Process improvement measures to accurately identify reprocessed endoscopes ready-for-use in a surgical services department

Abstract

ISSUE: Infection following endoscopic procedures remains a possibility if reprocessing between patients is incomplete or inadequate. In a busy surgical services department where movable carts are used to hang scopes before and after use, quality control measures are needed to minimize risk. After a patient exposure incident occurred in a surgical department of a large teaching facility, process improvement measures were developed. The incident involved a gastroscope left on a cart after use, having been pre-cleaned with an enzymatic solution and sterile water flush and having had exterior surfaces wiped down. The scope was subsequently used on a second patient. PROJECT: Following the aforementioned incident, endoscope technicians took responsibility for the process improvement initiative. Specifically, guidelines were established that focused on cleaning and restocking of endoscopy carts. Upon procedure completion, endoscope technicians are contacted to physically remove the scope from the procedure suite for reprocessing. A color-coded tag system was developed to differentiate endoscopes that have been used and require reprocessing (red) from those that are clean, disinfected, and ready-to-use (green). The red tag contains verbal warnings and reminders for starting the cleaning process. The green tag states the scope is clean with information about other content items on the cart. The technician must verify the tag placement by writing his or her initials and date of reprocessing on the tag following delivery. RESULTS: The initial incident did not result in cross-transmission of infectious organisms, notably HIV, HBV, and HCV, as the culprit endoscope had been pre-cleaned, flushed, and wiped down prior to its re-use. However, several “near misses” had occurred in the same department prior to the reported incident, which necessitated involvement of infection control and risk management. During the 6 months this new process has been in place, no further incidents or near misses have been reported. LESSONS LEARNED: Performing endoscopic procedures in a busy surgical services department requires collaboration between physicians, nurses, endoscopic technicians, and infection control to prevent contaminated endoscopes from being used between patients. Directly involving the endoscope technicians and using a color-coded tag system is one example of a successful quality assurance plan to prevent cross-transmission between patients and improve patient safety.