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Infection Control Today - 08/2002: Success Story

New High-Level Disinfectant Reduces Equipment-Repair Costs

By Celine Vollmer, RN

Providing high-quality patient care while controlling costs is an ongoing challenge for healthcare facilities and requires hospital administrators to closely monitor expenses while focusing on quality of care, employee safety and productivity. This is especially true for large hospitals like Baptist Hospital East, one of the largest non-profit, acute-care healthcare facilities in Kentucky. Our 407-bed facility treats more than 177,000 inpatients and outpatients annually.

The endoscopy department at Baptist East performs approximately 1,000 minimally invasive procedures each month and must ensure the ready availability of flexible endoscopes. In this high-volume department, efficient and effective cleaning and disinfecting of endoscopes is a priority in order to provide high-quality patient care, ensure equipment integrity, and maintain the hospital's busy surgical schedule.

During the last 10 years, the department has used a variety of methods to process its endoscope inventory. Each method had its own set of problems, including a serious increase in equipment damage. Then, in early 2000, the department adopted OPA (0.55 percent ortho-phthalaldehyde solution), a new high-level disinfectant for fast, safe and effective instrument processing. After two years using OPA, several benefits were identified, including increased convenience, improved patient care and reduced repair costs.

Processing Methods Evaluated

In 1995, the department used a liquid high-level disinfectant containing glutaraldehyde to reprocess its large, 15-endoscope inventory. The glutaraldehyde disinfectant had a high level of materials compatibility and was inexpensive to purchase on a per-gallon basis. However, in practice the glutaraldehyde disinfectant was costly to use. Due to the high volume of endoscopes processed, the glutaraldehyde disinfectant rarely maintained its minimum effective concentration (MEC) for a full 14 days, requiring the department to purchase and use more of the solution, thus increasing costs.

In addition, the glutaraldehyde disinfectant had several safety and handling requirements. The risk of exposure associated with the glutaraldehyde disinfectant motivated the department to consider alternative instrument processing technologies. After evaluating its needs and researching several different processing methods, the department converted to a peracetic acid sterilization system.

Peracetic acid systems sterilize surgical and diagnostic instruments and devices, including endoscopes, through an automatic process that the department felt would alleviate the safety and handling concerns associated with glutaraldehyde. And, while the new system addressed those specific concerns, it created separate but equally serious problems. The most serious problem experienced during the three years the peracetic acid system was in use was a significant increase in equipment damage and repair costs.

An investigation conducted by the department into the cause of the damage confirmed that the source was the peracetic acid system. Although the peracetic acid contained erosion and degradation inhibitors, resins that supported the endoscope lenses were compromised, and moisture infiltrated the inner components, thus damaging the equipment. The department spent more than $160,000 on endoscope repairs in 1999, an increase of $20,000 compared with glutaraldehyde. In addition to the increase in repair bills, the large number of endoscopes sent for repair affected the department's ability to keep up with a demanding endoscopic surgery schedule. In some instances, damaged endoscopes were discovered immediately before a procedure, causing delays until another, undamaged endoscope was available.

Once more, the department was forced to evaluate its instrument processing practices. With limited choices for flexible endoscope reprocessing, and despite handling and cost concerns, the department decided to return to glutaraldehyde -- the only alternative available at the time.

A New High-Level Disinfectant

In November 1999, CIDEX OPA Solution received U.S. Food and Drug Administration (FDA) approval for marketing. OPA is glutaraldehyde-free, almost without odor and compatible with a wide range of endoscopes and other medical devices. It has a 12-minute processing time at room temperature (20 degrees C), and allows high-volume patient care areas, to avoid surgical delays. The rapid throughput of endoscopes and medical instruments decreases capital costs by reducing the number of additional endoscopes a facility must purchase.

Implementing OPA

The introduction of OPA to the U.S. marketplace provided Baptist East with a solution to the problems associated with its instrument processing methods. In early 2000, with the support of hospital physicians and administrators, the endoscopy department at Baptist East began the acquisition process for OPA and developed a standard protocol for instrument processing with this new high-level disinfectant. Although instruments can be manually processed using OPA, the department purchased automatic endoscope reprocessors for use with the new solution to enhance efficiency.

In March 2000, the department's conversion to OPA was complete. The transition was problem free, and the new high-level disinfectant proved to be extremely user friendly. The absence of noxious fumes and low level of toxicity, compared with glutaraldehyde and peracetic acid, dramatically improved staff comfort, satisfaction and safety, stemming in part from the low concentration (0.55 percent) of active ingredient.

Cost Savings

Since switching to OPA, Baptist East's endoscopy department has experienced a significant reduction in costs for equipment repair and replacement. After one year using OPA, the department recorded a 77 percent decrease in repair costs -- saving the hospital more than $120,000. In addition, because damage to expensive flexible endoscopes was rare and utilization increased due to OPA's 12-minute processing time, surgical procedures were seldom delayed or postponed -- further reducing costs and benefiting physicians and patients. Finally, additional cost savings were achieved due to the efficacy of OPA. Unlike glutaraldehyde, OPA maintains its MEC with heavy use for a full 14 days.

Celine Vollmer, RN, is nurse manager of the endoscopy department at Baptist Hospital East Hospital in Louisville, Ky.

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