By Melinda Benedict, MS, CIC, CFER
Approximately 75 million endoscopies are performed annually in the United States, and 51.5 million of those procedures are dedicated to gastrointestinal-related procedures. With flexible endoscopes playing a crucial role in the effective diagnosis and treatment of disorders and diseases, keeping every scope at your facility in good working order is essential.
When a scope goes out of commission for repairs, it can be costly. Not only can repairs be expensive, but downtime during the repair process can impact departmental efficiency by causing scheduling delays or staff overtime for reprocessing scopes. Ultimately, satisfaction suffers-for patients, staff and physicians alike.
So, what’s the best way to minimize downtime, unnecessary repair expenditures and infection control risks? Avoid scope damage in the first place by following proper handling, reprocessing, transport and storage protocols. Following are four tips for minimizing some of the most frequent and costly types of scope damage. These preventive methods may also extend the useful life of your flexible endoscopes.
TIP 1: Protect the distal end
The distal end is the most fragile and easily damaged part of an endoscope. The tip houses the light guide lens assemblies, the CCD color chip, the protective C-cover, and the channel openings (biopsy/suction channel and air/water channel). A scratched or fractured distal end lens may have issues distributing light, and a broken seal around the lens may cause fluid invasion during reprocessing.
Main causes of distal tip damage:
Any impact to the distal end can harm the scope’s imaging quality or compromise its electrical insulation properties. Impacts are the main cause of light guide lens damage, such as the tip hitting the floor or striking against peripheral equipment. Impacts can occur during transport, inspection or maintenance, and they can have serious consequences.
• Keep the distal end separate from the control body and endoscope connector when handling the scope.
• Avoid striking the distal end during transport and reprocessing.
• Clean the lens surface using only the Original Equipment Manufacturer (OEM) recommended accessory.
• Store the endoscope properly and keep the lens dry.
TIP 2: Safeguard the channels
A hole or slice in an instrument channel can allow fluid to penetrate, which jeopardizes the integrity of internal components. Since internal damage cannot be detected during a routine visual inspection, it is critical to always perform diligent leak testing before reprocessing.
Main causes of channel damage:
Inserting, withdrawing or moving a deployed needle through the instrument channel can result in punctures to the channel. Likewise, using damaged accessories or improperly using them-such as retracting forceps while they are open-can result in scrapes to the channel wall.
• Only deploy needles when the tip of the device is in the scope’s field of view, and retract the needle before inserting it into, or withdrawing it from, the instrument channel.
• Ensure accessories are in good working condition. Use the closed position to move accessories through the channel.
• Follow proper pre-cleaning and cleaning reprocessing protocols per OEM and society guidelines.
TIP 3: Take care in transport
Improper transport of endoscopes can result in damage to the distal tip or exterior of the insertion tube, kinks in the bending section, or buckling of the insertion tube.
Main causes of scope damage during transport:
A variety of transgressions can happen during transport. Transporting and reprocessing endoscopes with other accessories, stacking endoscopes, resting the endoscope connector on other parts of the endoscope, and improperly coiling the insertion tube can all cause damage to the endoscope.
• Transport the endoscope in an appropriately sized, closed or covered container. Do not use soft bags or pillow cases to transport endoscopes-this can cause harmful over-coiling and impact damage during transport.
• Transport each endoscope separately from other instruments-especially sharp-edged accessories like biopsy forceps and scissors.
• Avoid stacking the electrical connector on top of the insertion tube.
• Avoid excessive coiling of the insertion and light guide tubes.
• Place control knobs facing up.
• Carefully position the distal end to avoid impact damage.
TIP 4: Follow proper storage protocols
Endoscopes should be stored in a manner that will protect them from contamination. Correct storage of each flexible endoscope also prevents damage to its exterior by protecting it from physical impact.
Main causes of endoscope damage during storage:
It goes without saying that not having an endoscope-specific storage cabinet or using its features incorrectly (such as installing incorrect adapters or filters), can lead to damage of high-level disinfected endoscopes. During storage, improper hanging techniques, overcrowding in the cabinet, and failure to remove detachable items and unlock control knobs can also result in damage.
• Store endoscopes in cabinets designed specifically for endoscope storage to protect them from damage. Don’t overcrowd the cabinet, which increases the risk of endoscopes falling or banging into each other.
• Hang endoscopes in a vertical position to facilitate drying. Remove caps, valves and other detachable components.
• Allow the light guide and insertion tubes to hang freely (not looped), out of the way of doors, hinges and other endoscopes.
• Leave control knobs and angulation locks in the “free” position. Store adjustable endoscopes with a variable stiffness mechanism in the “neutral” position.
Taking a few extra precautions in handling, reprocessing, transport and storage can help your facility reduce some of the most common and avoidable repair expenditures while maximizing scope uptime. When endoscope damage does occur, and repairs are required, you can further safeguard the performance of your endoscope and patient safety by ensuring that repairs are performed to OEM specifications so that the scope remains validated for reprocessing.
Melinda Benedict, MS, CIC, CFER, is an industry expert in infection control and endoscope reprocessing. She is a frequent presenter on the importance of endoscope reprocessing training and best practices for preventing endoscope-associated infections. In her work, she liaises with professional societies to improve patient safety and works with endoscope reprocessor and sterilizer manufacturers on validation studies. She currently serves as the manager of infection control at Olympus Corporation of the Americas.