AORN Guideline for Processing Flexible Endoscopes

AORN Guideline for Processing Flexible Endoscopes
Copyright © 2016 AORN, Inc. All rights reserved. Used or adapted with permission.

BSN and MSN: Middle Tennessee State University
Developed and originally presented by Sharon A. Van Wicklin, MSN, RN, CNOR, CRNFA(E), CPSN-R, PLNC Senior Perioperative Practice Specialist, AORN BSN and MSN: Middle Tennessee State University PhD in progress: University of Missouri Membership: Phi Kappa Phi Sigma Theta Tau Honor Society Certification: CNOR CRNFA(E) (RN first assistant-emeritus) CPSN-R (plastic and reconstructive surgical nursing-retired) PLNC (legal nurse consultant) Lead author: Guideline for Sterile Technique Guideline for Specimen Management Guideline for Autologous Tissue Management Guideline for Processing Flexible Endoscopes Co-author: Guideline for Surgical Attire Recipient: AORN Outstanding Achievement in the Application of Perioperative Clinical Research Award, 2005 These slides taken from the webinar AORN Guideline for Processing Flexible Endoscopes, presented January 26, To listen to the webinar, visit These slides are made available for educational use. Slides may be personalized for your facility and presentation. HOWEVER, THE VIEWS EXPRESSED IN THESE SLIDES ARE THOSE OF THE PRESENTERS AND DO NOT NECESSARILY REPRESENT THE VIEWS OF AND SHOULD NOT BE ATTRIBUTED TO AORN.

Objectives Explain requirements for endoscopy processing rooms
Discuss evidence-based practices for processing flexible endoscopes Describe recommendations for surveillance of flexible endoscopes Copyright © 2016 AORN, Inc. All rights reserved. Used or adapted with permission.

Purpose To provide guidance for
Processing reusable flexible endoscopes and accessories Design and construction of endoscopy suites Controlling and maintaining the environment Maintaining records for traceability and quality assurance measures Not all steps apply to all endoscopes! Copyright © 2016 AORN, Inc. All rights reserved. Used or adapted with permission.

Complex Design The complex design of flexible endoscopes increases the efficiency and effectiveness of endoscopic procedures; however, it creates significant challenges for effective processing. Copyright © 2016 AORN, Inc. All rights reserved. Used or adapted with permission.

Cycle of Processing Processing flexible endoscopes is a complex cycle of multiple steps that includes point-of-use precleaning, transporting, leak testing, cleaning, inspecting, HLD, liquid chemical sterilization, or packaging and sterilization, storing, and use. Reprinted with permission from Guidelines for Perioperative Practice. Copyright © 2016, AORN, Inc, 2170 S. Parker Road, Suite 400, Denver, CO All rights reserved.

Recommendation I Flexible endoscopes should be processed in an area designed and constructed to support processing activities Reprinted with permission from Guidelines for Perioperative Practice. Copyright © 2016, AORN, Inc, 2170 S. Parker Road, Suite 400, Denver, CO All rights reserved.

Recommendation I Perform processing in a room
where only processing activities are performed that is physically separated from locations where patient care activities are carried out

Endoscope processing may occur in a single endoscopy processing room, or it may occur in two separate rooms (ie, a decontamination room and a clean workroom). Having a single endoscopy processing room that contains both a decontamination and a clean area is the minimum standard for design and construction. Having separate decontamination and clean workrooms may avoid the risk of cross contamination from multiple individuals performing both clean and contaminated processing activities in a single area. Whether a one- or two-room design, the endoscopy processing room should be constructed to facilitate a unidirectional workflow from the decontamination area or decontamination room to the clean area or clean workroom, and then to clean storage in a separate location. Reprinted with permission from Guidelines for Perioperative Practice. Copyright © 2016, AORN, Inc, 2170 S. Parker Road, Suite 400, Denver, CO All rights reserved.

Recommendation I Decontamination sinks*
minimum of two sinks (or one sink with two divisions) in the endoscopy processing room One recommendation related to design and construction of the endoscopy processing area is the need for a minimum of two decontamination sinks (or one sink with two divisions) in the endoscopy processing room. Decontamination sinks are used for endoscope processing tasks such as leak testing, cleaning, and rinsing of flexible endoscopes and other reusable items, and not used for hand washing. Separate sinks or divisions facilitates endoscope processing and may help prevent cross contamination. *Decontamination sink: A sink used for endoscope processing tasks Copyright © 2016 AORN, Inc. All rights reserved. Used or adapted with permission.

Recommendation I Instrument air*
provided in the endoscopy processing room *Instrument air: A medical gas that is not respired, is filtered to 0.01 micron, free of liquids and hydrocarbon vapors, and dry to a dew point of -40º F (-40º C) Another recommendation related to design and construction is that instrument air should be provided in the endoscopy processing room. Instrument air is defined by the National Fire Protection Agency as a medical gas that is not respired, is filtered to 0.01 micron, is free of liquids and hydrocarbon vapors, and is dry to a dew point of -40º F (-40º C). Clean, filtered air under pressure is required for drying lumens and small channels of flexible endoscopes without introducing contaminants into the clean device. Copyright © 2016 AORN, Inc. All rights reserved. Used or adapted with permission.

Recommendation I Eyewash stations
immediately accessible where chemicals are located not installed in a location that requires flushing in a decontamination sink Eyewash stations must be provided within the endoscopy suite where chemicals that are hazardous to the eyes are located. It is a regulatory requirement that emergency eyewash stations be immediately accessible. Eyewash stations are necessary to provide flushing fluid when the safety data sheet identifies the chemical as a hazard, and recommends immediate flushing of the eyes as an emergency first aid measure. Eyewash stations should not be installed in a location that requires flushing of the eyes in a decontamination sink because splashing from the decontamination sink could potentially contaminate the eyes of personnel using the sink. Copyright © 2016 AORN, Inc. All rights reserved. Used or adapted with permission.

Recommendation II Flexible endoscopes should be processed in an area controlled and maintained to support processing activities Reprinted with permission from Guidelines for Perioperative Practice. Copyright © 2016, AORN, Inc, 2170 S. Parker Road, Suite 400, Denver, CO All rights reserved.

Recommendation II Controls that support processing activities
Heating, ventilation, air-conditioning parameters Environmental cleaning Surgical attire Traffic patterns Security measures Flexible endoscopes should be processed in an area controlled and maintained to support processing activities. The collective evidence supports processing flexible endoscopes in an area where activities such as heating, ventilation, and air conditioning (HVAC) parameters, environmental cleaning, surgical attire, traffic patterns, and security measures are managed in accordance with specific policies and procedures that promote processing activities. Copyright © 2016 AORN, Inc. All rights reserved. Used or adapted with permission.

Recommendation II Processing should be performed by personnel who have received education and completed competency verification activities AORN has long advocated for education and competency verification of perioperative, endoscopy, and sterile processing personnel, and this is critically important when it comes to processing flexible endoscopes. Flexible endoscopes and endoscope accessories should be cleaned and processed by qualified individuals who have received education and completed competency verification activities related to endoscope processing. The collective evidence shows that ensuring flexible endoscopes and endoscope accessories are processed by individuals whose primary duties are to clean and process flexible endoscopes minimizes variability and improves processing effectiveness, and may also reduce repair costs and extend the life of the endoscope. Copyright © 2016 AORN, Inc. All rights reserved. Used or adapted with permission.

Recommendation II Perform processing in the same manner in all locations Provide sufficient time and numbers of personnel Schedule procedures to allow sufficient time for processing Maintain sufficient inventory to meet the demand Process all endoscopes in the same manner Copyright © 2016 AORN, Inc. All rights reserved. Used or adapted with permission.

Recommendation III Flexible endoscopes and accessories should be precleaned at the point of use Reprinted with permission from Guidelines for Perioperative Practice. Copyright © 2016, AORN, Inc, 2170 S. Parker Road, Suite 400, Denver, CO All rights reserved.

Recommendation III Preclean as soon as possible after use
When the precleaning process will be delayed, wipe external surfaces suction water through the channels Precleaning should occur as soon as possible after the endoscope is removed from the patient (or the procedure is completed) and before organic material has dried on the surface or in the channels of the endoscope. When the precleaning process will be delayed (eg, an endoscope is used for intubation and remains in the procedure room for potential reuse), designated personnel (eg, RN circulator, endoscopy RN, scrub person) should wipe the external surfaces of the endoscope with a soft, lint-free cloth or sponge saturated with water and suction water through the channels. Wiping the external surfaces and suctioning water through the channels of the endoscope may help prevent organic soils from drying, reducing bacterial adherence and the risk of biofilm formation until precleaning with a cleaning solution can be accomplished. Copyright © 2016 AORN, Inc. All rights reserved. Used or adapted with permission.

Recommendation IV After precleaning at the point of use, contaminated flexible endoscopes and accessories should be transported to the endoscopy processing room Reprinted with permission from Guidelines for Perioperative Practice. Copyright © 2016, AORN, Inc, 2170 S. Parker Road, Suite 400, Denver, CO All rights reserved.

Recommendation IV Keep wet or damp but not submerged in liquid during transport Transport in a closed container or transport cart that is leak proof puncture resistant large enough to contain all contents labeled with a biohazard legend Transport in a horizontal position Contain accessories separately Contaminated endoscopes should be transported to the processing room as soon as possible after use. They should be kept wet or damp, but not submerged in liquid during transport. Contaminated endoscopes must be transported to the decontamination area in a closed container or closed transport cart. The container or cart must be leak proof, puncture resistant, and large enough to contain all contents. The transport cart or container must be labeled with a biohazard legend. Flexible endoscopes should be transported in a horizontal position because fluid may leak from the contaminated endoscope if the endoscope is transported vertically. Endoscope accessories should accompany the endoscope, but should be contained separately. Keeping the accessories with the endoscope helps prevent them from being lost or misplaced and supports traceability of the endoscope and its accessories as a single unit. Copyright © 2016 AORN, Inc. All rights reserved. Used or adapted with permission.

Recommendation IV Begin processing as soon as possible
Follow the manufacturer's instructions for use (IFU) for delayed processing Do not leave endoscopes soaking in enzymatic cleaning solutions Processing should begin as soon as possible after transport to the endoscopy processing room or within the manufacturer's recommended time to processing. When it is not possible to initiate the cleaning process within the endoscope manufacturer's recommended time to cleaning, the manufacturer's instructions for use (IFU) for delayed processing should be followed. Flexible endoscopes should not be left soaking in enzymatic cleaning solutions beyond the endoscope manufacturer's designated contact time unless this is specifically recommended in the manufacturer's IFU for delayed processing. Soaking endoscopes in enzymatic cleaning solutions increases the potential for microbial contamination, biofilm formation, ineffective disinfection or sterilization, and moisture damage to the endoscope. Copyright © 2016 AORN, Inc. All rights reserved. Used or adapted with permission.

Recommendation IV Record the times procedure is completed
cleaning is initiated A procedure should be developed and implemented for recording the times that the endoscopy procedure is completed and cleaning is initiated because this enables processing personnel to ascertain how long the endoscope has been awaiting processing, to establish priority order, and to determine whether routine processing within the manufacturer's recommended time to cleaning is achievable, and if not, to implement the manufacturer's procedures for delayed processing. Copyright © 2016 AORN, Inc. All rights reserved. Used or adapted with permission.

Recommendation V Flexible endoscopes designed to be leak tested, should be leak tested after each use, after any event that may have damaged the endoscope, and before use of a newly purchased, repaired, or loaned endoscope Reprinted with permission from Guidelines for Perioperative Practice. Copyright © 2016, AORN, Inc, 2170 S. Parker Road, Suite 400, Denver, CO All rights reserved.

Recommendation V Leak testing detects openings in external surfaces
internal channels Water, chemicals, and organic material can accumulate from the time the integrity of the endoscope is breached until the leak is identified! The collective evidence supports leak testing as a method to help ensure the endoscope has not been compromised and is safe to use. Leak testing detects openings in the external surfaces and internal channels of the endoscope that could permit water, chemicals, or organic material to enter portions of the endoscope not intended for fluids. These materials may accumulate from the time the integrity of the endoscope is breached until the time the leak is identified. Copyright © 2016 AORN, Inc. All rights reserved. Used or adapted with permission.

Recommendation V Perform leak testing before
manual cleaning placing into cleaning solutions When an endoscope fails a leak test remove from service repair or replace Leak testing should be performed before manual cleaning and before the endoscope is placed into cleaning solutions. When an endoscope fails a leak test, it should be removed from service and repaired or replaced. Copyright © 2016 AORN, Inc. All rights reserved. Used or adapted with permission.

Recommendation VI After leak testing and before high-level disinfection or sterilization, flexible endoscopes should be manually cleaned Reprinted with permission from Guidelines for Perioperative Practice. Copyright © 2016, AORN, Inc, 2170 S. Parker Road, Suite 400, Denver, CO All rights reserved.

Recommendation VI Begin manual cleaning as soon as possible after leak testing Cleaning is the most important step in processing flexible endoscopes! Use the type of water and cleaning solution recommended by the endoscope manufacturer Copyright © 2016 AORN, Inc. All rights reserved. Used or adapted with permission.

Recommendation VI Use a freshly prepared cleaning solution and change the solution before it becomes cloudy or discolored before there are visible particulates in the solution when the temperature of the solution does not meet the temperature specified in the manufacturer's IFU Copyright © 2016 AORN, Inc. All rights reserved. Used or adapted with permission.

Recommendation VI Completely submerge the endoscope in the cleaning solution Detach and submerge removable parts Clean all exterior surfaces with a soft, lint-free cloth or sponge saturated with the cleaning solution Copyright © 2016 AORN, Inc. All rights reserved. Used or adapted with permission.

Recommendation VI Clean all accessible channels and the distal end with a cleaning brush of the length, width, and material recommended by the endoscope manufacturer Actuate the endoscope valves while cleaning Copyright © 2016 AORN, Inc. All rights reserved. Used or adapted with permission.

Recommendation VI Clean the elevator mechanism, and the recesses surrounding it, with a cleaning brush of the length, width, and material recommended by the endoscope manufacturer Raise and lower the elevator mechanism throughout the manual cleaning process Reprinted with permission from Guidelines for Perioperative Practice. Copyright © 2016, AORN, Inc, 2170 S. Parker Road, Suite 400, Denver, CO All rights reserved.

Recommendation VI Use a clean brush for each endoscope cleaning
Visually inspect brushes and other items before use Do not use if the integrity of the brush or other cleaning item is in question Copyright © 2016 AORN, Inc. All rights reserved. Used or adapted with permission.

Recommendation VI Brush multiple times
Brush until no debris appears on the brush Remove debris from the brush after each pass and before retracting it back through the channel Swirl the brush in the cleaning solution and rinse Copyright © 2016 AORN, Inc. All rights reserved. Used or adapted with permission.

Recommendation VI Flush the channels of the endoscope with cleaning solution A cleaning adapter or automatic flushing system may be used Reprinted with permission from Guidelines for Perioperative Practice. Copyright © 2016, AORN, Inc, 2170 S. Parker Road, Suite 400, Denver, CO All rights reserved.

Recommendation VI Flush and rinse the exterior surfaces and internal channels with utility water* until all cleaning solution and residual debris is removed *Utility water: Water obtained from a faucet that has not been purified, distilled, or otherwise treated Copyright © 2016 AORN, Inc. All rights reserved. Used or adapted with permission.

Recommendation VI Dry the exterior surfaces with a soft, lint-free cloth or sponge Purge all channels with instrument air Reprinted with permission from Guidelines for Perioperative Practice. Copyright © 2016, AORN, Inc, 2170 S. Parker Road, Suite 400, Denver, CO All rights reserved.

Recommendation VI Clean, brush, rinse, dry, and high-level disinfect or sterilize reusable parts, accessories, and cleaning implements Discard single-use parts, accessories, and cleaning implements, and do not reprocess Copyright © 2016 AORN, Inc. All rights reserved. Used or adapted with permission.

Recommendation VII Flexible endoscopes, accessories, and associated equipment should be visually inspected for cleanliness, integrity, and function before use, during the procedure, after the procedure, after cleaning, and before disinfection or sterilization Reprinted with permission from Guidelines for Perioperative Practice. Copyright © 2016, AORN, Inc, 2170 S. Parker Road, Suite 400, Denver, CO All rights reserved.

Recommendation VII Visually inspect all new, repaired, refurbished, and loaned endoscopes, accessories, or other equipment before use Copyright © 2016 AORN, Inc. All rights reserved. Used or adapted with permission.

Recommendation VII Visually inspect and evaluate for cleanliness
missing parts clarity of lenses integrity of seals and gaskets moisture physical or chemical damage function Copyright © 2016 AORN, Inc. All rights reserved. Used or adapted with permission.

Recommendation VII Use lighted magnification to inspect for cleanliness and damage Use a borescope* to inspect internal channels of flexible endoscopes *Borescope: A device used to inspect the inside of an instrument through a small opening or lumen of the instrument Copyright © 2016 AORN, Inc. All rights reserved. Used or adapted with permission.

Recommendation VII Remove defective endoscopes, accessories, and equipment from service and repair or replace Decontaminate to the fullest extent possible Attach a biohazard label before transportation Copyright © 2016 AORN, Inc. All rights reserved. Used or adapted with permission.

Recommendation VIII After manual cleaning and inspection, flexible endoscopes and endoscope accessories should be high-level disinfected or sterilized Reprinted with permission from Guidelines for Perioperative Practice. Copyright © 2016, AORN, Inc, 2170 S. Parker Road, Suite 400, Denver, CO All rights reserved.

Recommendation VIII Classification Disinfection Level Effectiveness
Examples Critical: Items that come in contact with sterile tissue or the vascular system Sterilization Kills all microbial life Surgical instruments Semicritical: Items that come in contact with mucous membranes or non-intact skin High-level disinfection Kills all microorganisms, but not necessarily all bacterial spores Flexible endoscopes Noncritical: Items that come in contact with intact skin Intermediate-level disinfection Low-level disinfection Kills viruses, mycobacteria, fungi, vegetative bacteria Kills vegetative bacteria, some fungi, lipid viruses Blood pressure cuffs Stethoscopes According to the Spaulding classification, items such as flexible endoscopes that come in contact with nonintact skin or mucous membranes, are considered to be semicritical. Spaulding recommended that semicritical items be processed by sterilization, or at a minimum, by HLD. Copyright © 2016 AORN, Inc. All rights reserved. Used or adapted with permission.

Recommendation VIII Mechanically clean and process or mechanically clean and sterilize flexible endoscopes After manual cleaning, and when compatible with the endoscope manufacturer's IFU, flexible endoscopes and accessories should be either mechanically cleaned and mechanically processed by exposure to a high-level disinfectant or a liquid chemical sterilant, or should be mechanically cleaned and sterilized. The collective evidence shows that mechanical processing improves cleaning effectiveness, increases efficiency, minimizes personnel exposure to chemicals and biohazardous materials, and can be more successfully monitored for quality and consistency. Copyright © 2016 AORN, Inc. All rights reserved. Used or adapted with permission.

Recommendation VIII Perform mechanical processing in accordance with the endoscope and mechanical processor manufacturers’ IFU Copyright © 2016 AORN, Inc. All rights reserved. Used or adapted with permission.

Recommendation VIII Verify compatibility before processing
Position flexible endoscopes and accessories to ensure contact of processing solutions with all surfaces of the endoscope Ensure all connectors between the endoscope and the mechanical processor are connected correctly Monitor cycles to verify they are completed as programmed If a cycle is interrupted, repeat the entire cycle Copyright © 2016 AORN, Inc. All rights reserved. Used or adapted with permission.

Recommendation VIII Perform mechanical processing using critical water* and the cleaning, disinfectant, and sterilant solutions and chemicals recommended by the endoscope and mechanical processor manufacturers *Critical water: Water that is extensively treated to remove microorganisms and other materials Copyright © 2016 AORN, Inc. All rights reserved. Used or adapted with permission.

Recommendation VIII Do not process flexible endoscopes using
skin antiseptics hypochlorites phenolics quaternary ammonium compounds Copyright © 2016 AORN, Inc. All rights reserved. Used or adapted with permission.

Recommendation VIII Mechanically rinse and flush the endoscope and endoscope channels with critical or sterile water Rinse endoscope accessories and removable parts with critical or sterile water Copyright © 2016 AORN, Inc. All rights reserved. Used or adapted with permission.

Recommendation VIII Conduct a risk assessment to determine whether endoscope lumens should be flushed with 70% to 90% ethyl or isopropyl alcohol Many clinical practice guidelines and experts in the field recommend manual or mechanical flushing of endoscope lumens with alcohol because it facilitates drying of the endoscope lumens by binding with residual water and enhancing evaporation. Alcohol prevents colonization and transmission of waterborne bacteria. However, flushing endoscope lumens with alcohol may not be necessary if the endoscope is effectively dried. Because of the fixative properties of alcohol, this practice is not recommended in some countries. Copyright © 2016 AORN, Inc. All rights reserved. Used or adapted with permission.

Recommendation VIII Dry exterior surfaces of the endoscope with a soft, lint-free cloth or sponge Dry endoscope channels by purging with instrument air or drying with a mechanical processor drying system Dry removable parts and endoscope accessories Copyright © 2016 AORN, Inc. All rights reserved. Used or adapted with permission.

Recommendation IX Flexible endoscopes and endoscope accessories should be stored in a manner that minimizes contamination and protects the device or item from damage Reprinted with permission from Guidelines for Perioperative Practice. Copyright © 2016, AORN, Inc, 2170 S. Parker Road, Suite 400, Denver, CO All rights reserved.

Recommendation IX Store flexible endoscopes in a drying cabinet*
*Drying cabinet: A medical device designed for storage of flexible endoscopes that circulates continuous HEPA-filtered air through each endoscope channel and within the cabinet AORN recommends that flexible endoscopes be stored in a drying cabinet. The collective evidence shows that optimal storage of flexible endoscopes facilitates drying, decreases the potential for contamination, and provides protection from environmental contaminants. Drying cabinets include a drying system that circulates HEPA-filtered air through the cabinet while filtered air under pressure is forced through the endoscope channels. The internal and external surfaces of the endoscope are continuously dried, suppressing bacterial growth. Copyright © 2016 AORN, Inc. All rights reserved. Used or adapted with permission.

Recommendation IX If a drying cabinet is not available, store flexible endoscopes in a closed cabinet with HEPA-filtered air that provides positive pressure and allows air circulation Copyright © 2016 AORN, Inc. All rights reserved. Used or adapted with permission.

Recommendation IX Store flexible endoscopes in a cabinet that is either designed and intended by the cabinet manufacturer for horizontal storage of flexible endoscopes, or Copyright © 2016 AORN, Inc. All rights reserved. Used or adapted with permission.

Recommendation IX Store flexible endoscopes in a cabinet that is
of sufficient height, width, and depth to allow flexible endoscopes to hang vertically, without coiling and without touching the bottom of the cabinet Copyright © 2016 AORN, Inc. All rights reserved. Used or adapted with permission.

Recommendation IX Store flexible endoscopes with
all valves open removable parts detached but stored with the endoscope Use a distinct visual cue that clearly identifies flexible endoscopes as processed and ready for use Copyright © 2016 AORN, Inc. All rights reserved. Used or adapted with permission.

Recommendation IX Visually inspect flexible endoscopes for cleanliness before placing into or removing from storage Wear clean gloves when handling processed endoscopes transporting them to and from the storage cabinet Copyright © 2016 AORN, Inc. All rights reserved. Used or adapted with permission.

Professional Organization Recommendations
Recommendation IX Maximum Safe Storage Times for Flexible Endoscopes Professional Organization Recommendations 3 hours to 1 month Studies 48 hours to 56 days Facility Variables Type of endoscopes Processing effectiveness Compliance with IFU Storage conditions Frequency of use Patient population The collective evidence regarding the maximum safe storage time for processed endoscopes is inconclusive. There are benefits to eliminating unnecessary processing of flexible endoscopes that include reduced processing costs, reduced wear and tear on the endoscope and processing equipment, and lower replacement and repair costs. Recommendations from professional organizations for maximum storage times for flexible endoscopes are not in agreement; recommended storage times range from three hours to one month. Recommendations from studies are also not in agreement and have shown that when correctly processed, flexible endoscopes may be safe to use for 48 hours to 56 days after processing. Safe storage times may be affected by variables that are unique to the facility, including the type of endoscopes processed and stored, processing effectiveness, storage conditions, compliance with manufacturers' IFU, frequency of endoscope use, and patient population. Copyright © 2016 AORN, Inc. All rights reserved. Used or adapted with permission.

Recommendation IX Establish a policy to determine the maximum safe storage time for processed flexible endoscopes Establish a policy for removing and reprocessing the endoscope before use if the maximum storage time has been exceeded Copyright © 2016 AORN, Inc. All rights reserved. Used or adapted with permission.

Recommendation IX Clean and disinfect storage cabinets when visibly soiled and on a regular basis Establish a policy to determine the cleaning frequency of the storage cabinet Copyright © 2016 AORN, Inc. All rights reserved. Used or adapted with permission.

Recommendations X The health care organization should maintain records of flexible endoscope processing and procedures Reprinted with permission from Guidelines for Perioperative Practice. Copyright © 2016, AORN, Inc, 2170 S. Parker Road, Suite 400, Denver, CO All rights reserved.

Recommendations XI Personnel with responsibility for processing flexible endoscopes should receive initial and ongoing education and complete competency verification activities related to processing flexible endoscopes Reprinted with permission from Guidelines for Perioperative Practice. Copyright © 2016, AORN, Inc, 2170 S. Parker Road, Suite 400, Denver, CO All rights reserved.

Recommendations XII Policies and procedures for processing flexible endoscopes should be developed, reviewed periodically, revised as necessary, and readily available in the practice setting in which they are used Reprinted with permission from Guidelines for Perioperative Practice. Copyright © 2016, AORN, Inc, 2170 S. Parker Road, Suite 400, Denver, CO All rights reserved.

Recommendation XIII The health care organization's quality management program should evaluate processing of flexible endoscopes Reprinted with permission from Guidelines for Perioperative Practice. Copyright © 2016, AORN, Inc, 2170 S. Parker Road, Suite 400, Denver, CO All rights reserved.

Recommendation XIII Monitor and audit facility water quality
Assess at established intervals and after major maintenance to the water supply system Copyright © 2016 AORN, Inc. All rights reserved. Used or adapted with permission.

Recommendation XIII Collaborate with manufacturer service personnel to determine schedules for preventive maintenance Align frequency of maintenance with manufacturer’s IFU unique variables Have qualified individuals perform the maintenance Copyright © 2016 AORN, Inc. All rights reserved. Used or adapted with permission.

Recommendation XIII Verify manual cleaning of flexible endoscopes using cleaning verification tests when new endoscopes are purchased and at established intervals Copyright © 2016 AORN, Inc. All rights reserved. Used or adapted with permission.

Recommendation XIII Used to verify the ability of the cleaning process to remove organic soil and microbial contamination Cleaning verification tests include Adenosine triphosphate (ATP) Protein Carbohydrate May help reduce errors in manual cleaning and improve cleaning effectiveness No single method has been established as a standard Copyright © 2016 AORN, Inc. All rights reserved. Used or adapted with permission.

Recommendation XIII Microbiological Culture Surveillance Advantages
Advised in guidelines of several international organizations Monitors effectiveness and quality of processing Evaluates efficacy of corrective interventions Detects endoscopes requiring service May help identify source of contamination May reduce risk of patient infection or pseudo-infection Copyright © 2016 AORN, Inc. All rights reserved. Used or adapted with permission.

Recommendation XIII Microbiological Culture Surveillance Disadvantages
Not advised in current US guidelines Confounded by frequent isolation of nonpathogenic organisms from skin or environmental contamination Cultures not validated by correlating viable counts on endoscope with the development of an infection False-positive and false-negative rates and limits of detection not established Negative culture does not guarantee effective processing Sensitivity of routine cultures may not be reliable for detecting organisms associated with outbreaks Need to quarantine endoscopes until culture results have been obtained does not allow for rapid reuse of endoscope and could lead to delays in patient care Resource-intensive, requires additional expenses for testing and time for personnel to collect and process samples Impractical for facilities that do not have access to microbiology laboratories Copyright © 2016 AORN, Inc. All rights reserved. Used or adapted with permission.

Recommendation XIII Evaluate the need to implement a program for regular microbiologic surveillance cultures of flexible endoscopes and mechanical processors Copyright © 2016 AORN, Inc. All rights reserved. Used or adapted with permission.

Reference Guideline for processing flexible endoscopes. In: Guidelines for Perioperative Practice. Denver, CO:AORN; 2016: Copyright © 2016 AORN, Inc. All rights reserved. Used or adapted with permission.

AORN Guideline for Processing Flexible Endoscopes

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