Inconsistencies in Endoscope Reprocessing Guidelines: The importance of Endoscope Drying

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Inconsistencies in EndoscopeReprocessing
GuidelinesThe importance of Endoscope Drying

• Lawrence F. Muscarella, Ph.D.
• Director, Research and Development
• Chief, Infection Control
• Editor, The Q-Net Monthly
• Custom Ultrasonics, Inc.
• 144 Railroad Drive
• Ivyland, PA 18974
• T 215-364-8577
• F 215-364-7674
• E-mail editor_at_myendosite.com
• Internet www.myendosite.com
• (This presentations slides are available at this
  website)

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The 3 stages of effective endoscope reprocessing
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AORN (The Association of periOperative Registered
Nurses)
AORN recommends drying the endoscope only before
storage after high-level disinfection (or after
a tap water rinse Table 1). Drying is achieved
by rinsing the endoscopes internal channels with
70 alcohol followed by forced air.
AORN does not recommend endoscope drying
between-patient-procedures. Nor does AORN
recommend endoscope drying before storage after a
sterile water rinse (Table 1).
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What are the consequences of AORNs guidelines?
AORNs guidelines support The practice of
introducing between-patient-procedures
just-reprocessed-and-wet-with-rinse-water bronchos
copes into the lungs of patients, including those
who are critically ill and suffering from
bacterial pneumonia (or, wet arthroscopes into
the knees of ill or immuno-suppressed patients,
etc.).
Is this a safe practice? Why is a wet surgical
instrument considered contaminated, but a wet
endoscope safe, sterile? Instead of drying the
endoscope, AORN recommends (a) using the
endoscope immediately after reprocessing and
(b) reprocessing the endoscope immediately
before its first use of the day a practice that
is expensive and has not been shown to reduce the
risk of nosocomial infection.
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APIC (Association for Professionals in Infection
Control and Epidemiology)
APIC recommends drying the endoscope
except between patient procedures when using
sterile water for rinsing (or after liquid
sterilization) (Table 2).
Note This recommendation is different from
AORNs.
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SGNA (Society of Gastroenterology Nurses and
Associates)
SGNA recommends drying the endoscope after
completion of every reprocessing cycle (Table 3)
that is, both between patient procedures and
before storage, irrespective of the automated
reprocessors (or the liquid chemical sterilants)
label claim, or the quality of the rinse water.

• ? I recommend adoption of SGNAs all-inclusive,
  evidence-based, recommendation.
• A wet endoscope is a potentially contaminated
  endoscope.
• CSGNA is planning to adopt SGNAs
  recommendations on endoscope drying.

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Conclusion Do any of these differences really
matter? Is endoscope drying really all that
important?

• Yes. Differences in AORNs, APICs and SGNAs
  guidelines (a) cause staff confusion, (b) can
  increase
• the risk of nosocomial infection, and (c) cause
  variations in the standard of patient care.
• Several published reports directly link
  outbreaks, pseudo outbreaks, and patient deaths
  to wet
• endoscopes (e.g., Pseudomonas aeruginosa
  outbreaks linked to contaminated bronchoscopes).
• Several reports document the abrupt termination
  of bacterial outbreaks (and pseudo outbreaks)
  
• once the endoscope was thoroughly dried after
  reprocessing.
• Endoscope drying prevents
• transmission of waterborne bacteria via the
  endoscope between-patient-procedures
• bacterial colonization in the endoscopes
  internal channels during overnight storage, which
  can
• result in transmission of waterborne bacteria
  via the endoscope to the first patient of the
  day.
• Clinical use of a just-reprocessed-and-wet-with-ri
  nse-water flexible (or rigid) endoscope is a
• potentially unsafe and unnecessary practice.
  (Note, however, that this practice is recommended
  
• by some professional organizations as displayed
  on some of the previous slides.)