After investigations found hundreds of patients may have been exposed to antibiotic-resistant superbugs in procedures using a complex endoscope, several national standard-setting organizations updated their device reprocessing guidelines. The Society of Gastroenterology Nurses and Associates, Association of Perioperative Registered Nurses, and Association for the Advancement of Medical Instrumentation all issued new recommendations in areas including personal protective equipment (PPE), manual cleaning, visual inspection, use of automated endoscope reprocessors (AERs), drying, storage, and documentation.
For overseers of central services trying to determine the resources necessary to put the new guidelines into practice, a study recently published by the International Association of Healthcare Central Service Materiel Management gives perspective on the possible financial and time investments.
Researchers collected data from 14 healthcare providers, all using AERs for high-level disinfection, but otherwise variable in their protocols, equipment, chemicals, and other materials used. They offer these main takeaways:
Reprocessing one flexible endoscope requires approximately 76 minutes of hands on staff time.
The study breaks reprocessing down into 14 different steps in this section. Manual cleaning, considered of highest importance, far and away is the most time consuming (17 minutes). The new standards call for time intensive tasks like passing brushes down endoscope channels multiple times and performing biochemical tests to check cleaning effectiveness.
Changing protective equipment and hand washing (nine minutes) also accounts for more than 10% of total time. The recommendations suggest technicians change their PPE and clean their hands at least twice during the course of reprocessing each endoscope.
The cost of reprocessing one endoscope ranges from $114.07 to $280.71.
As more detailed visual inspections and tests for residual contamination are carried out, a higher proportion of endoscopes may require repair, the researchers write. In their study, they found repairs make up about half the average total reprocessing cost. The average reported cost of a repair—whether attributed to a leak test failure, damage during a visual inspection, or a failed cleaning verification test—is $5,833.
Visual inspection, cleaning verification, and recleaning of one in five endoscopes on average adds up to about 15% of the total costs. The new guidelines recommend using magnifying glasses with extra lighting to check for debris remaining on external surfaces after cleaning and borescopes to examine inside ports and channels. Borescopes, which are smaller endoscopes, can cost several thousand dollars, according to the study.
The findings are likely underestimates, and more research is needed.
A host of tasks (for example, reprocessing a scope after seven days of storage or performing annual competency testing) and resources (such as electricity, trash disposal) are not included in the estimates, leading the researchers to conclude the findings “only begin to scratch the surface in determining the true cost of endoscope reprocessing.” At the least, the results indicate that organizations may need to recalibrate their needs assessments.
“What we are seeing in the field is that facilities are not allocating the time and materials for technicians to do the job right,” says Cori Ofstead, the study’s lead author. “Technicians are being asked to do more with less, and the pressure on them to move quickly and use less materials really is not compatible with the need to do a more rigorous job to ensure patient safety.”