Defining Endoscope Precleaning Workflows in a Fast-paced Gastroenterology Clinic

Abstract

Background Infection Prevention and Control observations of endoscope workflows in a fast-paced Gastroenterology Clinic, located in an urban tertiary care hospital, identified inadequate precleaning processes. This included deviation such as staff who did not follow a clean to dirty workflow which resulted in contamination of clean supplies and possible staff and patient exposures from potentially infectious materials. Methods To address this problem, a multidisciplinary team was assembled. The team simulated and rehearsed precleaning in mock clinical settings in a variety of exam room layouts. Related tasks were organized into four focus areas: Set-up, Precleaning, Packaging, and Transportation. The team met over six months’ time frame to report on progress, review standards, and address obstacles encountered. Results Workflow maps were created and individualized to each exam room layout detailing the steps required to perform the entire precleaning process. Set-up: the nursing staff assisted in delineating and identifying which tasks should be done in a predetermined clean and dirty area. Precleaning: barriers identified during real-world observation were noted and corrected during simulation. Packaging: uniform non-perforated scope containers were purchased and distributed to the entire clinic. Transportation: Staff felt safe bringing the soiled scope in a closed fluid resistant container to the soiled Utility room. As a result of this systematic and organized improved initiative, the time spent precleaning decreased 50%, when comparing from before the initiative. Conclusions The interdisciplinary team was able to accomplish an organized, safe and time efficient precleaning workflow that can be adapted by other specialty settings. This improvement initiative is important for patient and staff safety in addition to compliance with regulatory standards of practice. Infection Prevention and Control observations of endoscope workflows in a fast-paced Gastroenterology Clinic, located in an urban tertiary care hospital, identified inadequate precleaning processes. This included deviation such as staff who did not follow a clean to dirty workflow which resulted in contamination of clean supplies and possible staff and patient exposures from potentially infectious materials. To address this problem, a multidisciplinary team was assembled. The team simulated and rehearsed precleaning in mock clinical settings in a variety of exam room layouts. Related tasks were organized into four focus areas: Set-up, Precleaning, Packaging, and Transportation. The team met over six months’ time frame to report on progress, review standards, and address obstacles encountered. Workflow maps were created and individualized to each exam room layout detailing the steps required to perform the entire precleaning process. Set-up: the nursing staff assisted in delineating and identifying which tasks should be done in a predetermined clean and dirty area. Precleaning: barriers identified during real-world observation were noted and corrected during simulation. Packaging: uniform non-perforated scope containers were purchased and distributed to the entire clinic. Transportation: Staff felt safe bringing the soiled scope in a closed fluid resistant container to the soiled Utility room. As a result of this systematic and organized improved initiative, the time spent precleaning decreased 50%, when comparing from before the initiative. The interdisciplinary team was able to accomplish an organized, safe and time efficient precleaning workflow that can be adapted by other specialty settings. This improvement initiative is important for patient and staff safety in addition to compliance with regulatory standards of practice.