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SPRING 2009  

CIDEX® OPA Solution Plays Key Role in Instrument Processing at Bryn Mawr Hospital for Almost 10 Years


Bryn Mawr Hospital is a busy 323-bed medical center that is part of Main Line Health, a five-hospital system serving suburban Philadelphia. It offers a range of endoscopic procedures and in 2008 handled more than 2,100 colonoscopies and endoscopies.

The hospital adopted CIDEX® OPA Solution more than nine years ago for its ease of use and contribution to staff safety, including a reduction in fumes. Since then, CIDEX OPA Solution has become a key part of its infection prevention practices, providing not only effective high-level disinfection, but also increasing efficiency and minimizing instrument damage and repair costs.

Standardization & Impact on Budget 
Bryn Mawr’s positive experience with CIDEX® OPA Solution led to its adoption at all four Main Line Health acute-care hospitals, as well as its rehab facility.  The five hospitals have standardized the use of CIDEX OPA Solution, allowing the infection prevention staff to develop and implement a common set of policies and procedures for all of the hospitals.  In turn, efficiency has increased by streamlining staff training and eliminating the need to customize materials for each site. 

The result—after almost 10 years of use, CIDEX OPA Solution continues to be a cornerstone of instrument processing.  According to Patricia McBride, RN, MSN, CIC, senior practitioner, infection prevention and control at Bryn Mawr Hospital, this commitment was reinforced recently during a product review following the launch of a generic ortho-phthalaldehyde-based high-level disinfectant.  The review found that despite an initial price advantage, the features of the generic—including a difference in OPA concentration—would actually require an expensive policy and procedure overhaul. 

For example, there would be different requirements for rinsing, different strips used to test minimum effective concentration, and different processing protocols.  If a change were made, hospital personnel also would have to be retrained, and policies and procedures updated (those very procedures that had been successfully standardized across the five facilities). 

McBride said the change would have been difficult.  “Anytime you have in-servicing involved, it is a big ordeal,” she said. “It is necessary but very time consuming.  Of course, we all want the lowest possible costs, but in healthcare you can’t decide on price alone.  Sometimes, a lower price does not mean a good deal—we have to look at the full picture.”  

Commitment to CIDEX® OPA Solution
During an in-depth comparison of the products, the committee determined that overall cost of use was similar, and a decision was made to stay with CIDEX® OPA Solution.  McBride said the commitment to CIDEX OPA Solution was well received. “Our infection prevention and materials management staff, as well as other users, had been pleased with its performance and did not want to change, but a possibility of lower costs opened the door for discussion,” she said.  “However, during the review, it became clear that our longtime positive experience with CIDEX OPA Solution and its proven performance over many years were extremely relevant to the decision-making process.  We have seen excellent results with CIDEX OPA Solution, and we want to keep it that way.” 

Proven Performance
CIDEX® OPA Solution—0.55% ortho-phthalaldehyde—is a nonglutaraldehyde high-level disinfectant for flexible endoscopes and other medical devices that is virtually odorless due to low vapor pressure and requires no special vents or air monitors. The microbial efficacy of CIDEX OPA Solution has been demonstrated by evaluation of the solution using prescribed test methods,(1) as well as by successful clinical use over nearly 10 years. According to McBride, the proven performance of the solution has provided staff with the confidence that expensive and delicate instruments are being effectively disinfected, especially important as the focus on healthcare-acquired infections continues to grow nationwide.

“Healthcare-associated infections are not tolerated,” McBride said.  “Hospitals care about preventing infections, and the public is much more aware.  Our commitment to the highest standards of instrument processing and use of CIDEX® OPA Solution have resulted in a record of no instrument-related infections.”

1. CIDEX® OPA Ortho-Phthalaldehyde Solution Instructions for Use. Irvine, Calif.: Advanced Sterilization Products; 2006.

Click here to download a copy of the complete Bryn Mawr Case Study, which provides additional details about the hospital’s successful use of CIDEX® OPA Solution.

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Safe, Effective Transport and Handling of Flexible Endoscopes

Safely transporting and storing fragile and expensive flexible endoscopes is vital for hospitals and GI departments, as improper handling of scopes can lead to compromised patient safety as well as significant repair bills. The new CLEANASCOPE System, a unique storage and transportation system available through Advanced Sterilization Products (ASP), addresses many of the challenges associated with transporting endoscopes before and after reprocessing.

Cross Contamination
Cross contamination of endoscopes can impact patient safety by exposing patients to the risk of infection. For this reason, professional organizations have developed guidelines to govern the transport and handling of flexible endoscopes. For example:

  • AORN recommends that endoscopes be transported “…in a manner that preserves the sterilization/disinfection status of the endoscope.”(1)
  • SGNA recommends transporting endoscopes in closed containers to avoid chances for cross contamination. Its guidelines state that, “When transporting a scope to the reprocessing area, an enclosed container will prevent escape of airborne and droplet contaminants. It is important to consider both the protection of the apparatus and the environment during transport.”(2,3)
  • CDC guidelines state that, “A protocol should be developed that ensures the user knows whether an endoscope has been appropriately cleaned and disinfected,” and endoscopes should be stored “in a manner that will protect them from damage or contamination.”(4)

Costly Endoscope Damage
Flexible endoscopes are expensive to purchase and repair.  On average, flexible endoscopes cost $44,300,(5) and repair costs can range from $100-8,000.(6,7)  One study showed that for every endoscope being used in hospital settings, at least half may be unavailable for use due to repair needs.(8)  Additionally, damaged scopes can contribute to increase operational costs, including cancelled procedures, delayed patient treatment, and increased procedure time related to reduced scope functionality, among others.(9)

The lifespan of an endoscope may be 5-8 years if appropriately handled and maintained,(5) but a high percentage of endoscope damage can be attributed to improper handling practices.(5,6,10)  In fact, an estimated 70–90% of scope damage is user related and preventable.  Proper scope care and handling can dramatically improve the useful life of an endoscope.(5)

The unique storage and transportation design of the new CLEANASCOPE System reduces airborne contaminants and clearly identifies clean and contaminated endoscopes via disposable color-coded sterile liners.  Its protective transportation box helps to avoid accidental damage to the equipment and allows for easy mobility around the GI suite.  It also provides a high level of standardization for the processing of endoscopes and other delicate instruments and can be used with manual or automated reprocessing systems, providing a total GI solution. This unique system offers critical benefits, such as:

  • Reduction in cross contamination of environment and devices
  • Quick identification of clean and contaminated endoscopes
  • Lower risk of infection for healthcare workers
  • Reduction in accidental damage to endoscopes
  • Safe and efficient organization of the endoscope reprocessing cycle

Using the CLEANASCOPE System: Green is Clean—Red is Dirty

Clean endoscopes are transported to the procedure room in a CLEANASCOPE System cart with green liners. When the endoscope is required, the green liner cover is removed and discarded. After the endoscope is used for a procedure, it is wiped down and flushed as per the manufacturer’s instructions and placed back inside the lined tray. A red liner cover is placed securely over the tray, identifying the scope as contaminated and requiring processing.

For More Information
Click here to receive the informative guide, “Endoscope Transport & Handling” from ASP.

CLEANASCOPE is a registered trademark of Medicart International Limited.

1. Conner R, Reno D. AORN standards, recommended practices and guidelines. Denver, CO: AORN; 2006.
2. Standards of infection control in reprocessing of flexible gastrointestinal endoscopes. Gastroenterol Nurs. March-April 2006;29:142-148.
3. Thomas L. Transporting the endoscope. Gastroenterol Nurs. March-April 2005;28:145-146.
4. Rutala W, Weber D, Healthcare Infection Control Practices Advisory Committee (HICPAC). Guideline for disinfection and sterilization in healthcare facilities, 2008. CDC.
5. Dilulio R. Service solutions: Protecting your endoscope investment. 24X7. Oct. 2006; Available at: http://www.24X7mag.com/issues/articles/2006-10_05.asp.  Accessed June 26, 2008.
6. Ellis K. Endoscope cleaning and repair: keeping valuable scopes fit for duty. EndoNurse. Posted Nov. 7, 2006; Available at: http://www.endonurse.com/articles/681feat2.html. Accessed June 26, 2008.
7. Dix K. The high price of scope leaks. EndoNurse. Posted April 1, 2008; Available at: http://www.endonurse.com/articles/high_price_of_scope_leaks.html.  Accessed Sept. 4, 2008.
8. Leiner D. Implementing cost-effective ways to reduce endoscope repair expenses. Biomed Instrum Technol. 2003;37:201-204.
9. Dix K. Scope cleaning and repair: top 10 ways to keep scopes happy. Infection Control Today. Posted March 1, 2008; Available at: http://www.infectioncontroltoday.com/articles/scope-cleaning-and-repair.html.  Accessed June 26, 2008.
10. Ellis K. Endoscope repair: perspectives and advice from industry experts. EndoNurse. Posted Feb. 1, 2005; Available at: http://www.endonurse.com/articles/521feat1.html. Accessed June 26, 2008.

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    © Ethicon, Inc. 2009

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