SPECIAL REPORT
Visually inspect internal channels with a bore- scope and inspect externally with lighted mag- nification. Of course, if any of these verification tests indi-
cate an issue, thoroughly reprocess that scope and test again. he overarching goal through these very difficult times as always - is ensuring safe patient care, as well as safe and effective management of resources staff, endoscopes, equipment, and supplies. HPN
CLOSING CONSIDERATIONS
Flexible endoscopes and storage • NOTE: Flexible endoscopes that are sterilized and remain in their sterile packaging require only that the packaging remains protected and intact.
• Review/ensure that complete processing - including internal and external drying - occurred before storage. Consider use of residual moisture detection methods and/or borescopic inspection. If any doubt re: level of processing/drying that occurred - consider re-processing.
• Leave flexible endoscopes post-HLD in protected storage (i.e. endoscope storage cabinets).
• Ensure storage cabinet doors are shut and HEPA filter fans are function- ing.
• Ensure security of storage – while limited or no staff are onsite. • Multidisciplinary determination re: affect on institution’s “hang time” requirements - versus reprocessing endoscopes when re-open (see re-opening considerations). This needs to be factored in before unit actually reopens (to allow for adequate time).
Endoscopy procedure areas • Multidisciplinary determination and/or established institutional pro- tocols re: cleaning requirements for endoscopy tower and procedure spaces.
• Catalog supplies repurposed to other clinical areas.
Endoscope processing equipment • Prepare AER for long-term storage as described in AER manufacturer IFU. This may require running a disinfection cycle.
• Automated flushing pumps and attachments will require disinfection cycle – follow pump manufacturer IFU.
• Chemistries may need to be completely discharged/emptied from AERs - follow AER manufacturer IFU.
• Cycle off any/all automated equipment - as per equipment manufactur- ers’ IFUs.
• Cycle off any/all lighted magnifiers. • Cycle off any/all computers.
Processing areas • Surface disinfection for all work surfaces. • Multidisciplinary determination re: reprocessing versus disposal for reus- able cleaning brushes before reopening (see re-opening considerations).
• Catalog supplies repurposed to other clinical areas. • Manual disinfectant soak bins emptied, cleaned, and disinfected.
Processing chemistries (detergents and disinfectants) • Multidisciplinary determination re: disposition for partially-used deter- gent containers.
• Ensure stored inventory for all chemistries meets local fire/safety requirements.
Documentation/Data • Secure any/all processing documentation (electronic and/or paper).
Below are some key questions and considerations for risk assessment and implementation planning. Please note:
• This is not an all-inclusive or exhaustive list for every setting.
• Frequent references to “multidisciplinary determina- tion” reflect both the variances between institutions’ practices, as well as the uncertainty regarding the shutdown length.
IN ADVANCE OF RE-OPENING
Flexible endoscopes and storage • Multidisciplinary determination re: re-processing flexible endoscopes before clinical use - taking into consideration institutional “hang time” policy.
• Disinfect storage cabinets - per established institutional protocol. • Ensure storage cabinet HEPA filters have been replaced as per IFU.
Endoscopy procedure areas • Focused disinfection for endoscopy tower and procedure spaces - to include reusable transport containers.
• Re-processing for any reusable endoscope buttons and valves left in procedure area.
• Evaluate/ensure adequate inventory/PAR for supplies. • Review expiration dates for disposable precleaning supplies.
Endoscope processing equipment • Multidisciplinary determination re: plumbing lines feeding AERs and de- contam. sink lanes - whether needs to be disinfected after lying unused (“dead legs”). Consult with Infection Prevention and Facilities.
• Filters and pre-filters will need to be changed – for any/all applicable equipment - as per applicable IFU and institutional policy. NOTE: Filters may require changing sooner than normal due to plumbing sitting idle.
• Follow AER manufacturer IFUs for how to take out of long-term storage - may require disinfection after extended downtime.
• Multidisciplinary determination re: whether to perform microbial surveil- lance on rinse water in AER. Consult AER IFU and Infection Prevention.
• Perform standard QC for manual and automated leak testers - before first use.
• Perform standard QC and disinfection cycle for automated flushing pumps and attachments - follow pump manufacturer IFU.
Processing areas • Multidisciplinary determination and institutional protocols assessment re: cleaning requirements for processing areas before re-opening.
• Surface disinfection for all work surfaces. • Multidisciplinary determination re: reprocessing reusable cleaning brushes before first use.
• Evaluate/ensure adequate inventory/PAR for supplies. • Check expiration dates on all cleaning supplies. • Check expiration date of cycle test strips - for manual and automated processes.
• Disinfection for all reusable transport containers.
Processing chemistries (detergents and disinfectants) • Check expiration dates on all chemistries. • Evaluate adequate inventory/PAR for chemistries.
Documentation/Data • Ensure processing documentation processes are reinstituted as per protocol.
hpnonline.com • HEALTHCARE PURCHASING NEWS • May 2020 41
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