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By Stephanie Davis, MSHA, RN, CNOR, CSSM
In every operating room (OR) or procedural area, a patient deserves the peace of mind that the endoscopic instruments they are exposed to are free of any potentially infectious matter that can harm them.
In a perioperative nurse’s work to uphold this commitment to our patients, one thing is certain-we can’t do it alone. When perioperative nurses work with our partners in infection prevention (IP) and the sterile processing department (SPD), we see the value of collaboration.
Together we audit practices throughout the cycle of endoscope reprocessing and use this knowledge to shore up breaks in practice and refine workflows to support staff members on the frontline. We also share new evidence, discuss established best practices, and brainstorm creative ways to improve safe use of endoscopes.
While we have made great strides in shoring up endoscope reprocessing infection risks, we still have work to do. That’s why a focus on collaboration between the OR, IP and SPD is more important than ever.
In the fast-paced and often highly-complex course of providing surgical care, perioperative nurses talk about the value of harmony-when members of the surgical team plan ahead, communicate clearly, and work in concert for their patient’s best possible outcome.
One important voice advocating this type of collaborative harmony in endoscope management is Cori Ofstead, MSPH. Through her research and advocacy around endoscope safety, we have learned how a combination of visual inspections, biochemical markers, and microbial cultures1 can be applied to identify contamination in reprocessed scopes, so we can improve our practices to mitigate these risks.
She has been very vocal in stressing the importance of collaboration between the OR, IP and SPD, and others to ensure all staff involved in handling and reprocessing scopes are trained and competency tested.
We have learned from Ofstead that perioperative nurses play a critical role in ensuring that endoscopes are safe for use. In a recent conversation with Ofstead, she reiterated recommendations experts in endoscope reprocessing suggest, including practices AORN recommends, such as:
• Checking the chemical indicator strip to confirm sterility before each case involving a sterilized endoscope.
• Wearing gloves whenever handling endoscopes.
• Visually inspecting each endoscope before the procedure to confirm that it appears clean and free of defects.
• Ensuring that two ureteroscopes are available in the OR for ureteroscopy cases, as the manufacturers’ instructions for use require a second scope to be on hand due to frequent malfunctions during use.
• Initiating pre-cleaning at the point-of-care immediately after an endoscope is removed from the patient. This involves rinsing the scope with sterile water or detergent solution and wiping the external surface.
• Making sure there are no delays between procedural use and the initiation of reprocessing. Endoscopes should be manually cleaned within one hour of removal from the patient.
• Performing interim rinsing if two scopes are used for a case or one scope is used at the beginning of a long procedure and may be needed again. This commonly happens with bronchoscopes. If the scope sits in the OR, it should be rinsed with sterile water and wiped immediately after use and again as needed to prevent residue from drying on it.
• Sending the scope down for reprocessing and getting another scope if interim rinses are not feasible.
“It’s so important to collaborate with IP and reprocessing managers to conduct unannounced audits involving the OR, the reprocessing area, and any place endoscopes are used or stored,” she recommends.
The collaborative information-sharing that happens between well-coordinated OR, IP and SPD professionals also involves product evaluation to help us understand the true value in adopting a new endoscope product, such as endoscope sheathing. This value analysis is recommended2 to be conducted by a multidisciplinary team that includes clinicians, perioperative nurses, infection preventionists, and reprocessing personnel, as well as other stakeholders to weigh out the costs and benefits of adopting a new endoscope product into their specific care setting.
This work together in evaluating new products can also support a standardized understanding of manufacturer instructions for use. We know that instructions for use for related endoscope products can sometimes be contradictory and can create confusion among users. When this happens, Ofstead says collaboration is a valuable mechanism to “assess risk and determine the best way forward before drafting new policies for the local circumstances.”
She also believes there’s considerable value in doing walk-throughs together using a tracer model whenever considering the use of new products. Ideally, she says a copy of pertinent guidelines and instructions for use should be in hand so stakeholders can discover any issues that may come up as they contemplate the real-world applicability of new products.
“We’ve found that this process can help identify substandard practices and areas for quality improvement-some that may be solved with a new product and some that will require training, other equipment or supplies,” Ofstead says.
It’s through valuable insights like this shared between colleagues in the OR, IP and SPD that these practical approaches to ensuring endoscope safety and other areas of infection prevention can be addressed, improved, and sustained for our surgical patients.
I encourage our colleagues in infection prevention and sterile processing to attend the AORN Global Surgical Conference & Expo in Nashville April 6-10 to learn more from their perioperative nurse colleagues about the challenges, innovations and other ideas to advance infection prevention in perioperative care. Don’t miss Ofstead’s presentation with colleague John Eiland, RN, MS, covering findings from a systematic literature review for endoscope sheaths.
Stephanie Davis, MSHA, RN, CNOR, CSSM, is president of the Association of periOperative Registered Nurses (AORN).
1. Ofstead CL, Wetzler, HP, Heymann OL, Johnson EA, Eiland JE, Shaw MJ. Longitudinal assessment of reprocessing effectiveness for colonoscopes and gastroscopes: Results of visual inspections, biochemical markers, and microbial cultures. American Journal of Infection Control. 2017; 4:e26-e33.
2. AORN. Guideline for product evaluation. In: Guidelines for Perioperative Practice. Pages 715-724. 2019.