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The Accreditation Association for Ambulatory Health Care (AAAHC) has released a new toolkit to help eliminate failures or lapses in flexible endoscope reprocessing through detailed guidelines and thorough checklists. The resource is designed to help healthcare organizations review and assess flexible endoscope reprocessing policies and procedures to mitigate risk of associated patient infection.
Flexible endoscopes are used in early detection of diseases such as colorectal cancer – which is the second leading cause of cancer death in men and third in women. Flexible endoscope interventions, such as colonoscopies, enable providers to remove adenomas, thus reducing morbidity and mortality, in a cost-effective way. In 2017, the ECRI Institute, an international nonprofit applied medical research organization, named inadequate cleaning of complex, reusable instruments – such as endoscopes – as one of the top 10 “technology hazards” in healthcare.
“Over the last several decades, we have seen an increase in the number of failures or lapses in flexible endoscope reprocessing as well as patient infections reported,” said Naomi Kuznets, PhD, vice president and senior director of the AAAHC Institute. “The costs of these failures include patient morbidity, mortality, pain and suffering, and decreased productivity, as well as legal, testing and treatment costs.”
To address this problem, national medical specialty societies and governmental agencies have developed and refined recommendations and clinical practice guidelines, including updates in 2016 and 2017.
In 2010, 4 million endoscopies of the large intestine and 2.2 million endoscopies of the small intestine were performed in an ambulatory setting. Almost half of these were estimated to take place in ambulatory surgery centers, underscoring how critical this patient safety issue is to ambulatory providers. [iii]
The AAAHC toolkit outlines a flexible endoscope reprocessing program that helps organizations comply with AAAHC standards on infection control and prevention for ambulatory providers as well as recommendations from other national organizations such as the American Society of Gastrointestinal Endoscopy, American College of Gastroenterology and Centers for Disease Control and Prevention. The toolkit guidelines are broken down into three steps:
1. Risk assess your existing flexible endoscope reprocessing program
• Use the provided checklist of elements required for a compliant reprocessing program, and alert a designated infection prevention and control staff member if any deficiencies are discovered so immediate action can be taken to eliminate the cause of the failure and prevent future occurrences.
• The reprocessing program should include policies on staffing training and competency training, requirements for physical environment, protocols for spill containment and breaches, and thorough and consistent documentation.
2. Develop a training plan to address deficiencies
• Follow the flowchart of reprocessing program components when training staff to ensure compliance.
• The training plan should include pre-cleaning, disassembling and leak testing, manual cleaning and visual inspection, disinfection, processing of accessories and proper storage.
3. Observe endoscope reprocessing routinely to ensure compliance
• Confirm all steps in the process are being followed by regularly observing the cleaning and disinfecting of endoscopes, and communicating any changes to the process to all staff.
• Provide opportunities for staff to make suggestions for improvements in the processes that may reduce the risk of patient infection and increase staff satisfaction.
The AAAHC toolkit also provides a checklist for documentation of flexible endoscope reprocessing policy, outlining steps for high-level disinfection testing, disposal and replacement, as well as maintenance and repair of equipment.
The Flexible GI Endoscope Reprocessing Toolkit is available for purchase at http://www.aaahc.org/en/institute for $10. For more information on flexible endoscope reprocessing, other AAAHC resources or ASC accreditation, visit www.aaahc.org/.