average. Major lapses and errors in endoscopy reprocessing include: • Noncompliance with internal and manufacturer guidelines • Skipped steps in the process • Improperly executing some or all steps • Contamination between endoscopes • Blocked channels • Using expired chemicals • Improper endoscope storage • Patient exposure to damaged and/or contaminated colono- scope An article published in a 2013 issue of the American Journal of Infection Control examines these issues in the literature as well as popular media and other reporting outlets. "Improper endoscope reprocessing is an ongoing and pervasive problem that has the potential to cause significant patient harm," the article authors concluded. However, the best minds in the industry have not let this issue go unnoticed. New technology and equipment — such as the EN- DORA™ Endoscope Tracking System — is being developed and released to help providers appropriately reprocess endoscopes and ensure their scopes are clean before reuse using advanced automated technology. "Because of the increasing volume of procedures and complex- ity of endoscope design and reprocessing, utilizing a system that provides reliable reprocessing management is critical to patient safety," said Don Byrne, president of Medivators Endoscopy Busi- ness Group. The ENDORA Endoscope Tracking System verifies that each re- processing step is completed on time and in the correct order therefore preventing a contaminated endoscope from being used on a patient. "ENDORA has actually saved us a couple of times by verifying the process that the endoscope went through in preparation for the patient and prevented us from missing steps in our reprocessing workflow," said Cheri Borgstede, OR business manager at Sing- ing River Health System. "It's a safety net and a reminder to the staff to follow all protocol at all times." Here are five ways endoscope reprocessing can put ASCs at risk and how to prevent these lapses: 1. Forgetting steps during reprocessing. Missing any step in endoscope reprocessing not only impacts the single endoscope, but the entire reprocessed batch due to contamination. It's ex- tremely important staff members are focused only on endoscope cleaning during that time and double-check their work before tak- ing the next step. ASCs with endoscope reprocessing are required to have protocol following the manufacturer's instructions as well as any other best practices from healthcare organizations and certification bodies. These guidelines are in place to protect the patient from harm and ASC from liability in the future. "I thought we were doing a great job with our scopes and pro- cesses until we implemented the tracking system," said Ms. Borg- stede. "ENDORA really has impacted the care of our patients and the life of our scopes." 5 Big Endoscope Reprocessing Risks in ASCs: How to Avoid Them By Laura Dyrda

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