Issue link: https://beckershealthcare.uberflip.com/i/653703
29 INFECTION PREVENTION & PATIENT SAFETY Special Focus on Sterile Processing & Reprocessing Checking in After an Outbreak: Q&A With Dr. Andrew Ross on How Virginia Mason Overhauled its Medical Scope Reprocessing Practices By Max Green D uodenoscopes are intricate, snakelike instruments used in more than 500,000 proce- dures each year in the U.S. e trouble is, they're made up of many tiny, moving parts and are difficult to properly clean and disinfect. is problem has garnered national attention aer outbreaks of an- tibiotic-resistant superbugs, which have affected at least 250 patients across 10 states and four countries between 2012 and 2015, were linked to the devices, according to a U.S. Senate health com- mittee report. One outbreak of a resistant form of E. coli, the spread of which was associated with duodenoscopes, occurred at Virginia Mason Medical Center in Seattle beginning in Novem- ber 2012. In the aftermath of that out- break, medical center clinicians took a hard look at the manufacturer-provid- ed guidelines for cleaning the scopes, and published research that suggests, oftentimes, those cleaning guidelines don't work. "e defect rate is about 1.9 per- cent," Andrew Ross, MD, section head of gastroenterology at Virginia Mason, says. "at's a big deal. What that tells us is that in a percentage of cases the guidelines as they have existed with the scopes … up until recently don't do what they're supposed to and what we've been told they were doing." In light of this realization, Virginia Mason expanded its scope-cleaning protocol to ensure the devices were bacteria-free before being used in pa- tient care. By March 2014, the medical center had fully implemented cleaning and disinfecting measures that in- cluded a strict culture and quarantine process in addition to the existing protocol, which entails a manual and an automated cleaning. "I think the most important part to recognize is by doing this we've extended the endoscope reprocessing procedure from an hour-long process to something that takes over two days," says Dr. Ross. Currently, when scopes fail Virginia Mason's high-level disinfection and cul- ture and quarantine process three times, they are considered defective and are decommissioned. Dr. Ross spoke with Becker's about Virginia Mason's culture and quarantine process, why standard guidelines for cleaning fall short and why hospitals are in a tough position when it comes to scope reprocessing. Question: How do you define high-level disinfection? Dr. Andrew Ross: I think there is a bit of confusion in the industry about what the reprocessing process is — in- cluding what the term "high-level disin- fection" really means. To me, high-level disinfection refers to the entire process of reprocessing an endoscope, and it's divided into two parts. The first is a manual clean where the scope is actually manually cleaned to get rid of all of the bioburden and proteinaceous debris that gets left inside of a scope after a procedure. The second component is the auto- mated endoscope reprocessor. When these scopes initially go through [the Food and Drug Administration] for a cleaning clearance, what they have to be able to prove is that you can actually manually reprocess the entire instru- ment. What the automated endoscope reprocessor does is cut out a signifi- cant number of the manual steps and automates them. at's the process as a whole and for all intents and purposes in the United States today high-level disinfection is really a manual clean followed by using the automated endoscope reproces- sor, then drying. ose are the typical guidelines that are put forth. e main difference in our scenario is that aer we go through that we add on the cul- "Why should we have to buy three endoscopes to make one work the way that it was sold to us?" — Dr. Andrew Ross